1
|
Proudfoot M, van Ede F, Quinn A, Colclough GL, Wuu J, Talbot K, Benatar M, Woolrich MW, Nobre AC, Turner MR. Impaired corticomuscular and interhemispheric cortical beta oscillation coupling in amyotrophic lateral sclerosis. Clin Neurophysiol 2018; 129:1479-1489. [DOI: 10.1016/j.clinph.2018.03.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 03/02/2018] [Accepted: 03/13/2018] [Indexed: 01/01/2023]
|
2
|
Pruppers MHJ, Draak THP, Vanhoutte EK, Van der Pol WL, Gorson KC, Léger JM, Nobile-Orazio E, Lewis RA, van den Berg LH, Faber CG, Merkies ISJ. Outcome measures in MMN revisited: further improvement needed. J Peripher Nerv Syst 2016; 20:306-18. [PMID: 26115442 DOI: 10.1111/jns.12124] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 04/23/2015] [Accepted: 06/10/2015] [Indexed: 11/27/2022]
Abstract
The objectives of this study were to provide an overview of the outcome measures (OMs) applied in clinical trials in multifocal motor neuropathy (MMN) and to determine the responsiveness of a core set of selected OMs as part of the peripheral neuropathy outcome measures standardization (PeriNomS) study. The following OMs were serially applied in 26 patients with newly diagnosed or relapsing MMN, receiving intravenous immunoglobulin (assessments: T0/T3/T12 months): 14 muscle pairs MRC (Medical Research Council) scale, the Neuropathy Impairment Scale motor-subset, a self-evaluation scale, grip strength, and MMN-RODS© (Rasch-built overall disability scale). All data, except the grip strength, were subjected to Rasch analyses before determining responsiveness. For grip strength, responsiveness was examined using a combined anchor- (SF-36 question-2) and distribution-based (½ × SD) minimum clinically important difference (MCID) techniques, determining the proportion of patients exceeding both the identified cut-offs. For the remaining scales, the magnitude of change for each patient on each scale was determined using the MCID related to the individual SE (responder definition: MCID-SE ≥ 1.96). Overall, a great assortment of measures has been used in MMN trials with different responsiveness definitions. For the selected OMs, responsiveness was poor and only seen in one fourth to one third of the patients, the grip strength being more responsive. Despite the efforts taken to standardize outcome assessment, further clinimetric responsiveness studies are needed in MMN.
Collapse
Affiliation(s)
- Mariëlle H J Pruppers
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Thomas H P Draak
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Els K Vanhoutte
- Department of Clinical Genetics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - W-Ludo Van der Pol
- Department of Neurology, Rudolf Magnus Institute of Neuroscience University Medical Center, Utrecht, The Netherlands
| | - Kenneth C Gorson
- Department of Neurology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA
| | - Jean-Marc Léger
- Department of Neurology, Hôpital de la Salpêtrière, Paris, France
| | - Eduardo Nobile-Orazio
- Department of Neurological Sciences, Milan University, Humanitas Clinical Institute, Rozzano, Milan, Italy
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Leonard H van den Berg
- Department of Neurology, Rudolf Magnus Institute of Neuroscience University Medical Center, Utrecht, The Netherlands
| | - Catharina G Faber
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ingemar S J Merkies
- Department of Neurology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, Spaarne Hospital, Hoofddorp, The Netherlands
| | | |
Collapse
|
3
|
Abstract
Multifocal motor neuropathy (MMN) is a rare disorder in which the symptoms are caused by persistent conduction block lesions. The mononeuropathy multiplex progresses over time with increasing axonal loss. The cause of the conduction blocks and axonal loss are not completely understood but immune mechanisms are involved and response to intravenous immunoglobulin has been established. The importance of MMN goes beyond its clinical incidence as the increasing understanding of the pathogenesis of this disorder has implications for other peripheral nerve diseases and for our knowledge of peripheral nerve biology.
Collapse
Affiliation(s)
- Ximena Arcila-Londono
- Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | | |
Collapse
|
4
|
Barraza G, Serranova T, Herrero C, Casanova-mollá J, To-figueras J, Herranz J, Valls-solé J. Brainstem dysfunction in variegate porphyria. Muscle Nerve 2012; 46:426-33. [DOI: 10.1002/mus.23367] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
5
|
Groppa S, Oliviero A, Eisen A, Quartarone A, Cohen LG, Mall V, Kaelin-Lang A, Mima T, Rossi S, Thickbroom GW, Rossini PM, Ziemann U, Valls-Solé J, Siebner HR. A practical guide to diagnostic transcranial magnetic stimulation: report of an IFCN committee. Clin Neurophysiol 2012; 123:858-82. [PMID: 22349304 DOI: 10.1016/j.clinph.2012.01.010] [Citation(s) in RCA: 791] [Impact Index Per Article: 65.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2011] [Revised: 01/16/2012] [Accepted: 01/22/2012] [Indexed: 11/29/2022]
Abstract
Transcranial magnetic stimulation (TMS) is an established neurophysiological tool to examine the integrity of the fast-conducting corticomotor pathways in a wide range of diseases associated with motor dysfunction. This includes but is not limited to patients with multiple sclerosis, amyotrophic lateral sclerosis, stroke, movement disorders, disorders affecting the spinal cord, facial and other cranial nerves. These guidelines cover practical aspects of TMS in a clinical setting. We first discuss the technical and physiological aspects of TMS that are relevant for the diagnostic use of TMS. We then lay out the general principles that apply to a standardized clinical examination of the fast-conducting corticomotor pathways with single-pulse TMS. This is followed by a detailed description of how to examine corticomotor conduction to the hand, leg, trunk and facial muscles in patients. Additional sections cover safety issues, the triple stimulation technique, and neuropediatric aspects of TMS.
Collapse
Affiliation(s)
- S Groppa
- Department of Neurology, Christian Albrechts University, Kiel, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society - first revis. J Peripher Nerv Syst 2010; 15:295-301. [PMID: 21199100 DOI: 10.1111/j.1529-8027.2010.00290.x] [Citation(s) in RCA: 273] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
7
|
Nobile-Orazio E, Carpo M, Meucci N. Are there immunologically treatable motor neuron diseases? ACTA ACUST UNITED AC 2009. [DOI: 10.1080/167-146608201300079382] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
8
|
Van Den Berg LH, Franssen H, Van Asseldonk JTH, Van Den Berg-Vos RM, Wokke JHJ. Chapter 12 Multifocal and other motor neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2007; 82:229-245. [PMID: 18808897 DOI: 10.1016/s0072-9752(07)80015-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Leonard H Van Den Berg
- Neuromuscular Research Group, Rudolf Magnus Institute of Neuroscience, Department of Neurology, University Medical Center Utrecht, The Netherlands
| | | | | | | | | |
Collapse
|
9
|
van Schaik IN, Bouche P, Illa I, Léger JM, Van den Bergh P, Cornblath DR, Evers EMA, Hadden RDM, Hughes RAC, Koski CL, Nobile-Orazio E, Pollard J, Sommer C, van Doorn PA. European Federation of Neurological Societies/Peripheral Nerve Society guideline on management of multifocal motor neuropathy. Eur J Neurol 2006; 13:802-8. [PMID: 16879289 DOI: 10.1111/j.1468-1331.2006.01466.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Several diagnostic criteria for multifocal motor neuropathy have been proposed in recent years and a beneficial effect of intravenous immunoglobulin (IVIg) and various other immunomodulatory drugs has been suggested in several trials and uncontrolled studies. The objectives were to prepare consensus guidelines on the definition, investigation and treatment of multifocal motor neuropathy. Disease experts and a patient representative considered references retrieved from MEDLINE and the Cochrane Library in July 2004 and prepared statements which were agreed in an iterative fashion. The Task Force agreed good practice points to define clinical and electrophysiological diagnostic criteria for multifocal motor neuropathy and investigations to be considered. The principal recommendations and good practice points were: (i) IVIg (2 g/kg given over 2-5 days) should be considered as the first line treatment (level A recommendation) when disability is sufficiently severe to warrant treatment. (ii) Corticosteroids are not recommended (good practice point). (iii) If initial treatment with IVIg is effective, repeated IVIg treatment should be considered (level C recommendation). The frequency of IVIg maintenance therapy should be guided by the individual response (good practice point). Typical treatment regimens are 1 g/kg every 2-4 weeks or 2 g/kg every 4-8 weeks (good practice point). (iv) If IVIg is not or not sufficiently effective then immunosuppressive treatment may be considered. Cyclophosphamide, ciclosporin, azathioprine, interferon beta1a, or rituximab are possible agents (good practice point). (v) Toxicity makes cyclophosphamide a less desirable option (good practice point).
Collapse
|
10
|
European Federation of Neurological Societies/Peripheral Nerve Society Guideline on management of multifocal motor neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. J Peripher Nerv Syst 2006; 11:1-8. [PMID: 16519777 DOI: 10.1111/j.1085-9489.2006.00058.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several diagnostic criteria for multifocal motor neuropathy (MMN) have been proposed in recent years, and a beneficial effect of intravenous immunoglobulin (IVIg) and various other immunomodulatory drugs has been suggested in several trials and uncontrolled studies. OBJECTIVES The aim of this guideline was to prepare consensus guidelines on the definition, investigation, and treatment of MMN. METHODS Disease experts and a representative of patients considered references retrieved from MEDLINE and the Cochrane Library in July 2004 and prepared statements that were agreed in an iterative fashion. RECOMMENDATIONS The Task Force agreed on good practice points to define clinical and electrophysiological diagnostic criteria for MMN and investigations to be considered. The principal recommendations and good practice points were as follows: (1) IVIg (2 g/kg given over 2-5 days) should be considered as the first line of treatment (level A recommendation) when disability is sufficiently severe to warrant treatment; (2) corticosteroids are not recommended (good practice point); (3) if initial treatment with IVIg is effective, repeated IVIg treatment should be considered (level C recommendation). The frequency of IVIg maintenance therapy should be guided by the individual response (good practice point). Typical treatment regimens are 1 g/kg every 2-4 weeks or 2 g/kg every 4-8 weeks (good practice point); (4) if IVIg is not (or not sufficiently) effective, then immunosuppressive treatment may be considered. Cyclophosphamide, cyclosporine, azathioprine, interferon-beta1a, or rituximab are possible agents (good practice point); and (5) toxicity makes cyclophosphamide a less desirable option (good practice point).
Collapse
|
11
|
Nobile-Orazio E, Cappellari A, Priori A. Multifocal motor neuropathy: current concepts and controversies. Muscle Nerve 2005; 31:663-80. [PMID: 15770650 DOI: 10.1002/mus.20296] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Multifocal motor neuropathy (MMN) is now a well-defined purely motor multineuropathy characterized by the presence of multifocal partial motor conduction blocks (CB), frequent association with anti-GM1 IgM antibodies, and usually a good response to high-dose intravenous immunoglobulin (IVIg) therapy. However, several issues remain to be clarified in the diagnosis, pathogenesis, and therapy of this condition including its nosological position and its relation to other chronic dysimmune neuropathies; the degree of CB necessary for the diagnosis of MMN; the existence of an axonal form of MMN; the pathophysiological basis of CB; the pathogenetic role of antiganglioside antibodies; the mechanism of action of IVIg treatments in MMN and the most effective regimen; and the treatment to be used in unresponsive patients. These issues are addressed in this review of the main clinical, electrophysiological, immunological, and therapeutic features of this neuropathy.
Collapse
Affiliation(s)
- Eduardo Nobile-Orazio
- Dino Ferrari Centre and Centre of Excellence for Neurodegenerative Diseases, Department of Neurological Sciences, Milan University, IRCCS Ospedale Maggiore Policlinico, and Humanitas Clinical Institute, Milan, Italy.
| | | | | |
Collapse
|
12
|
Van Asseldonk JTH, Franssen H, Van den Berg-Vos RM, Wokke JHJ, Van den Berg LH. Multifocal motor neuropathy. Lancet Neurol 2005; 4:309-19. [PMID: 15847844 DOI: 10.1016/s1474-4422(05)70074-0] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Multifocal motor neuropathy (MMN) is an immune-mediated disorder characterised by slowly progressive, asymmetrical weakness of limbs without sensory loss. The clinical presentation of MMN mimics that of lower-motor-neuron disease, but in nerve-conduction studies of patients with MMN motor-conduction block has been found. By contrast with chronic inflammatory demyelinating polyneuropathy, treatment with prednisolone and plasma exchange is generally ineffective in MMN and even associated with clinical worsening in some patients. Of the immunosuppressants, cyclophosphamide has been reported as effective but only anecdotally. Various open trials and four placebo-controlled trials have shown that treatment with high-dose intravenous immunoglobulin leads to improvement of muscle strength in patients with MMN. Although clinical, pathological, imaging, immunological, and electrophysiological studies have improved our understanding of MMN over the past 15 years, further research is needed to elucidate pathogenetic disease mechanisms in the disorder.
Collapse
Affiliation(s)
- Jan-Thies H Van Asseldonk
- Department of Clinical Neurophysiology, Neuromuscular Research Group, Rudolf Magnus Institute of Neuroscience, University Medical Centre Utrecht, Netherlands
| | | | | | | | | |
Collapse
|
13
|
van Schaik IN, van den Berg LH, de Haan R, Vermeulen M. Intravenous immunoglobulin for multifocal motor neuropathy. Cochrane Database Syst Rev 2005:CD004429. [PMID: 15846714 DOI: 10.1002/14651858.cd004429.pub2] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Multifocal motor neuropathy is a rare, probably immune mediated disorder characterised by slowly progressive, asymmetric, distal weakness of one or more limbs with no objective loss of sensation. It may cause prolonged periods of disability. The treatment options for multifocal motor neuropathy are sparse. Patients with multifocal motor neuropathy do not usually respond to steroids or plasma exchange, and may even worsen with these treatments. Many uncontrolled studies have suggested a beneficial effect of intravenous immunoglobulin. OBJECTIVES To review systematically the evidence from randomised controlled trials concerning the efficacy and safety of intravenous immunoglobulin in multifocal motor neuropathy. SEARCH STRATEGY We used the search strategy of the Cochrane Neuromuscular Disease Review Group to search the Disease Group register (searched September 2003), MEDLINE (January 1990 to September 2003), EMBASE (January 1990 to September 2003) and ISI (January 1990 to September 2003) databases for randomised controlled trials. SELECTION CRITERIA Randomised controlled studies examining the effects of any dose of intravenous immunoglobulin versus placebo in patients with definite or probable multifocal motor neuropathy. Outcome measures had to include one of the following: disability, strength, or conduction block. Studies which reported the frequency of adverse effects were used to assess safety. DATA COLLECTION AND ANALYSIS Two authors reviewed literature searches to identify potentially relevant trials, scored their quality and extracted data independently. For dichotomous data, we calculated relative risks, and for continuous data, effect sizes and weighted pooled effect sizes. Statistical uncertainty was expressed with 95% confidence intervals. MAIN RESULTS Four randomised controlled trials including a total of 34 patients were suitable for this systematic review. Strength improved in 78% of patients treated with intravenous immunoglobulin and only 4% of placebo-treated patients. Disability improved in 39% of patients after intravenous immunoglobulin treatment and in 11% after placebo (statistically not significantly different). Mild, transient side effects were reported in 71% of intravenous immunoglobulin treated patients. Serious side effects were not encountered. AUTHORS' CONCLUSIONS Limited evidence from randomised controlled trials shows that intravenous immunoglobulin has a beneficial effect on strength. There was a non-significant trend towards improvement in disability. More research is needed to discover whether intravenous immunoglobulin improves disability and is cost-effective.
Collapse
Affiliation(s)
- I N van Schaik
- Neurology, Academic Medical Center, University of Amsterdam, PO Box 22700, Amsterdam, Netherlands, 1100 DE.
| | | | | | | |
Collapse
|
14
|
Chapter 5 Clinical Aspects of Sporadic Amyotrophic Lateral Sclerosis/Motor Neuron Disease. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s1877-3419(09)70106-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
|
15
|
Obal I, Siklós L, Engelhardt JI. Altered calcium in motoneurons by IgG from human motoneuron diseases. Acta Neurol Scand 2002; 106:282-91. [PMID: 12371922 DOI: 10.1034/j.1600-0404.2002.01252.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The effect of IgG from patients with multifocal motor neuropathy (MMN) on the content and distribution of calcium in spinal motoneurons was compared with the effect of IgG from patients with sporadic amyotrophic lateral sclerosis (SALS) and IgG from normal individuals. MATERIAL AND METHODS Different purified IgG samples were injected intraperitoneally in mice. Then, the animals were subjected to histochemical techniques to visualize calcium in electron microscopic sections. RESULTS Quantitative morphometric analysis verified that IgG from MMN decreased the vesicular and axoplasmic calcium content in the axon terminals at the neuromuscular junctions and had no influence on the perikaryon. In contrast to this, IgG from patients with SALS increased the intracellular calcium both in the axon terminal and in the perikaryon. IgG from normal individuals exerted no effect. Elevated intracellular calcium may contribute to motoneuron degeneration. The lack of such effect with MMN immunoglobulins helps to explain the relative sparing of motoneurons in the disease.
Collapse
Affiliation(s)
- I Obal
- Department of Neurology, University of Szeged, Szeged, Hungary.
| | | | | |
Collapse
|
16
|
Oshima Y, Mitsui T, Yoshino H, Endo I, Kunishige M, Asano A, Matsumoto T. Central motor conduction in patients with anti-ganglioside antibody associated neuropathy syndromes and hyperreflexia. J Neurol Neurosurg Psychiatry 2002; 73:568-73. [PMID: 12397153 PMCID: PMC1738137 DOI: 10.1136/jnnp.73.5.568] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Several serum antibodies against gangliosides are diagnostically important, particularly in Guillain-Barré syndrome (GBS), Miller Fisher syndrome (MFS), and multifocal motor neuropathy (MMN). Although hyperreflexia is an atypical symptom in these disorders, it has been found in some patients with GBS, MFS, and MMN. The aim of the study was to determine whether hyperreflexia corresponds to corticospinal tract dysfunction in these patients. METHODS The study examined central and peripheral motor conduction in patients with hyperreflexia who exhibited acute paralysis (group 1, n=5), acute ataxia and ophthalmoplegia (group 2, n=7), or chronic paralysis with conduction block (group 3, n=2). The clinical symptoms are similar to those in patients with GBS, MFS, and MMN, respectively, and serum anti-ganglioside antibodies were found to be positive in all patients. Using magnetic and electrical stimulation techniques, central and peripheral motor conduction were compared in patients in groups 1, 2, and 3 and patients with GBS (n=7), MFS (n=8), and MMN (n=6). RESULTS Central motor conduction times (CMCTs) in patients in groups 1, 2, and 3 were significantly delayed compared with those in patients with GBS, MFS, and MMN (p<0.01, p<0.05, p<0.05, respectively), and the delayed CMCTs significantly improved in the recovery periods (p<0.01, p<0.01, p<0.05, respectively). However, motor conduction velocity, compound muscle action potential, and F wave conduction velocity were not significantly different between the patients. CONCLUSION These findings indicate that corticospinal tract is functionally involved in patients with anti-ganglioside antibody associated neuropathy syndromes and hyperreflexia
Collapse
Affiliation(s)
- Y Oshima
- First Department of Internal Medicine, School of Medicine, The University of Tokushima, Japan
| | | | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- L P Rowland
- Neurological Institute, Columbia-Persbyterian Medical Center, New York-Presbyterian Hospital, and Columbia University College of Physicians and Surgeons, NY 10032, USA.
| | | |
Collapse
|
18
|
Abstract
Multifocal motor neuropathy (MMN) is a recently identified peripheral nerve disorder characterized by progressive, predominantly distal, asymmetric limb weakness mostly affecting upper limbs, minimal or no sensory impairment, and by the presence on nerve conduction studies of multifocal persistent partial conduction blocks on motor but not sensory nerves. The etiopathogenesis of MMN is not known, but there is some evidence, based mostly on the clinical improvement after immunological therapies, that the disease has an immunological basis. Antibodies, mostly IgM, to the gangliosides GM1, and though less frequently, GM2 and GD1a, are frequently detected in patients' sera, helping in the diagnosis of this disease. Even if there is some experimental evidence that these antibodies may be pathogenic in vitro, their role in the neuropathy remains to be established. Patients with MMN do not usually respond to steroids or plasma exchange, which may occasionally worsen the symptoms, while the efficacy of cyclophosphamide is limited by its relevant side effects. More than 80% of MMN patients rapidly improve with high dose intravenous immunoglobulin therapy (IVIg). The effect of this therapy is, however, transient and improvement has to be maintained with periodic infusions. A positive response to interferon-beta has been recently reported in a minority of patients, some of whom were resistant to IVIg. Even if many progresses have been made on the diagnosis and therapy of MMN, there are still several issues on the nosological position, etiopathogenesis and long-term treatment of this neuropathy that need to be clarified.
Collapse
Affiliation(s)
- E Nobile-Orazio
- "Giorgio Spagnol" Service of Clinical Neuroimmunology, Dino Ferrari Centre, Department of Neurological Sciences, University of Milan, IRCCS Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| |
Collapse
|
19
|
Abstract
My assignment was to identify the 6 most important ALS papers published in 1999 but, great to relate, there were too many excellent candidates. Rather than confining the search to individual papers, six major themes seemed appropriate for discussion: 1) The study of transgenic mice that carry a mutated human gene for superoxide dismutase-1 (SOD1) has led to many far-reaching advances in ALS research. The mice are regarded as the best test system to evaluate potential therapies, including creatine. Inconsistencies between efficacy in mice and people are noted, however. 2) Transgenic mice have also been used to evaluate the role of glutamate toxicity in the pathogenesis of ALS, a dominant theory. 3) The role of mitochondria in the pathogenesis of ALS is gathering increasing attention. 4) The role of neurofilaments in the pathogenesis of ALS has provided new twists in mice and people. 5) Motor neuropathy is the most important differential diagnosis of ALS. 6) Gene therapy, as exemplified by the use of stem cells, has been applied successfully to animal models of other inherited diseases of the central nervous system.
Collapse
Affiliation(s)
- L P Rowland
- Eleanor and Lou Gehrig MDA/ALS Center, Neurological Institute, 710 West 168th Street, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
| |
Collapse
|
20
|
Molinuevo JL, Valls-Solé J, Valldeoriola F. The effect of transcranial magnetic stimulation on reaction time in progressive supranuclear palsy. Clin Neurophysiol 2000; 111:2008-13. [PMID: 11068236 DOI: 10.1016/s1388-2457(00)00443-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Reaction time is shortened when a startling acoustic stimulus (SAS) is delivered together with the 'go' signal in normal subjects and patients with Parkinson's disease (IPD), but not in patients with progressive supranuclear palsy (PSP). Similar shortening of reaction time has been reported in normal subjects and patients with IPD with transcranial magnetic stimulation (TMS). In this paper, we analyzed the effect of TMS on reaction time in patients with PSP. METHODS Six patients with PSP received the instruction to extend the wrist to a visual cue. In test trials, the visual signal was accompanied by either a SAS or a subthreshold TMS applied to the motor area. The same experimental paradigm was applied to 7 patients with IPD, and 10 normal subjects. We measured both reaction time and the slope of the initial accelerometric displacement (SAD). RESULTS Neither TMS nor SAS changed significantly reaction time in PSP patients. This observation was in contrast with the marked reaction time shortening induced by both stimuli in a similar amount in normal subjects and patients with IPD. Furthermore, SAS and TMS did not modify the SAD in PSP, but shortened it significantly in IPD. CONCLUSION The absence of an effect of TMS and SAS on reaction time in PSP patients suggests that these patients have a dysfunction in the mechanisms of facilitation of reaction time. The fact that TMS and SAS induced similar effects on reaction time in normal subjects, IPD and PSP patients indicate the possibility of common mechanisms of action for both types of stimuli.
Collapse
Affiliation(s)
- J L Molinuevo
- Unitat d'Electromiografia, Servei de Neurologia, Hospital Clínic, Facultad de Medicina, Universitat de Barcelona, Villarroel, 170, 08036-, Barcelona, Spain
| | | | | |
Collapse
|