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Mercure-Corriveau N, Roy S, Hu C, Crowe EP, Zhu X, Obando D, Patel EU, Tobian AAR, Wang Y, Bloch EM, Newsome SD. Therapeutic plasma exchange in the management of stiff person syndrome spectrum disorders: a case series and review of the literature. Ther Adv Neurol Disord 2023; 16:17562864231180736. [PMID: 37529719 PMCID: PMC10387686 DOI: 10.1177/17562864231180736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/11/2023] [Indexed: 08/03/2023] Open
Abstract
Background Stiff person syndrome spectrum disorders (SPSD) are a rare group of disabling neuroimmunological disorders. SPSD often requires immune therapies, especially in the setting of inadequate response to symptomatic treatments. The safety and efficacy of therapeutic plasma exchange (TPE) in SPSD remains uncertain. Objectives To describe the safety, tolerability, and efficacy of TPE in patients with SPSD. Design A retrospective observational study. Methods A retrospective review of SPSD patients seen at Johns Hopkins Hospital (JHH) from 1997 to 2021 was performed. Patient demographics/history, examination/diagnostic findings, treatment response, and TPE-related complications were recorded. Assessment for any associations between clinical characteristics, including age, sex, clinical phenotype, and time on immunotherapy, and response to TPE 3 months after treatment was performed. A subgroup of 18 patients treated with TPE at JHH and 6 patients treated with TPE at outside institutions were evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment. Literature review of SPSD and TPE was also conducted. Results Thirty-nine SPSD patients were treated with TPE (21 at JHH and 18 at outside institutions); median age 48 years, 77% female, median modified Rankin Scale 3; mean initial anti-GAD65 antibody titer was 23,508 U/mL. Twenty-four patients (62%) had classic SPS, 10 (26%) had SPS-plus, 2 (5%) had progressive encephalomyelitis with rigidity and myoclonus, and 3 (8%) had pure cerebellar ataxia. All patients were on symptomatic treatments, 30 (77%) previously received IVIg, and 3 (8%) previously received rituximab. Four patients (10%) had a TPE-related adverse event. One developed asymptomatic hypotension, another had both line thrombosis and infection, and two had non-life-threatening bleeding events. Twenty-three (59%) patients reported improvement in symptoms after TPE. Of the subgroup of 24 patients evaluated for any change in usage of symptomatic medications 3 months after the TPE treatment, 14 (58%) required fewer GABAergic symptomatic medications. Literature review identified 57 additional patients with SPSD; 43 (75%) reported temporary improvement after TPE. Conclusion The majority of patients treated with TPE had improvement. Moreover, most patients evaluated for any change in usage of symptomatic medications after the TPE treatment no longer required as much symptomatic medications months after TPE. TPE appears safe and well-tolerated in SPSD. Further studies are needed to assess the long-term efficacy of TPE in SPSD and identify which patients may benefit the most from TPE.
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Affiliation(s)
- Nicolas Mercure-Corriveau
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Shuvro Roy
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Chen Hu
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Elizabeth P. Crowe
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Xianming Zhu
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Danielle Obando
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Eshan U. Patel
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Aaron A. R. Tobian
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Yujie Wang
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Evan M. Bloch
- Division of Transfusion Medicine, Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Scott D. Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University, School of Medicine, 600 North Wolfe Street, Pathology 627, Baltimore, MD 21287, USA
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Betterle C, Furmaniak J, Sabbadin C, Scaroni C, Presotto F. Type 3 autoimmune polyglandular syndrome (APS-3) or type 3 multiple autoimmune syndrome (MAS-3): an expanding galaxy. J Endocrinol Invest 2023; 46:643-665. [PMID: 36609775 DOI: 10.1007/s40618-022-01994-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023]
Abstract
BACKGROUND The number of recognised distinct autoimmune diseases (AIDs) has progressively increased over the years with more than 100 being reported today. The natural history of AIDs is characterized by progression from latent and subclinical to clinical stages and is associated with the presence of the specific circulating autoantibodies. Once presented, AIDs are generally chronic conditions. AIDs have the tendency to cluster and co-occur in a single patient. Autoimmune thyroid diseases (AITD) are the most prevalent of AIDs in the world population, and about one-third of the AITD patients also present with a non-thyroid AID during their life-span. Furthermore, patient with non-thyroid AIDs often presents with a form of AITD as a concurrent condition. Many of the clusters of AIDs are well characterized as distinctive syndromes, while some are infrequent and only described in case reports. PURPOSE In this review, we describe the wide spectrum of the combinations and the intricate relationships between AITD and the other AIDs, excluding Addison's disease. These combinations are collectively termed type 3 Autoimmune Polyglandular Syndrome (APS-3), also called type 3 Multiple Autoimmune Syndrome (MAS-3), and represent the most frequent APS in the world populations. CONCLUSIONS Numerous associations of AITD with various AIDs could be viewed as if the other AIDs were gravitating like satellites around AITD located in the center of a progressively expanding galaxy of autoimmunity.
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Affiliation(s)
- C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy.
- Chair of Clinical Immunology and Allergy, Department of Medical and Surgical Sciences, University of Padua Medical School, Via Ospedale Civile 105, 35128, Padua, Italy.
| | | | - C Sabbadin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - C Scaroni
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - F Presotto
- Unit of Internal Medicine, Ospedale Dell'Angelo, Mestre-Venice, Italy
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Servais T, London F, Donckier JE. Graves' disease as a first autoimmune manifestation of a stiff person syndrome. ANNALES D'ENDOCRINOLOGIE 2019; 80:134-136. [PMID: 30846197 DOI: 10.1016/j.ando.2019.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/18/2018] [Accepted: 01/27/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Thomas Servais
- Department of endocrinology and diabetology, CHU UCL Namur, Université Catholique de Louvain, rue Dr. Gaston Thérasse 1, 5530 Yvoir, Belgium
| | - Frédéric London
- Department of neurology, CHU UCL Namur, rue Dr. Gaston Thérasse, 1, 5530 Yvoir, Belgium
| | - Julian E Donckier
- Department of endocrinology and diabetology, CHU UCL Namur, Université Catholique de Louvain, rue Dr. Gaston Thérasse 1, 5530 Yvoir, Belgium.
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Pagano MB, Murinson BB, Tobian AA, King KE. Efficacy of therapeutic plasma exchange for treatment of stiff-person syndrome. Transfusion 2014; 54:1851-6. [DOI: 10.1111/trf.12573] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 11/07/2013] [Accepted: 11/14/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Beth B. Murinson
- Department of Neurology; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Aaron A.R. Tobian
- Department of Pathology; Transfusion Medicine Service; The Johns Hopkins Medical Institutions; Baltimore Maryland
| | - Karen E. King
- Department of Pathology; Transfusion Medicine Service; The Johns Hopkins Medical Institutions; Baltimore Maryland
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Sellari-Franceschini S, Bartalena L, Seccia V. The challenge of orbital decompression in a patient with multiple autoimmune diseases and graves' orbitopathy: a case report and review of literature. Orbit 2010; 29:48-50. [PMID: 20302412 DOI: 10.3109/01676830903207836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The association between multiple autoimmune diseases can make management of the ocular proptosis very difficult and challenging for the orbit surgeon. We report an interesting case of a patient affected by Stiff person syndrome, type-1 diabetes and Graves' disease with Graves' orbitopathy, who underwent orbital decompression. Anaesthesiologic problems, as well as factors affecting the post-operative result, are discussed in detail; pertinent literature review was performed and discussed.
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Miao J, Liu R, Li J, Du Y, Zhang W, Li Z. Meige's syndrome and hemichorea associated with hyperthyroidism. J Neurol Sci 2009; 288:175-7. [PMID: 19883923 DOI: 10.1016/j.jns.2009.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Revised: 10/20/2009] [Accepted: 10/20/2009] [Indexed: 11/25/2022]
Abstract
Movement disorders are known to be associated with hyperthyroidism. However, the association of Meige's syndrome and hemichorea with hyperthyroidism has not been reported. We describe a young Chinese woman with hyperthyroidism, who presented with a unique combination of Meige's syndrome and hemichorea in the left limbs. Both neurologic manifestations were preceded by symptoms of hyperthyroidism, and resolved following treatment with methimazole for hyperthyroidism. Nevertheless, the neurologic symptoms recurred when she stopped taking methimazole, but abated when she returned to a euthyroid state after additional treatment with methimazole. The evolution of her clinical course indicated that the involuntary movements were in association with hyperthyroidism. This case is the first report of Meige's syndrome and hemichorea in a patient with hyperthyroidism, which raises the likelihood that hyperthyroidism may be a cause of Meige's syndrome and hemichorea. Furthermore, it emphasizes the need for greater attention to thyroid function in those afflicted with involuntary movements in order to optimize clinical management.
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Affiliation(s)
- Jianting Miao
- Department of Neurology, Tangdu Hospital, Fourth Military Medical University, Xi'an City, Shaanxi Province 710038, China
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