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Hansen PN, Mohammed AA, Markvardsen LK, Andersen H, Tankisi H, Sindrup SH, Krøigård T. Changes in axonal and clinical function during intravenous and subcutaneous immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy. J Peripher Nerv Syst 2023; 28:425-435. [PMID: 37212187 DOI: 10.1111/jns.12563] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/17/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND AND AIMS Intravenous immunoglobulin (IVIg) has a rapid clinical effect which cannot be explained by remyelination during each treatment cycle in patients with chronic inflammatory demyelinating polyneuropathy (CIDP). This study aimed to investigate axonal membrane properties during the IVIg treatment cycle and their potential correlation with clinically relevant functional measurements. METHODS Motor nerve excitability testing (NET) of the median nerve was performed before and 4 and 18 days after initiation of an IVIg treatment cycle in 13 treatment-naïve (early) CIDP patients and 24 CIDP patients with long term (late) IVIg treatment, 12 CIDP patients treated with subcutaneous immunoglobulin (SCIg) and 55 healthy controls. Clinical function was measured extensively using the Six Spot Step test, 10-Meter Walk test, 9-Hole Peg test, grip strength, MRC sum score, Overall Neuropathy Limitations Score and Patient Global Impression of Change. RESULTS Superexcitability and S2 accommodation decreased significantly in the early treatment group from baseline to day 4 and returned to baseline levels at day 18, suggesting temporary depolarization of the axonal membrane. A similar trend was observed for the late IVIg group. Substantial clinical improvement was observed in both early and late IVIg groups during the entire treatment cycle. No statistically significant correlation was found between clinical and NET changes. No change was found in NET or clinical function in the SCIg group or controls. INTERPRETATION NET suggested temporary depolarization of the axonal membrane during IVIg treatment in treatment naïve CIDP patients. The relation to clinical improvement, however, remains speculative.
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Affiliation(s)
- Peter N Hansen
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | - Abdullahi A Mohammed
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
| | | | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Hatice Tankisi
- Department of Clinical Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | - Søren H Sindrup
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - Thomas Krøigård
- Neurology Research Unit, Odense University Hospital, Odense, Denmark
- University of Southern Denmark, Odense, Denmark
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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2
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van Rosmalen MHJ, Goedee HS, Derks R, Asselman F, Verhamme C, de Luca A, Hendrikse J, van der Pol WL, Froeling M. Quantitative magnetic resonance imaging of the brachial plexus shows specific changes in nerve architecture in chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy and motor neuron disease. Eur J Neurol 2021; 28:2716-2726. [PMID: 33934438 PMCID: PMC8362016 DOI: 10.1111/ene.14896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/12/2021] [Accepted: 04/28/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The immunological pathophysiologies of chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN) differ considerably, but neither has been elucidated completely. Quantitative magnetic resonance imaging (MRI) techniques such as diffusion tensor imaging, T2 mapping, and fat fraction analysis may indicate in vivo pathophysiological changes in nerve architecture. Our study aimed to systematically study nerve architecture of the brachial plexus in patients with CIDP, MMN, motor neuron disease (MND) and healthy controls using these quantitative MRI techniques. METHODS We enrolled patients with CIDP (n = 47), MMN (n = 29), MND (n = 40) and healthy controls (n = 10). All patients underwent MRI of the brachial plexus and we obtained diffusion parameters, T2 relaxation times and fat fraction using an automated processing pipeline. We compared these parameters between groups using a univariate general linear model. RESULTS Fractional anisotropy was lower in patients with CIDP compared to healthy controls (p < 0.001), patients with MND (p = 0.010) and MMN (p < 0.001). Radial diffusivity was higher in patients with CIDP compared to healthy controls (p = 0.015) and patients with MND (p = 0.001) and MMN (p < 0.001). T2 relaxation time was elevated in patients with CIDP compared to patients with MND (p = 0.023). Fat fraction was lower in patients with CIDP and MMN compared to patients with MND (both p < 0.001). CONCLUSION Our results show that quantitative MRI parameters differ between CIDP, MMN and MND, which may reflect differences in underlying pathophysiological mechanisms.
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Affiliation(s)
- Marieke H. J. van Rosmalen
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - H. Stephan Goedee
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Rosina Derks
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Fay‐Lynn Asselman
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Camiel Verhamme
- Department of NeurologyAmsterdam NeuroscienceAmsterdam University Medical CentersUniversity of AmsterdamAmsterdamThe Netherlands
| | - Alberto de Luca
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - J. Hendrikse
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - W. Ludo van der Pol
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Martijn Froeling
- Department of RadiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
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3
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Grüter T, Motte J, Fisse AL, Bulut Y, Köse N, Athanasopoulos D, Otto S, Yoon MS, Schneider-Gold C, Gold R, Pitarokoili K. Pathological spontaneous activity as a prognostic marker in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2020; 27:2595-2603. [PMID: 32794258 DOI: 10.1111/ene.14476] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Monitoring of the disease course of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) remains challenging because nerve conduction studies do not adequately correlate with functional disability. The prognostic value of pathological spontaneous activity (PSA) in needle electromyography (EMG) in different CIDP subgroups in a longitudinal context has, to date, not been analysed. We aimed to determine whether PSA was a prognostic marker or a marker of disease activity in a cohort of patients with CIDP. METHODS A total of 127 patients with CIDP spectrum disorder were retrospectively analysed over 57 ± 47 months regarding the occurrence of PSA (fibrillations and positive sharp waves). The presence of PSA at diagnosis, newly occurring PSA, and continuously present PSA were longitudinally correlated with clinical disability using the Inflammatory Neuropathy Cause and Treatment Overall Disability Sum Score (INCAT-ODSS) and CIDP subtype. RESULTS Pathological spontaneous activity occurred in 49.6% of all CIDP patients at first diagnosis. More frequent evidence of PSA was significantly associated with a higher INCAT-ODSS at the last follow-up. Continuous and new occurrence of PSA were associated with higher degree of disability at the last follow-up. The majority of patients with sustained evidence of PSA were characterized by an atypical phenotype, higher degree of disability, and the need for escalation of treatment. CONCLUSIONS Pathological spontaneous activity was associated with a higher degree of disability and occurred more frequently in atypical CIDP variants according to the longitudinal data of a large cohort of patients with CIDP. Our results showed that EMG examination was an adequate marker for disease progression and should be evaluated during the disease course.
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Affiliation(s)
- T Grüter
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - J Motte
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - A L Fisse
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - Y Bulut
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - N Köse
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - D Athanasopoulos
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - S Otto
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - M-S Yoon
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany.,Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - C Schneider-Gold
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - R Gold
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - K Pitarokoili
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
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Sleutjes BTHM, Kovalchuk MO, Durmus N, Buitenweg JR, van Putten MJAM, van den Berg LH, Franssen H. Simulating perinodal changes observed in immune-mediated neuropathies: impact on conduction in a model of myelinated motor and sensory axons. J Neurophysiol 2019; 122:1036-1049. [PMID: 31291151 DOI: 10.1152/jn.00326.2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Immune-mediated neuropathies affect myelinated axons, resulting in conduction slowing or block that may affect motor and sensory axons differently. The underlying mechanisms of these neuropathies are not well understood. Using a myelinated axon model, we studied the impact of perinodal changes on conduction. We extended a longitudinal axon model (41 nodes of Ranvier) with biophysical properties unique to human myelinated motor and sensory axons. We simulated effects of temperature and axonal diameter on conduction and strength-duration properties. We then studied effects of impaired nodal sodium channel conductance and paranodal myelin detachment by reducing periaxonal resistance, as well as their interaction, on conduction in the 9 middle nodes and enclosed paranodes. Finally, we assessed the impact of reducing the affected region (5 nodes) and adding nodal widening. Physiological motor and sensory conduction velocities and changes to axonal diameter and temperature were observed. The sensory axon had a longer strength-duration time constant. Reducing sodium channel conductance and paranodal periaxonal resistance induced progressive conduction slowing. In motor axons, conduction block occurred with a 4-fold drop in sodium channel conductance or a 7.7-fold drop in periaxonal resistance. In sensory axons, block arose with a 4.8-fold drop in sodium channel conductance or a 9-fold drop in periaxonal resistance. This indicated that motor axons are more vulnerable to developing block. A boundary of block emerged when the two mechanisms interacted. This boundary shifted in opposite directions for a smaller affected region and nodal widening. These differences may contribute to the predominance of motor deficits observed in some immune-mediated neuropathies.NEW & NOTEWORTHY Immune-mediated neuropathies may affect myelinated motor and sensory axons differently. By the development of a computational model, we quantitatively studied the impact of perinodal changes on conduction in motor and sensory axons. Simulations of increasing nodal sodium channel dysfunction and paranodal myelin detachment induced progressive conduction slowing. Sensory axons were more resistant to block than motor axons. This could explain the greater predisposition of motor axons to functional deficits observed in some immune-mediated neuropathies.
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Affiliation(s)
- Boudewijn T H M Sleutjes
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maria O Kovalchuk
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Naric Durmus
- Biomedical Signals and Systems, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands.,Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands
| | - Jan R Buitenweg
- Biomedical Signals and Systems, MIRA, Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Michel J A M van Putten
- Department of Clinical Neurophysiology, University of Twente, Enschede, The Netherlands.,Department of Neurology and Clinical Neurophysiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hessel Franssen
- Department of Neurology, Brain Center Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
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Goedee HS, van der Pol WL, Hendrikse J, van den Berg LH. Nerve ultrasound and magnetic resonance imaging in the diagnosis of neuropathy. Curr Opin Neurol 2019; 31:526-533. [PMID: 30153189 DOI: 10.1097/wco.0000000000000607] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most relevant developments in the fields of nerve ultrasound and MRI in the diagnosis of treatable inflammatory neuropathies over the last 18 months. RECENT FINDINGS MRI and nerve ultrasound can accurately identify potentially treatable neuropathies and thereby help to improve diagnosis. Advanced MRI techniques also show potential to dissect pathophysiology. The apparent mismatch between nerve function and morphology is not surprising and reflects different dimensions of the disease process in neuropathies. SUMMARY MRI and nerve ultrasound have become useful tools in the diagnosis of inflammatory neuropathies. VIDEO ABSTRACT.
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Affiliation(s)
- H Stephan Goedee
- Brain Center Rudolf Magnus, Department of Neurology and Neurosurgery
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6
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Physiology of Myelinated Nerve Conduction and Pathophysiology of Demyelination. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1190:85-106. [DOI: 10.1007/978-981-32-9636-7_7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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7
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Yermakov LM, Hong LA, Drouet DE, Griggs RB, Susuki K. Functional Domains in Myelinated Axons. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1190:65-83. [PMID: 31760639 DOI: 10.1007/978-981-32-9636-7_6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Propagation of action potentials along axons is optimized through interactions between neurons and myelinating glial cells. Myelination drives division of the axons into distinct molecular domains including nodes of Ranvier. The high density of voltage-gated sodium channels at nodes generates action potentials allowing for rapid and efficient saltatory nerve conduction. At paranodes flanking both sides of the nodes, myelinating glial cells interact with axons, forming junctions that are essential for node formation and maintenance. Recent studies indicate that the disruption of these specialized axonal domains is involved in the pathophysiology of various neurological diseases. Loss of paranodal axoglial junctions due to genetic mutations or autoimmune attack against the paranodal proteins leads to nerve conduction failure and neurological symptoms. Breakdown of nodal and paranodal proteins by calpains, the calcium-dependent cysteine proteases, may be a common mechanism involved in various nervous system diseases and injuries. This chapter reviews recent progress in neurobiology and pathophysiology of specialized axonal domains along myelinated nerve fibers.
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Affiliation(s)
- Leonid M Yermakov
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Lulu A Hong
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Domenica E Drouet
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Ryan B Griggs
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Keiichiro Susuki
- Department of Neuroscience, Cell Biology, and Physiology, Boonshoft School of Medicine, Wright State University, Dayton, OH, USA.
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8
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Abstract
PURPOSE OF REVIEW This article provides a conceptual framework for the evaluation of patients with suspected polyneuropathy to enhance the clinician's ability to localize and confirm peripheral nervous system pathology and, when possible, identify an etiologic diagnosis through use of rational clinical and judicious testing strategies. RECENT FINDINGS Although these strategies are largely time-honored, recent insights pertaining to the pathophysiology of certain immune-mediated neuropathies and to evolving genetic testing strategies may modify the way that select causes of neuropathy are conceptualized, evaluated, and managed. SUMMARY The strategies suggested in this article are intended to facilitate accurate bedside diagnosis in patients with suspected polyneuropathy and allow efficient and judicious use of supplementary testing and application of rational treatment when indicated.
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9
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Van den Bergh PYK, Piéret F, Woodard JL, Attarian S, Grapperon AM, Nicolas G, Brisset M, Cassereau J, Rajabally YA, Van Parijs V, Verougstraete D, Jacquerye P, Raymackers JM, Redant C, Michel C, Delmont E. Guillain-BarrÉ syndrome subtype diagnosis: A prospective multicentric European study. Muscle Nerve 2018; 58:23-28. [PMID: 29315669 DOI: 10.1002/mus.26056] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 12/29/2017] [Accepted: 12/30/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION There is uncertainty as to whether the Guillain-Barré syndrome (GBS) subtypes, acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN), can be diagnosed electrophysiologically. METHODS We prospectively included 58 GBS patients. Electrodiagnostic testing (EDX) was performed at means of 5 and 33 days after disease onset. Two traditional and one recent criteria sets were used to classify studies as demyelinating or axonal. Results were correlated with anti-ganglioside antibodies and reversible conduction failure (RCF). RESULTS No classification shifts were observed, but more patients were classified as axonal with recent criteria. RCF and anti-ganglioside antibodies were present in both subtypes, more frequently in the axonal subtype. DISCUSSION Serial EDX has no effect on GBS subtype proportions. The absence of exclusive correlation with RCF and anti-ganglioside antibodies may challenge the concept of demyelinating and axonal GBS subtypes based upon electrophysiological criteria. Frequent RCF indicates that nodal/paranodal alterations may represent the main pathophysiology. Muscle Nerve, 2018.
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Affiliation(s)
- Peter Y K Van den Bergh
- Neuromuscular Reference Centre, University Hospital St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | | | - John L Woodard
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Shahram Attarian
- Centre de référence des maladies Neuromusculaires et la SLA, Hôpital de la Timone, Marseille, France
| | - Aude-Marie Grapperon
- Centre de référence des maladies Neuromusculaires et la SLA, Hôpital de la Timone, Marseille, France
| | | | - Marion Brisset
- Service de neurologie, Hôpital Raymond Poincaré, Garches, France
| | - Julien Cassereau
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers, Centre Hospitalier Universitaire d'Angers, Angers, France
| | - Yusuf A Rajabally
- Regional Neuromuscular Service, Neurology, University Hospitals Birmingham, Birmingham, UK
| | - Vinciane Van Parijs
- Neuromuscular Reference Centre, University Hospital St-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium
| | | | | | | | | | | | - Emilien Delmont
- Centre de référence des maladies Neuromusculaires et la SLA. Hôpital de la Timone, Marseille, France
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10
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Kovalchuk MO, Franssen H, Van Schelven LJ, Sleutjes BTHM. Comparing excitability at 37°C versus at 20°C: Differences between motor and sensory axons. Muscle Nerve 2017; 57:574-580. [DOI: 10.1002/mus.25960] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Maria O. Kovalchuk
- Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht The Netherlands
| | - Hessel Franssen
- Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht The Netherlands
| | - Leonard J. Van Schelven
- Department of Medical Technology and Clinical PhysicsUniversity Medical Center UtrechtUtrecht the Netherlands
| | - Boudewijn T. H. M. Sleutjes
- Department of Neurology and Neurosurgery, Brain Center Rudolf MagnusUniversity Medical Center UtrechtUtrecht The Netherlands
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11
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Leussink VI, Hartung HP, Kieseier BC, Stettner M. Subcutaneous immunoglobulins in the treatment of chronic immune-mediated neuropathies. Ther Adv Neurol Disord 2016; 9:336-43. [PMID: 27366241 DOI: 10.1177/1756285616641583] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intravenous immunoglobulins represent an established therapy for the treatment of chronic immune-mediated neuropathies, specifically chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs) as well as multifocal motor neuropathies (MMNs). For the treatment of antibody deficiency syndromes, subcutaneous immunoglobulins (SCIgs) have represented a mainstay for decades. An emerging body of evidence suggests that SCIg might also exhibit clinical efficacy in CIDP and MMN. This article reviews the current evidence for clinical effectiveness, as well as safety of SCIg for the treatment of immune-mediated neuropathies, and addresses remaining open questions in this context. We conclude that despite the need for controlled long-term studies to demonstrate long-term efficacy of SCIg in immune-mediated neuropathies, SCIg may already represent a potential therapeutic alternative for selected patients.
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Affiliation(s)
- Verena I Leussink
- Department of Neurology, Medical Faculty, Research Group for Clinical and Experimental Neuroimmunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Research Group for Clinical and Experimental Neuroimmunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Bernd C Kieseier
- Department of Neurology, Medical Faculty, Research Group for Clinical and Experimental Neuroimmunology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mark Stettner
- Department of Neurology, Heinrich-Heine-University, Moorenstr. 5, 40225 Düsseldorf, Germany
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12
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Uncini A, Kuwabara S. Nodopathies of the peripheral nerve: an emerging concept. J Neurol Neurosurg Psychiatry 2015; 86:1186-95. [PMID: 25699569 DOI: 10.1136/jnnp-2014-310097] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 01/31/2015] [Indexed: 12/17/2022]
Abstract
Peripheral nerve diseases are traditionally classified as demyelinating or axonal. It has been recently proposed that microstructural changes restricted to the nodal/paranodal region may be the key to understanding the pathophysiology of antiganglioside antibody mediated neuropathies. We reviewed neuropathies with different aetiologies (dysimmune, inflammatory, ischaemic, nutritional, toxic) in which evidence from nerve conductions, excitability studies, pathology and animal models, indicate the involvement of the nodal region in the pathogenesis. For these neuropathies, the classification in demyelinating and axonal is inadequate or even misleading, we therefore propose a new category of nodopathy that has the following features: (1) it is characterised by a pathophysiological continuum from transitory nerve conduction block to axonal degeneration; (2) the conduction block may be due to paranodal myelin detachment, node lengthening, dysfunction or disruption of Na(+) channels, altered homeostasis of water and ions, or abnormal polarisation of the axolemma; (3) the conduction block may be promptly reversible without development of excessive temporal dispersion; (4) axonal degeneration, depending on the specific disorder and its severity, eventually follows the conduction block. The term nodopathy focuses to the site of primary nerve injury, avoids confusion with segmental demyelinating neuropathies and circumvents the apparent paradox that something axonal may be reversible and have a good prognosis.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G d'Annunzio", Chieti-Pescara, Chieti, Italy
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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13
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Franssen H. Relation between symptoms and pathophysiology in inflammatory neuropathies: Controversies and hypotheses. Neurosci Lett 2015; 596:84-9. [PMID: 25483620 DOI: 10.1016/j.neulet.2014.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 11/11/2014] [Accepted: 12/02/2014] [Indexed: 10/24/2022]
Abstract
This review attempts to explain the symptoms experienced by patients with inflammatory neuropathies by pathophysiological events. The emphasis is not on the primary events that may cause a particular illness but on downstream events taking place in peripheral nerves or muscles. Symptoms that will be discussed include sensory predominance, motor predominance, activity-induced weakness, heat paresis, and cold paresis. Each symptom is associated with, but not limited to, particular neuropathies.
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Affiliation(s)
- Hessel Franssen
- Brain Center Rudolf Magnus, Section Neuromuscular Disorders, Department of Neurology F02.230, University Medical Center Utrecht, Heidelberglaan 100, 3584CX Utrecht, Netherlands.
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14
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Kuntzer T. [2013: what's new in inflammatory neuropathies]. Rev Neurol (Paris) 2014; 170:850-3. [PMID: 25459118 DOI: 10.1016/j.neurol.2014.05.011] [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: 03/24/2014] [Revised: 04/27/2014] [Accepted: 05/14/2014] [Indexed: 11/19/2022]
Abstract
Several high-quality publications were published in 2013 and some major trials studies were started. In Guillain-Barré syndrome, events included the launch of IGOS and a better understanding of diagnostic limits, the effect of influenza vaccination, and better care, but uncertainty remains about analgesics. A new mouse model was also described. In chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), diagnostic pitfalls can be recalled. Our knowledge of underlying pathophysiological processes has improved, and the value of monitoring with function and deficit scores has been demonstrated. IVIG can sometimes be effective longer than expected, but CIDP remains sensitive to corticosteroids, particularly with the long-term beneficial effects of megadose dexamethasone. The impact of fingolimod remains to be demonstrated in an ongoing trial. Advances concerning multifocal motor neuropathy, inflammatory plexopathy, and neuropathy with anti -MAG activity are discussed but treatments already recognized as effective should not be changed. Imaging of peripheral nerve progresses.
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Affiliation(s)
- T Kuntzer
- Département des neurosciences cliniques, université de Lausanne, CHU Vaudois (CHUV), BH07/413, rue du Bugnon 46, 1011 Lausanne, Suisse.
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Franssen H, Straver DCG. Pathophysiology of immune-mediated demyelinating neuropathies--Part II: Neurology. Muscle Nerve 2013; 49:4-20. [PMID: 24037667 DOI: 10.1002/mus.24068] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 12/13/2022]
Abstract
In the second part of this review we deal with the clinical aspects of immune-mediated demyelinating neuropathies. We describe the relationship between pathophysiology and symptoms and discuss the pathophysiology of specific disease entities, including Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, multifocal motor neuropathy, anti-myelin-associated glycoprotein neuropathy, and POEMS syndrome.
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Affiliation(s)
- Hessel Franssen
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584, CX Utrecht, The Netherlands
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Franssen H, Straver DC. Pathophysiology of immune-mediated demyelinating neuropathies-part I: Neuroscience. Muscle Nerve 2013; 48:851-64. [DOI: 10.1002/mus.24070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Hessel Franssen
- Department of Neurology, Section Neuromuscular Disorders, F02.230, Rudolf Magnus Institute for Neuroscience; University Medical Center Utrecht; Heidelberglaan 100, 3584 CX Utrecht The Netherlands
| | - Dirk C.G. Straver
- Department of Neurology, Section Neuromuscular Disorders, F02.230, Rudolf Magnus Institute for Neuroscience; University Medical Center Utrecht; Heidelberglaan 100, 3584 CX Utrecht The Netherlands
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