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Fernández-Vidal JM, Olmedo-Saura G, Querol-Gutiérrez LA, Kulisevsky J, Pérez-Pérez J. Crossed-reflex in antiphospholipid chorea. Neurol Sci 2024; 45:4635-4637. [PMID: 38896185 PMCID: PMC11306537 DOI: 10.1007/s10072-024-07622-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024]
Abstract
Chorea is a hyperkinetic movement disorder associated with various underlyingconditions, including autoimmune diseases such as antiphospholipid syndrome (APS). APS can manifest with a wide range of neurological symptoms, including chorea. We present a case of a 77-year-old man with subacute generalized chorea secondary to primary APS. Notably, the patient exhibited a left patellar crossed-reflex, a phenomenon rarely documented in chorea cases, the pathophysiology of which has not yet been elucidated. In summary, this case challenges the traditional demographics of antiphospholipid syndrome (APS) by suggesting a potential link between APS and late-age patients. It emphasizes the importance of considering APS in late-onset chorea cases.
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Affiliation(s)
| | - Gonzalo Olmedo-Saura
- Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Movement Disorders Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, 90 Mas Casanovas St 08040, Barcelona, Spain
- Network Research Center, Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Department of Medicine, Barcelona Autonomous University, Barcelona, Spain
| | - Luis Antonio Querol-Gutiérrez
- Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Network Research Center-Rare Diseases (CIBERER), Madrid, Spain
- Department of Medicine, Barcelona Autonomous University, Barcelona, Spain
| | - Jaime Kulisevsky
- Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain
- Movement Disorders Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, 90 Mas Casanovas St 08040, Barcelona, Spain
- Network Research Center, Neurodegenerative Diseases (CIBERNED), Madrid, Spain
- Department of Medicine, Barcelona Autonomous University, Barcelona, Spain
| | - Jesús Pérez-Pérez
- Department of Neurology, Hospital de La Santa Creu I Sant Pau, Barcelona, Spain.
- Movement Disorders Unit, Department of Neurology, Hospital de La Santa Creu I Sant Pau, 90 Mas Casanovas St 08040, Barcelona, Spain.
- Network Research Center, Neurodegenerative Diseases (CIBERNED), Madrid, Spain.
- Department of Medicine, Barcelona Autonomous University, Barcelona, Spain.
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Justiz-Vaillant AA, Gopaul D, Soodeen S, Arozarena-Fundora R, Barbosa OA, Unakal C, Thompson R, Pandit B, Umakanthan S, Akpaka PE. Neuropsychiatric Systemic Lupus Erythematosus: Molecules Involved in Its Imunopathogenesis, Clinical Features, and Treatment. Molecules 2024; 29:747. [PMID: 38398500 PMCID: PMC10892692 DOI: 10.3390/molecules29040747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/14/2024] [Accepted: 01/16/2024] [Indexed: 02/25/2024] Open
Abstract
Systemic lupus erythematosus (SLE) is an idiopathic chronic autoimmune disease that can affect any organ in the body, including the neurological system. Multiple factors, such as environmental (infections), genetic (many HLA alleles including DR2 and DR3, and genes including C4), and immunological influences on self-antigens, such as nuclear antigens, lead to the formation of multiple autoantibodies that cause deleterious damage to bodily tissues and organs. The production of autoantibodies, such as anti-dsDNA, anti-SS(A), anti-SS(B), anti-Smith, and anti-neuronal DNA are characteristic features of this disease. This autoimmune disease results from a failure of the mechanisms responsible for maintaining self-tolerance in T cells, B cells, or both. Immune complexes, circulating antibodies, cytokines, and autoreactive T lymphocytes are responsible for tissue injury in this autoimmune disease. The diagnosis of SLE is a rheumatological challenge despite the availability of clinical criteria. NPSLE was previously referred to as lupus cerebritis or lupus sclerosis. However, these terms are no longer recommended because there is no definitive pathological cause for the neuropsychiatric manifestations of SLE. Currently, the treatment options are primarily based on symptomatic presentations. These include the use of antipsychotics, antidepressants, and anxiolytic medications for the treatment of psychiatric and mood disorders. Antiepileptic drugs to treat seizures, and immunosuppressants (e.g., corticosteroids, azathioprine, and mycophenolate mofetil), are directed against inflammatory responses along with non-pharmacological interventions.
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Affiliation(s)
- Angel A. Justiz-Vaillant
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
| | - Darren Gopaul
- Port of Spain General Hospital, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago;
| | - Sachin Soodeen
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
| | - Rodolfo Arozarena-Fundora
- Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Champs Fleurs, San Juan 00000, Trinidad and Tobago; (R.A.-F.); (O.A.B.)
- Department of Clinical and Surgical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine 00000, Trinidad and Tobago
| | - Odette Arozarena Barbosa
- Eric Williams Medical Sciences Complex, North Central Regional Health Authority, Champs Fleurs, San Juan 00000, Trinidad and Tobago; (R.A.-F.); (O.A.B.)
| | - Chandrashehkar Unakal
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
| | - Reinand Thompson
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
| | - Bijay Pandit
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
| | - Srikanth Umakanthan
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
| | - Patrick E. Akpaka
- Department of Para-Clinical Sciences, University of the West Indies, St. Augustine Campus, St. Augustine 00000, Trinidad and Tobago; (S.S.); (C.U.); (R.T.); (B.P.); (P.E.A.)
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Kim MS, Park DG, Yoon JH. Chorea Associated with Genetic-Confirmed CADASIL. Mov Disord Clin Pract 2023; 10:1433-1435. [PMID: 37772287 PMCID: PMC10525063 DOI: 10.1002/mdc3.13847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/23/2023] [Accepted: 07/16/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- Min Seung Kim
- Department of Neurology, Parkinson CenterAjou University School of MedicineSuwonRepublic of Korea
- Department of NeurologyDongtan Sacred Heart Hospital Hallym University College of MedicineHwaseongRepublic of Korea
| | - Don Gueu Park
- Department of Neurology, Parkinson CenterAjou University School of MedicineSuwonRepublic of Korea
| | - Jung Han Yoon
- Department of Neurology, Parkinson CenterAjou University School of MedicineSuwonRepublic of Korea
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Farag M, Hunt BJ, Andrews TC. Antiphospholipid-related chorea. Pract Neurol 2023; 23:150-152. [PMID: 36207127 DOI: 10.1136/pn-2022-003587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 11/03/2022]
Abstract
Chorea can be associated with autoimmune diseases such as antiphospholipid syndrome and has been associated with the isolated presence of antiphospholipid antibodies (aPL). Chorea is a rare neurological manifestation of antiphospholipid syndrome. The pathophysiological mechanisms underlying aPL-related chorea are still debated. One postulated mechanism is aPL or other autoantibody binding to brain-blood vessel endothelium, resulting in endothelial dysfunction secondary to a proinflammatory cascade, with sequalae of inflammation and local microthrombosis. Another postulated mechanism considers immune-mediated attack (aPL or antibasal ganglia antibodies) against specific basal ganglia epitopes. Here, we report a patient with isolated aPL-related chorea that followed a relapsing-remitting course. We highlight the role of brain metabolic imaging with fluorodeoxy glucose positron-emission tomography in the diagnostic workup of chorea and the challenges in the practical management of aPL-related chorea with symptomatic treatments.
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Affiliation(s)
- Mena Farag
- Neurology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Beverley J Hunt
- Thrombosis & Haemophilia Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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