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Parmar ST, Deshpande C, Kadam DS. Role of physical therapy intervention in acute disseminated encephalomyelitis. BMJ Case Rep 2024; 17:e257339. [PMID: 38589237 PMCID: PMC11015239 DOI: 10.1136/bcr-2023-257339] [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] [Indexed: 04/10/2024] Open
Abstract
We reported a case of a school-going child, diagnosed with acute disseminated encephalomyelitis (ADEM) who presented with symptoms such as high fever, acute hemiplegia and ataxia and was referred for physiotherapeutic intervention. This case report aims to document the assessment and management of ADEM from the intensive care unit to the home setting by physical therapy. Also, the child developed ventilator-associated pneumonia and a right lower motor neuron facial injury for which the child was referred to paediatric physical therapy. Since then, continuing for 8 months has helped the child to be independent in all aspects of mobility with no complaints. The child showed improvement in WeeFIM scores and Sunnybrook facial grading after 99 sessions of intensive physical therapy for approximately 83 hours along with the home programme. It has been proven an efficient treatment method along with other medical lines of treatment for neurological impairment associated with ADEM.
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Alawad MJ, Almayoof M, Al Bozom A, Alkhidir T, Emam SS, Farfar K. Post-malaria neurological syndrome (PMNS): a rare case report with brain biopsy findings. BMC Infect Dis 2023; 23:886. [PMID: 38114951 PMCID: PMC10729502 DOI: 10.1186/s12879-023-08704-z] [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: 03/31/2023] [Accepted: 10/12/2023] [Indexed: 12/21/2023] Open
Abstract
Post-malaria neurological syndrome (PMNS) is a rare, self-limiting condition that presents with a wide range of neurological manifestations after clearance of malarial infection, especially 𝘗𝘭𝘢𝘴𝘮𝘰𝘥𝘪𝘶𝘮 f𝘢𝘭𝘤𝘪𝘱𝘢𝘳𝘶𝘮, most patients recover without residual deficits. Here we present a case of a 29-year-old, male with a recent history of malaria treated successfully, who presented due to a generalized tonic-clonic seizure, without any other neurological symptoms, the examination and labs were unremarkable, he underwent a computer tomography (CT) scan and Magnetic resonant imaging (MRI) which both showed two areas of vasogenic edema involving the subcortical white matter of left frontal and right posterior parasagittal regions, all autoimmune screens, infection workup from blood and CSF were negative, he underwent a brain biopsy that showed intense perivascular inflammation with neuronal loss and gliosis, findings are nonspecific and can be seen in a variety of condition. The patient's condition improved, and he was discharged without any complications.
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Affiliation(s)
- Mouhammad J Alawad
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar.
| | - Moustafa Almayoof
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar
| | - Adel Al Bozom
- Department of Medical Education, Internal Medicine Residency Program, Hamad Medical Corporation, Doha, 3050, Qatar
| | - Taha Alkhidir
- Department of Medicine, Division of Neurology, Hamad Medical Corporation, Doha, Qatar
| | - Saeed S Emam
- Department of clinical radiology, Hamad Medical Corporation, Doha, Qatar
| | - Khalifa Farfar
- Department of Medicine, Al Wakra hospital, Hamad Medical Corporation, Doha, Qatar
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3
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Khatri S, Xerras M, Chamay S, Sharma S. Insights from neuroradiology in acute disseminated encephalomyelitis. Radiol Case Rep 2023; 18:4318-4322. [PMID: 37789924 PMCID: PMC10542600 DOI: 10.1016/j.radcr.2023.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/02/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated demyelinating disorder primarily observed in children, typically triggered by recent vaccination or viral infection. Although uncommon, there have been reports of ADEM occurring in adults, with varying radiological findings compared to pediatric cases. Distinguishing ADEM from other demyelinating disorders, such as multiple sclerosis (MS) and neuromyelitis optica (NMO), can pose a diagnostic challenge. We present a case report of an 18-year-old male with a history of polysubstance use who was successfully treated with corticosteroids and highlight the neuroradiological presentation of ADEM, emphasizing the importance of accurate diagnosis and management in both pediatric and adult populations.
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Affiliation(s)
| | | | - Salomon Chamay
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
| | - Shorabh Sharma
- Division of Internal Medicine, Department of Medicine, St. Barnabas Hospital, Bronx, NY 10457, USA
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4
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Bakirtzis C, Lima M, De Lorenzo SS, Artemiadis A, Theotokis P, Kesidou E, Konstantinidou N, Sintila SA, Boziki MK, Parissis D, Ioannidis P, Karapanayiotides T, Hadjigeorgiou G, Grigoriadis N. Secondary Central Nervous System Demyelinating Disorders in the Elderly: A Narrative Review. Healthcare (Basel) 2023; 11:2126. [PMID: 37570367 PMCID: PMC10418902 DOI: 10.3390/healthcare11152126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 07/14/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
Secondary demyelinating diseases comprise a wide spectrum group of pathological conditions and may either be attributed to a disorder primarily affecting the neurons or axons, followed by demyelination, or to an underlying condition leading to secondary damage of the myelin sheath. In the elderly, primary demyelinating diseases of the central nervous system (CNS), such as multiple sclerosis, are relatively uncommon. However, secondary causes of CNS demyelination may often occur and in this case, extensive diagnostic workup is usually needed. Infectious, postinfectious, or postvaccinal demyelination may be observed, attributed to age-related alterations of the immune system in this population. Osmotic disturbances and nutritional deficiencies, more commonly observed in the elderly, may lead to conditions such as pontine/extrapontine myelinolysis, Wernicke encephalopathy, and demyelination of the posterior columns of the spinal cord. The prevalence of malignancies is higher in the elderly, sometimes leading to radiation-induced, immunotherapy-related, or paraneoplastic CNS demyelination. This review intends to aid clinical neurologists in broadening their diagnostic approach to secondary CNS demyelinating diseases in the elderly. Common clinical conditions leading to secondary demyelination and their clinical manifestations are summarized here, while the current knowledge of the underlying pathophysiological mechanisms is additionally presented.
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Affiliation(s)
- Christos Bakirtzis
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Maria Lima
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Sotiria Stavropoulou De Lorenzo
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Artemios Artemiadis
- Faculty of Medicine, University of Cyprus, Nicosia CY-2029, Cyprus; (A.A.); (G.H.)
| | - Paschalis Theotokis
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Evangelia Kesidou
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Natalia Konstantinidou
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Styliani-Aggeliki Sintila
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Marina-Kleopatra Boziki
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Dimitrios Parissis
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Panagiotis Ioannidis
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | - Theodoros Karapanayiotides
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
| | | | - Nikolaos Grigoriadis
- Second Department of Neurology, Aristotle University of Thessaloniki, GR-54124 Thessaloniki, Greece; (M.L.); (S.S.D.L.); (P.T.); (E.K.); (N.K.); (S.-A.S.); (M.-K.B.); (D.P.); (P.I.); (T.K.); (N.G.)
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Stoian A, Bajko Z, Stoian M, Cioflinc RA, Niculescu R, Arbănași EM, Russu E, Botoncea M, Bălașa R. The Occurrence of Acute Disseminated Encephalomyelitis in SARS-CoV-2 Infection/Vaccination: Our Experience and a Systematic Review of the Literature. Vaccines (Basel) 2023; 11:1225. [PMID: 37515041 PMCID: PMC10385010 DOI: 10.3390/vaccines11071225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/30/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The neurological complications of coronavirus disease 2019 (COVID-19) infection and the side effects of vaccination include immune-mediated diseases of the central nervous system (CNS) such as acute disseminated encephalomyelitis (ADEM). It is an acute-onset demyelinating disease that involves a rapid evolution and multifocal neurological deficits that develops following a viral or bacterial infection or, less frequently, following vaccination. Acute hemorrhagic leukoencephalitis (AHLE) is the hemorrhagic variant of ADEM that presents a more severe evolution which can be followed by coma and death. The objectives of this study consist in evaluating the diagnosis, clinical characteristics, imaging and laboratory features, evolution, and treatment of ADEM and AHLE following COVID-19 infection or vaccination. METHODS We performed a systematic review of the medical literature according to PRISMA guidelines that included ADEM cases published between 1 January 2020 and 30 November 2022 following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination and also included our own clinical experience regarding this pathology. RESULTS A total number of 74 patients were diagnosed with ADEM, 45 following COVID-19 infection and 29 after a SARS-CoV-2 vaccine. A total of 13 patients (17.33%) presented AHLE. The moderate form of COVID-19 presented a positive correlation with AHLE (r = 0.691, p < 0.001). The existence of coma and AHLE was correlated with poor outcomes. The following more aggressive immunomodulatory therapies applied in severe cases were correlated with poor outcomes (major sequelae and death): therapeutic plasma exchange (TPE) treatment (r = 382, p = 0.01) and combined therapy with corticosteroids and TPE (r = 0.337, p = 0.03). CONCLUSIONS Vaccinations are essential to reduce the spread of the COVID-19 pandemic, and the monitoring of adverse events is an important part of the strategic fight against SARS-CoV-2. The general benefits and the overall good evolution outweigh the risks, and prompt diagnosis is associated with a better prognosis in these patients.
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Affiliation(s)
- Adina Stoian
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Zoltan Bajko
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Mircea Stoian
- Department Anesthesiology and Critical Care Medicine, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | | | - Raluca Niculescu
- Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
| | - Emil Marian Arbănași
- Doctoral School of Medicine and Pharmacy, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology of Targu Mures, 540142 Targu Mures, Romania
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Eliza Russu
- Department of Vascular Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
- Clinic of Vascular Surgery, Mures County Emergency Hospital, 540136 Targu Mures, Romania
| | - Marian Botoncea
- Department of General Surgery, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Rodica Bălașa
- Department of Neurology, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
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Acute disseminated encephalitis (ADEM) as the first presentation of COVID-19; a case report. Ann Med Surg (Lond) 2022; 77:103511. [PMID: 35369575 PMCID: PMC8958253 DOI: 10.1016/j.amsu.2022.103511] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/08/2022] [Accepted: 03/26/2022] [Indexed: 01/02/2023] Open
Abstract
Introduction and importance: Neurological ailments are reported during and after SARS-COV-2 infection. Case presentation We report a 67-year-old Iranian man with COVID-19 infection and Acute Disseminated Encephalomyelitis (ADEM) whose neurological symptoms appeared before clinical and radiological pulmonary manifestations. Clinical discussion COVID-19 can cause neurological complication without entering the CNS via para infectious inflammatory mechanisms. Conclusions This report shows that ADEM might be among primary presentations of COVID-19.
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Ancau M, Liesche-Starnecker F, Niederschweiberer J, Krieg SM, Zimmer C, Lingg C, Kumpfmüller D, Ikenberg B, Ploner M, Hemmer B, Wunderlich S, Mühlau M, Knier B. Case Series: Acute Hemorrhagic Encephalomyelitis After SARS-CoV-2 Vaccination. Front Neurol 2022; 12:820049. [PMID: 35185757 PMCID: PMC8847228 DOI: 10.3389/fneur.2021.820049] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/31/2021] [Indexed: 01/10/2023] Open
Abstract
We present three cases fulfilling diagnostic criteria of hemorrhagic variants of acute disseminated encephalomyelitis (acute hemorrhagic encephalomyelitis, AHEM) occurring within 9 days after the first shot of ChAdOx1 nCoV-19. AHEM was diagnosed using magnetic resonance imaging, cerebrospinal fluid analysis and brain biopsy in one case. The close temporal association with the vaccination, the immune-related nature of the disease as well as the lack of other canonical precipitating factors suggested that AHEM was a vaccine-related adverse effect. We believe that AHEM might reflect a novel COVID-19 vaccine-related adverse event for which physicians should be vigilant and sensitized.
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Affiliation(s)
- Mihai Ancau
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | | | | | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Charlotte Lingg
- Department of Anesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Kumpfmüller
- Department of Anesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benno Ikenberg
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Markus Ploner
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benjamin Knier
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- *Correspondence: Benjamin Knier
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Satheesh NJ, Salloum-Asfar S, Abdulla SA. The Potential Role of COVID-19 in the Pathogenesis of Multiple Sclerosis-A Preliminary Report. Viruses 2021; 13:2091. [PMID: 34696521 PMCID: PMC8540806 DOI: 10.3390/v13102091] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/17/2022] Open
Abstract
Coronavirus 2019 (COVID-19) is an infectious respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that mainly affects the lungs. COVID-19 symptoms include the presence of fevers, dry coughs, fatigue, sore throat, headaches, diarrhea, and a loss of taste or smell. However, it is understood that SARS-CoV-2 is neurotoxic and neuro-invasive and could enter the central nervous system (CNS) via the hematogenous route or via the peripheral nerve route and causes encephalitis, encephalopathy, and acute disseminated encephalomyelitis (ADEM) in COVID-19 patients. This review discusses the possibility of SARS-CoV-2-mediated Multiple Sclerosis (MS) development in the future, comparable to the surge in Parkinson's disease cases following the Spanish Flu in 1918. Moreover, the SARS-CoV-2 infection is associated with a cytokine storm. This review highlights the impact of these modulated cytokines on glial cell interactions within the CNS and their role in potentially prompting MS development as a secondary disease by SARS-CoV-2. SARS-CoV-2 is neurotropic and could interfere with various functions of neurons leading to MS development. The influence of neuroinflammation, microglia phagocytotic capabilities, as well as hypoxia-mediated mitochondrial dysfunction and neurodegeneration, are mechanisms that may ultimately trigger MS development.
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Affiliation(s)
| | - Salam Salloum-Asfar
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha 34110, Qatar;
| | - Sara A. Abdulla
- Neurological Disorders Research Center, Qatar Biomedical Research Institute (QBRI), Hamad Bin Khalifa University (HBKU), Qatar Foundation (QF), Doha 34110, Qatar;
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Nasa P, Mortada M, Singh A, Malhotra V, Syed H. Transient Myelin Oligodendrocyte Glycoprotein Antibody-positive Acute Disseminated Encephalomyelitis Following Influenza A Infection: A Rare Case. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2021; 9:271-275. [PMID: 34667476 PMCID: PMC8474001 DOI: 10.4103/sjmms.sjmms_791_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 06/14/2021] [Accepted: 07/05/2021] [Indexed: 02/07/2023]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an uncommon disease generally with a preceding history of infectious illness. Here, we report a rare case of ADEM following influenza A infection with transient detection of anti-myelin oligodendrocyte glycoprotein (MOG) antibody in a young male patient who presented with extensive demyelination of brain and spinal cord, likely the result of dysregulated immune response from previous influenza A infection. The patient presented to the emergency with urinary retention and progressive ascending weakness of lower limbs. Magnetic resonance imaging (MRI) of the brain and spinal cord showed multiple ill-defined hyperintensities, suggestive of demyelination. The clinical presentation, MRI findings, cerebrospinal fluid examination, negative anti-aquaporin-4 antibody and metabolic and other viral infectious screening supported the diagnosis of ADEM. The patient had transiently positive anti-MOG antibodies (for 3 months) and was treated with intravenous immunoglobulin followed by oral prednisolone for 3 months. There was a significant recovery in the upper limb weakness and brainstem function. This case highlights the association of anti-MOG antibody with ADEM following viral infections and the need for prolonged follow-up to differentiate between transient antibodies from relapsing MOG antibody disease.
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Affiliation(s)
- Prashant Nasa
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Address for correspondence: Dr. Prashant Nasa, NMC Specialty Hospital, Al Qusais, Dubai, United Arab Emirates. E-mail:
| | - Mohamed Mortada
- Neurosciences, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Aanchal Singh
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | | | - Habib Syed
- Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
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10
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Ferorelli P, Antonelli F, Shevchenko A, Mischiati C, Doepp M, Lenzi S, Borromeo I, Feriotto G, Beninati S. Reduction in Fatigue Symptoms Following the Administration of Nutritional Supplements in Patients with Multiple Sclerosis. Med Sci (Basel) 2021; 9:52. [PMID: 34287336 PMCID: PMC8293375 DOI: 10.3390/medsci9030052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 12/14/2022] Open
Abstract
Despite recent advances in immune-modulatory drugs, pharmacological therapies have been proven ineffective in severe presentations of multiple sclerosis (MS), including secondary progressive MS. At present, therapeutic interventions' performance is primarily focused on ameliorating symptoms to improve the patient's quality of life (QOL). Among complementary treatments, nutrition has been considered a decisive factor to control symptoms and enhance the wellness of MS patients. Although no special diets are associated with MS, the impact of diet and dietary supplements on the course of progressive forms of the disease has been studied during the last few years. Fatigue is among the most common and disabling symptoms reported by MS patients. Fatigue has been defined in the Multiple Sclerosis Council for Clinical Practice Guidelines (MSCCPG, 1998) as a "subjective lack of physical and/or mental energy that the individual perceives as an interference with habitual and desired activities". This study aimed to compare the psychometric functioning of the "Fatigue Severity Scale" (FSS) and the "Modified Fatigue Impact Scale" (MFIS) in our sample of people with MS. Specifically, during chronic treatment, the change in these two parameters with two vitamin-rich dietary supplements (Citozym® and Ergozym®) was evaluated. The impact of these nutritional supplements revealed differences in antioxidant and anti-inflammatory parameters among the volunteers in the treatment group, with a subsequent improvement in fatigue. In conclusion, the results obtained have confirmed the effectiveness of complementary nutritional therapies, evaluated essentially based on hematological biomarkers, through which it is possible to act on disability to improve the QOL of MS patients.
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Affiliation(s)
| | | | - Anna Shevchenko
- Department of Pharmacology, Kabardine University, 101000 Nalchik, Russia;
| | - Carlo Mischiati
- Department of Neuroscience and Rehabilitation, University of Ferrara, 44100 Ferrara, Italy;
| | - Manfred Doepp
- Department of Psychology and Sports Science, Giessen Justus, Liebig University Gießen, 35398 Gießen, Germany;
| | - Stefano Lenzi
- Department of Health Engineering, Université Européenne de Bruxelles Jean Monnet, Schaerbeek, 1030 Brussels, Belgium;
| | - Ilaria Borromeo
- Department of Physics, University of Tor Vergata, 00100 Rome, Italy;
| | - Giordana Feriotto
- Department of Chemical, Pharmaceutical and Agricultural Sciences, University of Ferrara, 44100 Ferrara, Italy;
| | - Simone Beninati
- Department of Biology, University of Rome Tor Vergata, Via della Ricerca Scientifica, 00100 Rome, Italy
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Bozzola E, Spina G, Valeriani M, Papetti L, Ursitti F, Agostiniani R, Mascolo C, Ruggiero M, Di Camillo C, Quondamcarlo A, Matera L, Vecchio D, Memo L, Villani A. Management of pediatric post-infectious neurological syndromes. Ital J Pediatr 2021; 47:17. [PMID: 33494818 PMCID: PMC7836589 DOI: 10.1186/s13052-021-00968-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-Infectious Neurological Syndromes (PINS) are heterogeneous neurological disorders with post or para-infectious onset. PINS diagnosis is complex, mainly related to the absence of any recognized guidelines and a univocal definition. AIM OF THE STUDY To elaborate a diagnostic guide for PINS. MATERIALS AND METHODS We retrospectively analysed patients younger than 14 years old admitted to Bambino Gesù Children's Hospital in Rome for PINS from December 2005 to March 2018. Scientific literature using PubMed as research platform was analysed: the key words "Post-Infectious Neurological Syndromes" were used. RESULTS A polysymptomatic presentation occurred in a percentage of 88% of the children. Motor signs and visual disturbances the most observed symptoms/signs were the most detached, followed by fever, speech disturbances, sleepiness, headache and bradipsychism. Blood investigations are compatible with inflammation, as a prodromal illnesses was documented in most cases. Normal cerebral spinal fluid (CSF) characteristics has been found in the majority of the study population. Magnetic resonance imaging (MRI) was positive for demyelinating lesions. Antibiotics, acyclovir and steroids have been given as treatment. DISCUSSION We suggest diagnostic criteria for diagnosis of PINS, considering the following parameters: neurological symptoms, timing of disease onset, blood and CSF laboratory tests, MRI imaging. CONCLUSIONS We propose criteria to guide clinician to diagnose PINS as definitive, probable or possible. Further studies are required to validate diagnostic criteria.
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Affiliation(s)
| | | | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | | | | | | | | | | | | | | | - Luigi Memo
- Italian Pediatric Society, Florence, Italy
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Tfaily MAH, Titanji B, Schniederjan MJ, Goodman A, Lava NS, Pouch SM, Collins MH, Adelman MW. Neuromyelitis Optica Presenting as Infectious Meningoencephalitis: Case Report and Literature Review. Am J Med Sci 2020; 361:534-541. [PMID: 33342552 DOI: 10.1016/j.amjms.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/20/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
In this patient-focused review, we present a 34-year-old previously healthy man admitted for fever and headache two weeks after a motor vehicle accident. On admission, his workup was concerning for meningoencephalitis based on elevated cerebrospinal fluid (CSF) white blood cell count and elevated CSF protein. He was admitted for management of meningoencephalitis. During his course, no causative infectious agent was identified despite an extensive workup. He additionally underwent an autoimmune and paraneoplastic workup that was negative. During his hospitalization, he developed acute transverse myelitis manifested by bilateral lower extremity paralysis. After four weeks marked by persistent clinical deterioration, brain biopsy was performed. Pathologic examination was consistent with neuromyelitis optica spectrum disorder (NMOSD). In this case report and literature review, we explore the presentations of NMOSD that mimic an infection. Clinicians should be aware of the possibility of NMOSD masquerading as infectious meningoencephalitis or acute transverse myelitis.
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Affiliation(s)
| | - Boghuma Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Abigail Goodman
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Neil S Lava
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew H Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Fang X, Huda R. Acute Flaccid Myelitis: Current Status and Diagnostic Challenges. J Clin Neurol 2020; 16:376-382. [PMID: 32657057 PMCID: PMC7354978 DOI: 10.3988/jcn.2020.16.3.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/07/2023] Open
Abstract
Acute flaccid myelitis (AFM) is a sudden-onset polio-like neuromuscular disability found commonly in young children. There is an increasing incidence of confirmed AFM cases in the USA and other countries in recent years, and in association with nonpolio enterovirus infection. This represents a significant challenge to clinicians and causes significant concern to the general public. Acute flaccid paralysis (AFP) is the long-known limb paralytic syndrome caused by a viral pathogen. AFM is a subset of AFP that is also characterized by a limb paralytic condition, but it has certain distinct features such as lesions in magnetic resonance imaging of the spinal cord gray matter. AFM leads to spinal cord, brainstem, or motor neuron dysfunction. The clinical phenotypes, pathology, and patient presentation of AFM closely mimic AFP. This article provides a concise overview of our current understanding of AFM and the clinical features that distinguish AFM from AFP and similar other neurological infectious and autoimmune diseases or disorders. We also discuss the diagnosis, clinical pathology, possible pathogenetic mechanisms, and currently available therapies.
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Affiliation(s)
- Xiang Fang
- Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Ruksana Huda
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA.
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The Spectrum of Acute Disseminated Encephalomyelitis and Mild Encephalopathy with Reversible Splenial Lesion. Case Rep Neurol Med 2019; 2019:9272074. [PMID: 31781440 PMCID: PMC6855051 DOI: 10.1155/2019/9272074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 08/05/2019] [Accepted: 08/19/2019] [Indexed: 11/18/2022] Open
Abstract
Background Acute disseminated encephalomyelitis and mild encephalopathy with reversible splenial lesion are autoimmune demyelinating disorders of central nervous system. Diagnosis remains clinical, aided by neuroimaging confirmation and excluding other causes. In the absence of a biological marker, the diagnosis of these entities based on clinical and imaging criteria could overlap. Methods We describe a 22-year-old woman developing mild neurological signs after an upper tract infection, a brain magnetic resonance image revealed confluent, symmetrical white matter lesions with corpus callosum involvement; after extensive ancillary testing that ruled out secondary causes we concluded that this subject had a post infectious encephalitis sharing clinical and imaging criteria for acute disseminated encephalomyelitis. However, mild encephalopathy with reversible splenial lesion could be an alternate diagnosis for this subject. Treatment with methylprednisolone completely solved both the clinical and image abnormalities without relapsing for more than 3 years of follow-up. Conclusion Both acute disseminated encephalomyelitis and mild encephalopathy with reversible splenial lesion share clinical and radiological features. A biological marker is needed to differentiate among these entities, since overlap is seen according to current criteria.
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Ruan J, Cheng M, Li XJ. [Clinical features of children with acute disseminated encephalomyelitis and related recurrence factors]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:223-228. [PMID: 30907344 PMCID: PMC7389356 DOI: 10.7499/j.issn.1008-8830.2019.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the clinical features of children with acute disseminated encephalomyelitis (ADEM) and related recurrence factors. METHODS A retrospective analysis was performed for the clinical data and prognosis of 73 children with ADEM who were hospitalized from November 2011 to January 2017. RESULTS Among the 73 children, 41 (56%) had a history of infection before onset and 7 (10%) had a history of vaccination. All children had the symptoms of encephalopathy, including disturbance of consciousness in 47 children (64%) and mental and behavioral disorders in 54 children (74%). Pyrexia was observed in 53 children (73%), dyskinesia in 47 children (64%), headache in 47 children (64%) and vomiting in 40 children (55%). Brain MRI was performed for 65 children and the results showed involvement of the subcortical white matter (83%, 54/65), the deep nuclei (60%, 39/65), the brain stem (58%, 38/65) and the cerebellum (42%, 27/65). Spinal cord involvement was observed in 20 children (20/43, 47%). A total of 15 children experienced recurrence during follow-up. Compared with the non-recurrence group, the recurrence group had significantly higher percentages of children with deep nucleus involvement (P<0.05), with injury in ≥3 spinal segments (P<0.01) and with a time from disease onset to gamma-globulin/hormone treatment of >2 weeks (P<0.05). CONCLUSIONS ADEM in children have various clinical manifestations. A small number of children may experience recurrence. Deep nucleus involvement on MRI, long spinal segmental injury (≥3 segments) and late treatment with gamma-globulin/hormone (>2 weeks) may be associated with the recurrence of ADEM.
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Affiliation(s)
- Jin Ruan
- Department of Neurology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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Kang P, Schmidt RE, Dahiya S, Varadhachary AS. A 42-Year-Old Man with AIDS and Multiple Incomplete Ring Enhancing Lesions. Brain Pathol 2018; 27:697-698. [PMID: 28805005 DOI: 10.1111/bpa.12542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Peter Kang
- Department of Neurology, Washington University School of Medicine, St Louis, MO
| | - Robert E Schmidt
- Division of Neuropathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Sonika Dahiya
- Division of Neuropathology, Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO
| | - Arun S Varadhachary
- Department of Neurology, Washington University School of Medicine, St Louis, MO
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Chen Y, Ma F, Xu Y, Chu X, Zhang J. Vaccines and the risk of acute disseminated encephalomyelitis. Vaccine 2018; 36:3733-3739. [PMID: 29784468 DOI: 10.1016/j.vaccine.2018.05.063] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND It is important to examine the risk of Acute disseminated encephalomyelitis (ADEM) after vaccination. METHODS We conducted a nested case-control study between January 2011 and December 2015. Four controls per case were matched for age, gender, address. An independent expert committee validated the diagnoses of cases and controls. Data on vaccinations were obtained from computerized vaccination records. The analyses were conducted with the use of conditional logistic regression. RESULTS The analyses include 272 cases of ADEM and 1096 controls. No increase in the risk of ADEM was observed for vaccination against hepatitis B, influenza, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, meningitis, hepatitis A, varicella and rabies vaccines. Vaccine was associated with a statistically significant increase in risk in the 31-60-day exposure interval (OR, 4.04 [95% CI, 1.07-12.69]), but not the 0-30 and 61-180-day interval. There was no association between vaccine received and the recurrence of ADEM. CONCLUSIONS Findings from the present study do not demonstrate an association of vaccines with an increased risk of ADEM and its recurrence among either paediatric (≤18 years) or adult (>18 years) individuals within the 180 days after vaccinations. The finding in children in the 31-60 day risk interval is likely coincidental and was not confirmed in separate self-control analyses.
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Affiliation(s)
- Yong Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China.
| | - Fubao Ma
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Yuanling Xu
- Department of Neurology, Nanjing Brain Hospital, China.
| | - Xuhua Chu
- Department of Neurology, Jiangsu Provincial People's Hospital, China.
| | - Jinlin Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China.
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Samra K, Boon IS, Packer G, Jacob S. Lethal high: acute disseminated encephalomyelitis (ADEM) triggered by toxic effect of synthetic cannabinoid black mamba. BMJ Case Rep 2017; 2017:bcr-2016-218431. [PMID: 28433979 DOI: 10.1136/bcr-2016-218431] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A previously well 25-year-old man presented with agitation, double incontinence and left-sided incoordination. His symptoms started after smoking a synthetic cannabinoid (black mamba) 5 days earlier. Over 48 hours, he developed aphasia, generalised hypertonia, hyper-reflexia and dense left hemiparesis. This progressed to profuse diaphoresis, fever, tachycardia, hypertension and a possible seizure necessitating admission to the intensive care unit. CT head and cerebrospinal fluid analysis were unremarkable. MRI brain demonstrated asymmetric multifocal hyperintense lesions in white and grey matter, which raised suspicions of acute disseminated encephalomyelitis (ADEM). An electroencephalogram showed widespread brain wave slowing, indicating diffuse cerebral dysfunction. Cerebral angiogram was normal. Toxicology analysis of the substance confirmed a potent synthetic cannabinoid NM2201, technically legal at the time. The patient made a slow but significant recovery after a course of intravenous methylprednisolone, intravenous immunoglobulins and oral steroids, and was later transferred to a rehabilitation bed.
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Affiliation(s)
- Kiran Samra
- Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ian S Boon
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gregory Packer
- Clinical Decision Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Saiju Jacob
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Kim YM, Orvedahl A, Morris S, Schmidt R, Mar S. A 12-Year-Old Girl With Encephalopathy and Acute Flaccid Paralysis: A Neuropathological Correlation and Cohort Review. Pediatr Neurol 2017; 66:5-11. [PMID: 27769728 DOI: 10.1016/j.pediatrneurol.2016.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/01/2016] [Accepted: 08/07/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Young-Min Kim
- Division of Pediatric Neurology, Department of Pediatrics, Loma Linda University School of Medicine, Loma Linda, California.
| | - Anthony Orvedahl
- Division of Infectious Diseases, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Stephanie Morris
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Robert Schmidt
- Division of Neuropathology, Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Soe Mar
- Division of Pediatric and Developmental Neurology, Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Vitaliti G, Tabatabaie O, Matin N, Ledda C, Pavone P, Lubrano R, Serra A, Di Mauro P, Cocuzza S, Falsaperla R. The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data. Hum Vaccin Immunother 2016; 11:2749-63. [PMID: 26266339 DOI: 10.1080/21645515.2015.1061161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Immunotherapeutic strategies to treat neurodegenerative disorders have inspired the scientific community. The aim of our review is to address the translational aspects of neuroimmunology to describe the efficacy of immunotherapy in the treatment of pediatric neurodegenerative disorders. In the studies we analyzed IVIG were found to be efficient in the treatment of post-streptococcal neurodegenerative disorders, even if in PANDAS, plasma-exchange (PE) showed a higher efficiency. IVIG were also successfully used in ADEM and Guillan-Barré syndrome. In Sydenham Chorea the use of methylprednisolone was found in most cases as efficient as IVIG, while in Tourette's Syndrome, Colecoxib was successfully used in one patient. Pediatric Multiple Sclerosis seems to respond better to immunosuppressant agents (Mitoxantrone, Cyclophosphamide, Natalizumab), as well as Neuromyelitis optica (Rituximab, Mycofenolate). The importance of this review relies in the attempt to draw standardized guidelines for immunotherapy in pediatric neurodegeneratve disorders.
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Affiliation(s)
- Giovanna Vitaliti
- a Acute and Emergency Paediatric and General Paediatric Operative Unit; Policlinico-Vittorio Emanuele Hospital; University of Catania ; Catania , Italy
| | | | - Nassim Matin
- b School of Medicine; Tehran University of Medical Sciences ; Tehran , Iran
| | - Caterina Ledda
- c Hygiene and Public Health; Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia"; University of Catania ; Catania , Italy
| | - Piero Pavone
- a Acute and Emergency Paediatric and General Paediatric Operative Unit; Policlinico-Vittorio Emanuele Hospital; University of Catania ; Catania , Italy
| | - Riccardo Lubrano
- d Pediatric Department ; Pediatric Nephrology Operative Unit of the Sapienza University of Rome ; Rome , Italy
| | - Agostino Serra
- e ENT Department G.F. Ingrassia ; Policlinico-Vittorio Emanuele University Hospital; University of Catania ; Catania , Italy
| | - Paola Di Mauro
- e ENT Department G.F. Ingrassia ; Policlinico-Vittorio Emanuele University Hospital; University of Catania ; Catania , Italy
| | - Salvatore Cocuzza
- e ENT Department G.F. Ingrassia ; Policlinico-Vittorio Emanuele University Hospital; University of Catania ; Catania , Italy
| | - Raffaele Falsaperla
- a Acute and Emergency Paediatric and General Paediatric Operative Unit; Policlinico-Vittorio Emanuele Hospital; University of Catania ; Catania , Italy
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Cardiogenic shock from atypical Takotsubo cardiomyopathy attributed to acute disseminated encephalomyelitis lesion involving the medulla. Clin Auton Res 2016; 26:149-51. [DOI: 10.1007/s10286-016-0346-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
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Popovic M, Stanojevic Z, Tosic J, Isakovic A, Paunovic V, Petricevic S, Martinovic T, Ciric D, Kravic-Stevovic T, Soskic V, Kostic-Rajacic S, Shakib K, Bumbasirevic V, Trajkovic V. Neuroprotective arylpiperazine dopaminergic/serotonergic ligands suppress experimental autoimmune encephalomyelitis in rats. J Neurochem 2015; 135:125-38. [PMID: 26083644 DOI: 10.1111/jnc.13198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 05/26/2015] [Accepted: 06/01/2015] [Indexed: 12/17/2022]
Abstract
Arylpiperazine-based dopaminergic/serotonergic ligands exert neuroprotective activity. We examined the effect of arylpiperazine D2 /5-HT1A ligands, N-{4-[2-(4-phenyl-piperazin-1-yl)-ethyl}-phenyl]-picolinamide (6a) and N-{3-[2-(4-phenyl-piperazin-1-yl)-ethyl]-phenyl}-picolinamide (6b), in experimental autoimmune encephalomyelitis (EAE), a model of neuroinflammation. Both compounds (10 mg/kg i.p.) reduced EAE clinical signs in spinal cord homogenate-immunized Dark Agouti rats. Compound 6b was more efficient in delaying the disease onset and reducing the maximal clinical score, which correlated with its higher affinity for D2 and 5-HT1A receptors. The protection was retained if treatment was limited to the effector (from day 8 onwards), but not the induction phase (day 0-7) of EAE. Compound 6b reduced CNS immune infiltration and expression of mRNA encoding the proinflammatory cytokines tumor necrosis factor, IL-6, IL-1, and GM-CSF, TH 1 cytokine IFN-γ, TH 17 cytokine IL-17, as well as the signature transcription factors of TH 1 (T-bet) and TH 17 (RORγt) cells. Arylpiperazine treatment reduced apoptosis and increased the activation of anti-apoptotic mediators Akt and p70S6 kinase in the CNS of EAE animals. The in vitro treatment with 6b protected oligodendrocyte cell line OLN-93 and neuronal cell line PC12 from mitogen-activated normal T cells or myelin basic protein-activated encephalitogenic T cells. In conclusion, arylpiperazine dopaminergic/serotonergic ligands suppress EAE through a direct neuroprotective action and decrease in CNS inflammation. Arylpiperazine dopaminergic/serotonergic ligands reduce neurological symptoms of acute autoimmune encephalomyelitis in rats without affecting the activation of autoreactive immune response, through mechanisms involving a decrease in CNS immune infiltration, as well as direct protection of CNS from immune-mediated damage. These data indicate potential usefulness of arylpiperazine-based compounds in the treatment of neuroinflammatory disorders such as multiple sclerosis.
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Affiliation(s)
- Marjan Popovic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zeljka Stanojevic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Tosic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Isakovic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Verica Paunovic
- Institute of Medical and Clinical Biochemistry, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Tamara Martinovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Darko Ciric
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tamara Kravic-Stevovic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Kaveh Shakib
- Division of Surgery & Interventional Science, University College London (UCL), London, UK
| | - Vladimir Bumbasirevic
- Institute of Histology and Embryology, School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladimir Trajkovic
- Institute of Microbiology and Immunology, School of Medicine, University of Belgrade, Belgrade, Serbia
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Chen Y, Ma F, Xu Y, Chu X, Zhang J. Incidence of acute disseminated encephalomyelitis in the Jiangsu province of China, 2008-2011. Mult Scler J Exp Transl Clin 2015; 1:2055217315594831. [PMID: 28607697 PMCID: PMC5433407 DOI: 10.1177/2055217315594831] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 06/15/2015] [Indexed: 11/17/2022] Open
Abstract
Background It is important to have an estimate of the incidence of acute disseminated encephalomyelitis (ADEM) because the incidence of ADEM is unknown and the outcomes undefined in China. Objectives This study attempts to describe ADEM incidence in large Chinese populations located in four geographically different and moderately distant areas of the same province. Methods A retrospective investigation was conducted with ADEM patients in Nanjing, Nantong, Yancheng and Xuzhou. The survey was carried out in regions that might have received patients meeting the case definition of ADEM provided by the International Pediatric MS Study Group from 2008 to 2011. A total of 125 hospitals were included and 412 patients were identified through the hospital information systems (HIS). Results The incidence of ADEM was 0.32/100,000/year. There are two peaks on the age-specific ADEM rates curve. One is 0.77/100,000/year among 0- to 9-year-olds, the other is 0.45/100,000/year in those aged 50–59 years. The incidence rate found for ADEM in males was 0.34/100,000/year, and in females was 0.29/100,000/year. The highest incidence rate was in Nanjing (0.40/100,000/year). Conclusions The average annual incidence of ADEM was 0.32/100,000/year. The peak age of onset was 50–59 years old and 0–9 years old. The incidence among males was insignificantly higher than that among females. There was no significant difference in incidence by seasonal variation.
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Affiliation(s)
- Yong Chen
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Fubao Ma
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
| | - Yuanling Xu
- Department of Neurology, Nanjing Brain Hospital, China
| | - Xuhua Chu
- Department of Neurology, Jiangsu Provincial People's Hospital, China
| | - Jinlin Zhang
- Department of Expanded Program on Immunization, Jiangsu Provincial Center for Disease Control and Prevention, China
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Ludlow M, McQuaid S, Milner D, de Swart RL, Duprex WP. Pathological consequences of systemic measles virus infection. J Pathol 2014; 235:253-65. [DOI: 10.1002/path.4457] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 09/30/2014] [Accepted: 10/03/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Martin Ludlow
- Department of Microbiology; Boston University School of Medicine; MA USA
| | - Stephen McQuaid
- Tissue Pathology Laboratories; Belfast Health and Social Care Trust; Northern Ireland
| | - Dan Milner
- Department of Immunology and Infectious Diseases; Harvard School of Public Health; Boston MA USA
- Department of Pathology; Brigham and Women's Hospital; Boston MA USA
| | - Rik L de Swart
- Department of Viroscience; Erasmus MC; Rotterdam The Netherlands
| | - W Paul Duprex
- Department of Microbiology; Boston University School of Medicine; MA USA
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