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Giesche N, Böhm‐Gonzalez ST, Kleiser B, Kowarik MC, Dubois E, Stransky E, Armbruster M, Grimm A, Marquetand J. Antiganglioside antibody frequency in routine clinical care settings. Eur J Neurol 2024; 31:e16290. [PMID: 38556758 PMCID: PMC11236029 DOI: 10.1111/ene.16290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE Antiganglioside antibodies (AGAs) might be involved in the etiopathogenesis of many neurological diseases, such as Miller-Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS). Available comprehensive reference data regarding AGA positivity rates and cross-responsiveness among AGAs (where one line immunoblot is positive for ≥1 AGA) during routine clinical care are scant. METHODS In this 10-year monocentric retrospective study, 3560 immunoglobulin (Ig) G and IgM line blots (GA Generic Assays' Anti-Ganglioside Dot kit) obtained using cerebrospinal fluid (CSF) and serum samples from 1342 patients were analyzed for AGA positivity in terms of 14 diagnosis categories and AGA cross-responsiveness. RESULTS Of all 3560 line blots 158 (4.4%) and of all CSF samples 0.4% (4/924) CSF line blots were AGA positive. For serum IgG, blots with positivity rates higher than the standard deviation of 15.6% were associated with MFS (GD3, GD1a, GT1a and GQ1b) and acute motor axonal neuropathy (AMAN) (GM1, GD1a and GT1a). For serum IgM, blots with positivity rates higher than the standard deviation of 8.1% were associated with AMAN (GM2, GT1a and GQ1b), MFS (GM1, GT1a and GQ1b), multifocal motor neuropathy (MMN) (GM1, GM2 and GQ1b) and chronic inflammatory demyelinating polyneuropathy (CIDP) (GM1). Cross-responsiveness was observed in 39.6% of all positive serum AGA. CONCLUSIONS Testing for AGAs during routine clinical care rarely led to positive findings, both in serum and even less in CSF, except for the diagnoses AMAN, MFS, MMN and CIDP. Nonspecific findings found as cross-responsiveness between different AGA samples occur frequently, impacting the positivity of most AGA subtypes.
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Affiliation(s)
- Niklas Giesche
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Samuel Tobias Böhm‐Gonzalez
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Benedict Kleiser
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Markus C. Kowarik
- Department of Neurology and Stroke, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Evelyn Dubois
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Elke Stransky
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Marcel Armbruster
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Alexander Grimm
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
| | - Justus Marquetand
- Department of Epileptology, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- Department of Neural Dynamics and Magnetoencephalography, Hertie‐Institute for Clinical Brain ResearchUniversity of TübingenTübingenGermany
- MEG‐CenterUniversity of TübingenTübingenGermany
- Institute for Modelling and Simulation of Biomechanical SystemsStuttgartGermany
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2
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Budding K, Bos JW, Dijkxhoorn K, de Zeeuw E, Bloemenkamp LM, Zekveld EM, Groen EJN, Jacobs BC, Huizinga R, Goedee HS, Cats EA, Leusen JHW, van den Berg LH, Hack CE, van der Pol WL. IgM anti-GM2 antibodies in patients with multifocal motor neuropathy target Schwann cells and are associated with early onset. J Neuroinflammation 2024; 21:100. [PMID: 38632654 PMCID: PMC11025174 DOI: 10.1186/s12974-024-03090-y] [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: 02/02/2024] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Multifocal motor neuropathy (MMN) is a rare, chronic immune-mediated polyneuropathy characterized by asymmetric distal limb weakness. An important feature of MMN is the presence of IgM antibodies against gangliosides, in particular GM1 and less often GM2. Antibodies against GM1 bind to motor neurons (MNs) and cause damage through complement activation. The involvement of Schwann cells (SCs), expressing GM1 and GM2, in the pathogenesis of MMN is unknown. METHODS Combining the data of our 2007 and 2015 combined cross-sectional and follow-up studies in Dutch patients with MMN, we evaluated the presence of IgM antibodies against GM1 and GM2 in serum from 124 patients with MMN and investigated their binding to SCs and complement-activating properties. We also assessed the relation of IgM binding and complement deposition with clinical characteristics. RESULTS Thirteen out of 124 patients (10%) had a positive ELISA titer for IgM anti-GM2. Age at onset of symptoms was significantly lower in MMN patients with anti-GM2 IgM. IgM binding to SCs correlated with IgM anti-GM2 titers. We found no correlation between IgM anti-GM2 titers and MN binding or with IgM anti-GM1 titers. IgM binding to SCs decreased upon pre-incubation of serum with soluble GM2, but not with soluble GM1. IgM anti-GM2 binding to SCs correlated with complement activation, as reflected by increased C3 fixation on SCs and C5a formation in the supernatant. CONCLUSION Circulating IgM anti-GM2 antibodies define a subgroup of patients with MMN that has an earlier onset of disease. These antibodies probably target SCs specifically and activate complement, similarly as IgM anti-GM1 on MNs. Our data indicate that complement activation by IgM antibodies bound to SCs and MNs underlies MMN pathology.
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Affiliation(s)
- Kevin Budding
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen W Bos
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Kim Dijkxhoorn
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Elisabeth de Zeeuw
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lauri M Bloemenkamp
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Eva M Zekveld
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ewout J N Groen
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - H Stephan Goedee
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - Elisabeth A Cats
- Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Jeanette H W Leusen
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leonard H van den Berg
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands
| | - C Erik Hack
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - W Ludo van der Pol
- Department of Neurology and Neurosurgery, University Medical Center Utrecht Brain Center, Utrecht, The Netherlands.
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3
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Chen L, Zhang Y, Qin N, Han R, Li Y. Atypical chronic inflammatory demyelinating polyradiculoneuropathy with ophthalmoplegia and anti-sulfatide IgM positivity. J Int Med Res 2023; 51:3000605231193575. [PMID: 37812511 PMCID: PMC10563483 DOI: 10.1177/03000605231193575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a heterogeneous group of chronic immune-mediated polyradiculoneuropathies. The clinical presentation of CIDP is mainly characterized by a classic peripheral demyelinating sensory-motor type and persists for a minimum of 2 months. However, CIDP may also present with atypical symptoms.Case presentation: This report presents the case of a patient with CIDP with ophthalmoplegia and anti-sulfatide IgM antibodies. Maintenance intravenous immunoglobulin and glucocorticoid therapies were administered to the patient in accordance with the clinical, laboratory, and electrophysiological findings, which were indicative of CIDP. The treatment partially improved the symptoms, and no recurrence was detected throughout the 3-month monitoring phase. CONCLUSIONS This study combines a retrospective analysis and a literature review to explore the possible mechanism of CIDP.
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Affiliation(s)
- Li Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yanjun Zhang
- Department of Neurology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Nan Qin
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ranran Han
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuwang Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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4
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Doneddu PE, Ruiz M, Bianchi E, Liberatore G, Manganelli F, Cocito D, Cosentino G, Benedetti L, Marfia GA, Filosto M, Briani C, Giannotta C, Nobile-Orazio E. A diagnostic score for anti-myelin-associated-glycoprotein neuropathy or chronic inflammatory demyelinating polyradiculoneuropathy in patients with anti-myelin-associated-glycoprotein antibody. Eur J Neurol 2023; 30:501-510. [PMID: 35191144 PMCID: PMC10078711 DOI: 10.1111/ene.15296] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE A diagnostic score was developed to discriminate anti-myelin-associated-glycoprotein (MAG) neuropathy from chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and applied it to patients with atypical anti-MAG neuropathy. METHODS The clinical and electrophysiological features of patients with a diagnosis of typical anti-MAG neuropathy were compared to those of patients with a diagnosis of CIDP. The association of each feature with the diagnosis was assessed in the two groups. Features showing a significant association with the diagnosis were included in a multivariable logistic regression model and adjusted odds ratios were estimated for each feature. A score ranging from 1 to 3 was applied to each feature based on the magnitude of the estimated odds ratios. The score was then applied to patients with a clinical diagnosis of CIDP who also had high anti-MAG antibody titers (CIDP-MAG). RESULTS Thirty-one anti-MAG neuropathy patients, 45 typical CIDP patients and 16 CIDP-MAG patients were included. Scores in anti-MAG antibody patients ranged from 1 to 5 and in CIDP patients from -7 to -1. Using the score, 4/16 CIDP-MAG patients were diagnosed to have anti-MAG neuropathy and 12/16 patients to have CIDP. Response to intravenous immunoglobulin in the CIDP-MAG patients classified as CIDP was similar to that of definite CIDP patients and higher than that of anti-MAG neuropathy patients. CONCLUSIONS Our score allowed an accurate discrimination to be made, amongst patients with anti-MAG antibodies, of those affected by CIDP and the patients with anti-MAG neuropathy. This score may help proper treatment to be chosen for patients with anti-MAG antibodies with a CIDP-like presentation.
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Affiliation(s)
- Pietro E Doneddu
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Marta Ruiz
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, IRCCS-Istituto Mario Negri, Milan, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - Dario Cocito
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - Giuseppe Cosentino
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy
| | - Luana Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - Girola A Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, NeMO-Brescia Clinical Center for Neuromuscular Diseases, University of Brescia, Brescia, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Claudia Giannotta
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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5
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Amaador K, Wieske L, Koel-Simmelink MJA, Kamp A, Jongerius I, de Heer K, Teunissen CE, Minnema MC, Notermans NC, Eftimov F, Kersten MJ, Vos JMI. Serum neurofilament light chain, contactin-1 and complement activation in anti-MAG IgM paraprotein-related peripheral neuropathy. J Neurol 2022; 269:3700-3705. [PMID: 35157138 PMCID: PMC9217848 DOI: 10.1007/s00415-022-10993-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In anti-myelin-associated glycoprotein IgM paraprotein-related peripheral neuropathy (anti-MAG PN), there is a lack of reliable biomarkers to select patients eligible for therapy and for evaluating treatment effects, both in routine practice and in clinical trials. Neurofilament light chain (NfL) and contactin-1 (CNTN1) can serve as markers of axonal and paranodal damage. Complement activation is involved in the pathogenesis in anti-MAG PN. We, therefore, hypothesized that serum NfL, CNTN1, C3b/c and C4b/c may function as biomarkers of disease activity in anti-MAG PN. METHODS In this prospective cohort study, we included 24 treatment-naïve patients with anti-MAG PN (mean age 69 years, 57% male) that had IgM paraproteinemia, a high IgM MAG-antibody, and clinical diagnosis of anti-MAG PN by a neurologist specialized in peripheral nerve disorders. We measured serum NfL, CNTN1, C3b/c and C4b/c, reference values were based on healthy controls. As controls, 10 treatment-naïve patients with IgM Monoclonal gammopathy of undetermined significance (MGUS) or Waldenström's Macroglobulinemia (mean age 69 years, 60% male) without signs of neuropathy were included (non-PN). RESULTS NfL, CNTN1 levels in serum were mostly normal in anti-MAG PN patients and comparable to non-PN patients. C3b/c and C4b/c levels were normal in anti-MAG PN patients. CONCLUSION Our results do not support serum NfL, CNTN1, and C3b/c and C4b/c as potential biomarkers in anti-MAG PN, although we cannot exclude that subgroups or subtle abnormalities could be found in a much larger cohort with longitudinal follow-up.
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Affiliation(s)
- Karima Amaador
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands
| | - Luuk Wieske
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Marleen J A Koel-Simmelink
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - A Kamp
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1066CX, The Netherlands
| | - Ilse Jongerius
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, 1066CX, The Netherlands
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koen de Heer
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands
- Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Charlotte E Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam UMC, Location VU Medical Center, Amsterdam, The Netherlands
| | - Monique C Minnema
- Department of Hematology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Filip Eftimov
- Department of Neurology and Neurophysiology, Amsterdam Neuroscience, Amsterdam UMC, Location AMC, Amsterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands
| | - Josephine M I Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam, LYMMCARE, Amsterdam, The Netherlands.
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Liberatore G, De Lorenzo A, Giannotta C, Manganelli F, Filosto M, Cosentino G, Cocito D, Briani C, Cortese A, Fazio R, Lauria G, Clerici AM, Rosso T, Marfia GA, Antonini G, Cavaletti G, Carpo M, Doneddu PE, Spina E, Cotti Piccinelli S, Peci E, Querol L, Nobile-Orazio E. Frequency and clinical correlates of anti-nerve antibodies in a large population of CIDP patients included in the Italian database. Neurol Sci 2022; 43:3939-3947. [PMID: 35048233 DOI: 10.1007/s10072-021-05811-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the frequency and clinical correlates of anti-nerve autoantibodies in an unselected series of Italian patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) METHODS: Sera from 276 CIDP patients fulfilling the EFNS/PNS criteria and included in the Italian CIDP database were examined for the presence of anti-nerve autoantibodies. Results were correlated with the clinical data collected in the database. RESULTS Anti-neurofascin155 (NF155) antibodies were found in 9/258 (3.5%) patients, anti-contactin1 (CNTN1) antibodies in 4/258 (1.6%) patients, and anti-contactin-associated protein1 (Caspr1) in 1/197 (0.5%) patients, while none had reactivity to gliomedin or neurofascin 186. Predominance of IgG4 isotype was present in 7of the 9 examined patients. Anti-NF155 patients more frequently had ataxia, tremor, and higher CSF protein levels than antibody-negative patients. Anti-CNTN1 patients more frequently had a GBS-like onset, pain, and ataxia and had more severe motor impairment at enrollment than antibody-negative patients. They more frequently received plasmapheresis, possibly reflecting a less satisfactory response to IVIg or steroids. IgM antibodies against one or more gangliosides were found in 6.5% of the patients (17/260) and were more frequently directed against GM1 (3.9%). They were frequently associated with a progressive course, with a multifocal sensorimotor phenotype and less frequent cranial nerve involvement and ataxia. CONCLUSIONS Anti-paranodal and anti-ganglioside antibodies are infrequent in patients with CIDP but are associated with some typical clinical association supporting the hypothesis that CIDP might be a pathogenically heterogeneous syndrome possibly explaining the different clinical presentations.
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Affiliation(s)
- Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Manzoni 56, 20089, Rozzano, Italy.
| | - Alberto De Lorenzo
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Manzoni 56, 20089, Rozzano, Italy
| | - Claudia Giannotta
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Manzoni 56, 20089, Rozzano, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Massimiliano Filosto
- Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology, ASST "Spedali Civili", University of Brescia, Brescia, Italy
| | - Giuseppe Cosentino
- Department of Experimental BioMedicine and Clinical Neurosciences (BioNeC), University of Palermo, Palermo, Italy
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy
| | - Dario Cocito
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padua, Padua, Italy
| | - Andrea Cortese
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy
- Molecular Neurosciences, University College London, London, UK
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Lauria
- Unit of Neuroalgology, IRCCS Foundation "Carlo Besta" Neurological Institute, Milan, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco", University of Milan, Milan, Italy
| | - Angelo Maurizio Clerici
- Neurology Unit, Circolo & Macchi Foundation Hospital, Insubria University, DBSV, Varese, Italy
| | - Tiziana Rosso
- ULSS2 Marca Trevigiana, UOC Neurologia-Castelfranco Veneto, Treviso, Italy
| | - Girolama Alessandra Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Giovanni Antonini
- Unit of Neuromuscular Diseases, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, "Sapienza" University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Guido Cavaletti
- School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
| | | | - Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Manzoni 56, 20089, Rozzano, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Stefano Cotti Piccinelli
- Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology, ASST "Spedali Civili", University of Brescia, Brescia, Italy
| | - Erdita Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - Luis Querol
- Neuromuscular Diseases Unit, Autoimmune Neurology, Neuromuscular Laboratory, Neurology Department, Hospital de la Santa Creu i Sant Pau, Institut de Recerca Biomèdica Sant Pau, Barcelona, Spain
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Manzoni 56, 20089, Rozzano, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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Kwan J, Vullaganti M. Amyotrophic lateral sclerosis mimics. Muscle Nerve 2022; 66:240-252. [PMID: 35607838 DOI: 10.1002/mus.27567] [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: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/10/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common adult-onset motor neuron disorder characterized by progressive degeneration of cortical, bulbar, and spinal motor neurons. When a patient presents with a progressive upper and/or lower motor syndrome, clinicians must pay particular attention to any atypical features in the history and/or clinical examination suggesting an alternate diagnosis, as up to 10% percent of patients initially diagnosed with ALS have a mimic of ALS. ALS is a clinical diagnosis and requires the exclusion of other disorders that may have similar presentations but a more favorable prognosis or an effective therapy. Because there is currently no specific diagnostic biomarker that is sensitive or specific for ALS, understanding the spectrum of clinical presentations of ALS and its mimics is paramount. While true mimics of ALS are rare, the clinician must correctly identify these disorders to avoid the misdiagnosis of ALS and to initiate effective treatment where available.
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Affiliation(s)
- Justin Kwan
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Mithila Vullaganti
- Department of Neurology, Tufts Medical Center, Tuft University School of Medicine, Boston, Massachusetts, USA
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8
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Liberatore G, Giannotta C, Sajeev BP, Morenghi E, Terenghi F, Gallia F, Doneddu PE, Manganelli F, Cocito D, Filosto M, Antonini G, Cosentino G, Marfia GA, Clerici AM, Lauria G, Rosso T, Cavaletti G, Nobile-Orazio E. Sensitivity and specificity of a commercial ELISA test for anti-MAG antibodies in patients with neuropathy. J Neuroimmunol 2020; 345:577288. [DOI: 10.1016/j.jneuroim.2020.577288] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/10/2020] [Accepted: 06/05/2020] [Indexed: 12/15/2022]
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9
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Gastaldi M, Zardini E, Scaranzin S, Uccelli A, Andreetta F, Baggi F, Franciotta D. Autoantibody Diagnostics in Neuroimmunology: Experience From the 2018 Italian Neuroimmunology Association External Quality Assessment Program. Front Neurol 2020; 10:1385. [PMID: 32010046 PMCID: PMC6971200 DOI: 10.3389/fneur.2019.01385] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/16/2019] [Indexed: 12/31/2022] Open
Abstract
Background: Neuroimmunology has impressively expanded in the past decade. Novel assays, especially cell-based assays (CBAs) can detect conformational antibodies (Abs) recognizing antigens in their native conformation. Generally, the availability of in-house and of commercial tests has improved the diagnostics, but introduced demanding laboratory tasks. Hence, standardization and quality controls represent a key step to promote accuracy. We report on the results of the 2018 external quality assessment program (EQAP) organized by the Italian Neuroimmunology Association. Methods: EQAP regarded 10 schemes, including oligoclonal bands (OCBs), intracellular-neuronal (ICN)-Abs, neuronal-surface (NS)-Abs, aquaporin-4 (AQP4)-Abs, myelin oligodendrocyte glycoprotein (MOG)-Abs, myelin-associated glycoprotein (MAG)-Abs, ganglioside-Abs, acetylcholine-receptor (AChR)-Abs, and muscle-specific-kinase (MuSK)-Abs, and 34 laboratories. Assays were classified as tissue-based assays (TBAs), solid-phase assays (SPAs), liquid-phase assays (LPAs), and CBAs. Thirty-three samples were provided. Results: Three-quarter of the tests were commercial. Median accuracy for the laboratories was 75% (range 50–100). In 8/10 schemes, at least one sample provided discrepant results. Inter-laboratory “substantial agreement” was found in 6/10 schemes (AChR, MuSK, MAG, AQP4, MOG, and NS-Abs), whereas the worst agreements regarded OCBs and ganglioside-Abs. Both commercial and in-house assays performed better in experienced laboratories. Conclusions: Assays could be divided in (a) robust commercial tests with substantial inter-laboratory agreement (MAG-Abs; AChR- and MuSK-Abs); commercial/“in-house” tests with (b) partial inter-laboratory agreement (AQP4-Abs, MOG-Abs, NS-Abs, ICN-Abs), and (c) with large inter-laboratory disagreement (OCBs, ganglioside-Abs). This real-life snapshot of the neuroimmunology test performances highlights shortcomings attributable to technician-dependent performances, assay structural limitations, and errors in test interpretations.
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Affiliation(s)
- Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Elisabetta Zardini
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Science, University of Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Antonio Uccelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesca Andreetta
- UO Neurology IV, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Fulvio Baggi
- UO Neurology IV, IRCCS Fondazione Istituto Neurologico Carlo Besta, Milan, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Maeda H, Ishii R, Kusunoki S, Chiyonobu T. Childhood-onset multifocal motor neuropathy with IgM antibodies to GM2 and GalNac-GD1a. Brain Dev 2020; 42:88-92. [PMID: 31522790 DOI: 10.1016/j.braindev.2019.08.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/26/2019] [Accepted: 08/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Multifocal motor neuropathy (MMN) is an acquired immune-mediated form of neuropathy characterized by upper and asymmetric limb weakness without sensory loss. The mean age of onset is 40 years (range, 20-70 years), and childhood-onset MMN is extremely rare. In the present report, we discuss a case of childhood-onset MMN in a patient who tested positive for anti-GM2 and anti-GalNac-GD1a immunoglobulin M (IgM) antibodies. CASE REPORT A 12-year-old girl presented with progressive weakness of the upper extremities without sensory loss. Electrophysiological assessments revealed definite conduction blocks in the left median and bilateral radial nerves. She was diagnosed with MMN in accordance with the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria. Serological studies revealed that she tested positive for IgM antibodies to GM2 and GalNac-GD1a. Partial improvements in both muscle weakness and electrophysiological assessments were achieved after 8 months of high-dose intravenous immunoglobulin (IVIg) treatment. CONCLUSION Although childhood-onset MMN is rare, most patients respond to IVIg treatment. This is the first case of childhood-onset MMN in a patient who tested positive for anti-GM2 and anti-GalNac-GD1a IgM antibodies. Although half of the adult patients with MMN test positive for anti-GM1 IgM antibodies, they were not detected in our patient. Comprehensive testing for serum anti-glycolipid antibodies in addition to GM1 may aid in the diagnosis of childhood-onset MMN.
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Affiliation(s)
- Hiroshi Maeda
- Department of Pediatrics, North Medical Center, Kyoto Prefectural University of Medicine, Japan
| | - Ryotaro Ishii
- Department of Emergency, North Medical Center, Kyoto Prefectural University of Medicine, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kinki University School of Medicine, Japan
| | - Tomohiro Chiyonobu
- Department of Pediatrics, Kyoto Prefectural University of Medicine, Japan.
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Gao XM, Jia MN, Qian M, Ren HT, Zhang L, Shen KN, Cao XX, Li J. [Anti-myelin-associated glycoprotein antibody positive IgM monoclonal gammopathy related peripheral neuropathy: 11 cases and literature review]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:901-905. [PMID: 31856437 PMCID: PMC7342372 DOI: 10.3760/cma.j.issn.0253-2727.2019.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 11/08/2022]
Abstract
Objective: To improve the understanding of rare anti-myelin-associated glycoprotein (MAG) positive IgM monoclonal gammopathy related peripheral neuropathy (IgM-PN) . Methods: Eleven cases of IgM paraproteinemia and anti-MAG antibody positive neuropathy diagnosed since 2014 in Peking Medical Union College Hospital were summarized. The medical records including clinical manifestation, lab results, treatment and prognosis were analyzed. Results: Among the 11 patients (8 male and 3 female) , the median onset age is 63 years old (range from 52 to 77 years old) . The peripheral neuropathy of 9 patients were characterized by distal onset of numbness, 6 patients suffered from muscle weakness. The nerve conduction velocity study indicated that all 11 patients had demyelinating peripheral nerve damage, which was sensory predominant and more severe in lower limbs, 6 of them had secondary axonal damage. Monoclonal IgM gammopathy was identified in all 11 patients, among which 6 were IgM κ, 2 IgG κ and IgM κ bi-clonal, 3 IgM λ. Three patients were diagnosed with Waldenström's macroglobulinaemia. The anti-MAG-IgM antibody was positive in all 11 cases. After diagnosis, 9 patients received combination chemotherapy including rituximab or rituximab treatment alone. The monoclonal IgM level declined significantly in 7 patients. The neuropathy was stable or improved. Conclusions: Anti-MAG antibody positive IgM-PN is a rare M protein related disease. In peripheral neuropathy with undetermined etiology, we suggest to screen M protein and anti-MAG antibody. Chemotherapy including rituximab or rituximab alone is recommended as first-line therapy.
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Affiliation(s)
- X M Gao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - M N Jia
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - M Qian
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - H T Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - L Zhang
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - K N Shen
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - X X Cao
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
| | - J Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences, Beijing 100730, China
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12
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Franciotta D, Gastaldi M, Biagioli T, Benedetti L, Giannotta C, Bedin R, Zardini E, Nobile-Orazio E. Anti-ganglioside antibodies: experience from the Italian Association of Neuroimmunology external quality assessment scheme. Clin Chem Lab Med 2019; 56:1921-1925. [PMID: 30204587 DOI: 10.1515/cclm-2018-0234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 04/05/2018] [Indexed: 11/15/2022]
Abstract
Background Anti-ganglioside antibodies are currently used in the differential diagnosis of suspected immune-mediated neuropathies. In-house and increasingly used commercial assays seem to perform suboptimally, and comparative information on their analytical performance are essentially lacking. Born within the frame of guidelines and standardization activities by the Italian Association of Neuroimmunology, this external quality assessment scheme (EQAS) is a real-life snapshot of the laboratory diagnostics in this field. Methods The EQAS consisted of five surplus, anonymized serum samples from patients with clinically-defined neuropathies and two serum samples from healthy blood donors. Eight laboratories used commercial line-/dot-blots, seven in-house/commercial ELISAs (in addition, 13 laboratories tested a recently released ELISA by Bühlmann). Only high anti-ganglioside antibody reactivities were considered, in accordance with consolidated recommendations. Results Large variations in anti-ganglioside antibody profiles were observed, even, although to a lesser extent, within homogeneous classes of assays. Concordance between the profiles and clinical phenotypes was also partial. Conclusions Although conducted on a relatively small, but representative number of Italian laboratories, this EQAS shows a critical between-laboratory disagreement in the test results of anti-ganglioside antibodies. Also considering the trend for using certified assays in generalist laboratories, strong efforts toward standardization and the identification of the best method(s) for their determinations are compellingly needed.
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Affiliation(s)
- Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, Via Mondino 2, I-27100 Pavia, Italy, Phone: 0039-0382-380365, Fax: 0039-0382-380286
| | - Matteo Gastaldi
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | | | - Luana Benedetti
- IRCCS Ospedale Policlinico San Martino, University of Genova, Genoa, Italy
| | - Claudia Giannotta
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Humanitas Clinical and Research Institute, Milan University, Rozzano, Milan, Italy
| | - Roberta Bedin
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Elisabetta Zardini
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, Department of Medical Biotechnology and Translational Medicine, Humanitas Clinical and Research Institute, Milan University, Rozzano, Milan, Italy
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13
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Elchaninov AP, Zhuravlev PV, Amosova NV, Dekan VS, Mitusova GM, Pavlov DG, Kozlova GA, Grishchenkov AS. [Bickerstaff's encephalitis]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:84-88. [PMID: 30132464 DOI: 10.17116/jnevro20181187184] [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: 11/18/2022]
Abstract
A clinical case of Bickerstaff encephalitis, an autoimmune neuropathy, which affects central and peripheral nerve systems, is presented. This article describes problems of the diagnosis and treatment of the disease. Results of MRI, PET, electrophysiological and immunological studies are presented.
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Affiliation(s)
- A P Elchaninov
- Sokolov Memorial Hospital #122, Saint-Petersburg, Russia
| | - P V Zhuravlev
- Sokolov Memorial Hospital #122, Saint-Petersburg, Russia
| | - N V Amosova
- Sokolov Memorial Hospital #122, Saint-Petersburg, Russia
| | - V S Dekan
- Sokolov Memorial Hospital #122, Saint-Petersburg, Russia; Almazov North-West Federal Medical Research Centre, Saint-Petersburg, Russia
| | | | - D G Pavlov
- City Hospital #40, Saint-Petersburg, Russia
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Abstract
This document presents the guidelines for anti-myelin-associated glycoprotein (MAG) antibody testing that have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of sponsoring Italian Association of Neuroimmunology (AINI) congresses. The main clinical information on anti-MAG antibody polyneuropathy, indications and limits of anti-MAG antibody testing, instructions for result interpretation, and an agreed laboratory protocol (Appendix) are reported for the communicative community of neurologists and clinical pathologists.
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15
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Franciotta D, Gastaldi M, Benedetti L, Pesce G, Biagioli T, Lolli F, Costa G, Melis C, Andreetta F, Simoncini O, Giannotta C, Bazzigaluppi E, Fazio R, Bedin R, Ferraro D, Mariotto S, Ferrari S, Galloni E, De Riva V, Zardini E, Cortese A, Nobile-Orazio E. Diagnostics of dysimmune peripheral neuropathies. Neurol Sci 2018; 38:243-247. [PMID: 29030769 DOI: 10.1007/s10072-017-3025-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This document presents the guidelines for anti-ganglioside antibody testing that have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Main clinical information on dysimmune peripheral neuropathies, indications and limits of anti-ganglioside antibody testing, instructions for result interpretation, and an agreed laboratory protocol (Appendix) are reported for the communicative community of neurologists and clinical pathologists.
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Affiliation(s)
- Diego Franciotta
- Laboratory of Neuroimmunology, C. Mondino National Neurological Institute, Via Mondino 2, I-27100, Pavia, Italy.
| | - Matteo Gastaldi
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Luana Benedetti
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | - Giampaola Pesce
- Ospedale Policlinico San Martino IRCCS, University of Genova, Genoa, Italy
| | | | - Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences, University of Florence, Florence, Italy
| | | | | | | | | | | | | | | | - Roberta Bedin
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Diana Ferraro
- Ospedale Civile Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | | | - Elisabetta Zardini
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Andrea Cortese
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
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16
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The Changing Role of Electrodiagnostic Testing in Cancer Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2018. [DOI: 10.1007/s40141-018-0180-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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17
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Morishima R, Nagaoka U, Nagao M, Isozaki E. Chronic Brachial Plexus Neuritis That Developed into Typical Neuralgic Amyotrophy and Positively Responded to Immunotherapy. Intern Med 2018; 57:1021-1026. [PMID: 29269655 PMCID: PMC5919865 DOI: 10.2169/internalmedicine.9482-17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Based on the hypothesis that autoimmunity plays a role in the pathogenesis of neuralgic amyotrophy (NA), immunotherapy is sometimes administered. Early intervention is recommended for a good prognosis. We herein report the case of a 55-year-old man who presented with neuralgia, weakness, and muscle atrophy in his right shoulder girdle and upper arm, which progressed for ten months following a marine sports accident. The patient was diagnosed with NA. His neurological deficits gradually improved after several courses of immunotherapy, suggesting that in addition to being effective for treating early-stage disease, immunotherapy may be effective for treating chronic cases.
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Affiliation(s)
- Ryo Morishima
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Utako Nagaoka
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Masahiro Nagao
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
| | - Eiji Isozaki
- Department of Neurology, Tokyo Metropolitan Neurological Hospital, Japan
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18
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Nobile-Orazio E, Bianco M, Nozza A. Advances in the Treatment of Paraproteinemic Neuropathy. Curr Treat Options Neurol 2017; 19:43. [DOI: 10.1007/s11940-017-0479-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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19
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D'Hooghe T, Kyriakidi K, Karassa FB, Politis D, Skamnelos A, Christodoulou DK, Katsanos KH. Biomarker Development in Chronic Inflammatory Diseases. BIOMARKERS FOR ENDOMETRIOSIS 2017. [PMCID: PMC7122305 DOI: 10.1007/978-3-319-59856-7_3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic inflammatory diseases, such as inflammatory bowel disease—namely, Crohn’s disease and ulcerative colitis—psoriasis, multiple sclerosis, rheumatoid arthritis, and many others affect millions of people worldwide, causing a high burden of disease, socioeconomic impact, and healthcare cost. These diseases have common features including autoimmune pathogenesis and frequent co morbidity. The treatment of these chronic inflammatory diseases usually requires long-term immunosuppressive therapies with undesirable side effects. The future of chronic inflammatory disease prevention, detection, and treatment will be greatly influenced by the use of more effective biomarkers with enhanced performance. Given the practical issues of collecting tissue samples in inflammatory diseases, biomarkers derived from body fluids have great potential for optimized patient management through the circumvention of the abovementioned limitations. In this chapter, peripheral blood, urine, and cerebrospinal fluid biomarkers used in chronic inflammatory conditions are reviewed. In detail, this chapter reviews biomarkers to fore used or emerging to be used in patients with chronic inflammatory conditions. Those include inflammatory bowel diseases, chronic inflammatory conditions of the liver, biliary tract, pancreas, psoriasis, atopic disease, inflammatory skin diseases, rheumatic diseases, demyelination, and also the chronic inflammatory component of various other diseases in general medicine—including diabetes, cardiovascular disease, renal disease, and chronic obstructive pulmonary disease. Development of personalized medicine is closely linked to biomarkers, which may serve as the basis for diagnosis, drug discovery, and monitoring of diseases.
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Affiliation(s)
- Thomas D'Hooghe
- 0000 0001 0668 7884grid.5596.fDepartment of Development and Regeneration Organ Systems, Group Biomedical Sciences, KU Leuven (University of Leuven), Leuven, Belgium
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20
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Boso F, Ruggero S, Giannotta C, Benedetti L, Marfia GA, Ermani M, Campagnolo M, Salvalaggio A, Gallia F, De Michelis C, Visentin A, Bianco M, Ruiz M, Mataluni G, Nobile-Orazio E, Briani C. Anti-sulfatide/galactocerebroside antibodies in immunoglobulin M paraproteinemic neuropathies. Eur J Neurol 2017; 24:1334-1340. [PMID: 28782863 DOI: 10.1111/ene.13387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- F. Boso
- Department of Neurosciences; University of Padova; Padova Italy
| | - S. Ruggero
- Department of Neurosciences; University of Padova; Padova Italy
| | - C. Giannotta
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - L. Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova and IRCCS AOU San Martino-IST; Genoa Italy
| | - G. A. Marfia
- Neurology COU; Department of Systems Medicine; University of Tor Vergata; Rome Italy
| | - M. Ermani
- Department of Neurosciences; University of Padova; Padova Italy
| | - M. Campagnolo
- Department of Neurosciences; University of Padova; Padova Italy
| | - A. Salvalaggio
- Department of Neurosciences; University of Padova; Padova Italy
| | - F. Gallia
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - C. De Michelis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova and IRCCS AOU San Martino-IST; Genoa Italy
| | - A. Visentin
- Hematology and Clinical Immunology Unit; Department of Medicine; University of Padova; Italy
| | - M. Bianco
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - M. Ruiz
- Department of Neurosciences; University of Padova; Padova Italy
| | - G. Mataluni
- Neurology COU; Department of Systems Medicine; University of Tor Vergata; Rome Italy
| | - E. Nobile-Orazio
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - C. Briani
- Department of Neurosciences; University of Padova; Padova Italy
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Autoantibodies in chronic inflammatory neuropathies: diagnostic and therapeutic implications. Nat Rev Neurol 2017; 13:533-547. [PMID: 28708133 DOI: 10.1038/nrneurol.2017.84] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The chronic inflammatory neuropathies (CINs) are rare, very disabling autoimmune disorders that generally respond well to immune therapies such as intravenous immunoglobulin (IVIg). The most common forms of CIN are chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), multifocal motor neuropathy, and polyneuropathy associated with monoclonal gammopathy of unknown significance. The field of CIN has undergone a major advance with the identification of IgG4 autoantibodies directed against paranodal proteins in patients with CIDP. Although these autoantibodies are only found in a small subset of patients with CIDP, they can be used to guide therapeutic decision-making, as these patients have a poor response to IVIg. These observations provide proof of concept that identifying the target antigens in tissue-specific antibody-mediated autoimmune diseases is important, not only to understand their underlying pathogenic mechanisms, but also to correctly diagnose and treat affected patients. This state-of-the-art Review focuses on the role of autoantibodies against nodes of Ranvier in CIDP, a clinically relevant emerging field of research. The role of autoantibodies in other immune-mediated neuropathies, including other forms of CIN, primary autoimmune neuropathies, neoplasms, and systemic diseases that resemble CIN, are also discussed.
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22
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Nobile-Orazio E, Gallia F, Terenghi F, Bianco M. Comparing treatment options for chronic inflammatory neuropathies and choosing the right treatment plan. Expert Rev Neurother 2017; 17:755-765. [DOI: 10.1080/14737175.2017.1340832] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eduardo Nobile-Orazio
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), University of Milan, Milan, Italy
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
| | - Francesca Gallia
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
| | - Fabrizia Terenghi
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
| | - Mariangela Bianco
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical Institute, Milan, Italy
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23
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Morikawa M, Kuwahara M, Ueno R, Samukawa M, Hamada Y, Kusunoki S. Serological study using glycoarray for detecting antibodies to glycolipids and glycolipid complexes in immune-mediated neuropathies. J Neuroimmunol 2016; 301:35-40. [PMID: 27836184 DOI: 10.1016/j.jneuroim.2016.10.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 09/27/2016] [Accepted: 10/31/2016] [Indexed: 11/29/2022]
Abstract
We performed a serological investigation using glycoarray in Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), and multifocal motor neuropathy (MMN). Antibodies to 10 glycolipids and 45 glycolipid complexes were tested. Anti-GM1/sulfatide and anti-GA1/sulfatide IgG antibodies were common in GBS (20.0% and 19.0%, respectively). Anti-GQ1b/sulfatide IgG antibody was detected in 14.0% of GBS patients. IgG antibodies to antigens containing GQ1b were significantly correlated with ophthalmoplegia in GBS (p<0.01). IgM antibodies to antigens containing GM1 or GalNAc-GD1a were in 50% and 37.5% of MMN patients, respectively. Glycoarray is efficient for detecting antibodies against numerous glycolipid complexes in immune-mediated neuropathies.
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Affiliation(s)
- Miyuki Morikawa
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Motoi Kuwahara
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Rino Ueno
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Makoto Samukawa
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Yukihiro Hamada
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan.
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Ishigaki H, Hiraide T, Miyagi Y, Hayashi T, Matsubayashi T, Shimoda A, Kusunoki S, Fukuda T. Childhood-Onset Multifocal Motor Neuropathy With Immunoglobulin M Antibodies to Gangliosides GM1 and GM2: A Case Report and Review of the Literature. Pediatr Neurol 2016; 62:51-7. [PMID: 27400822 DOI: 10.1016/j.pediatrneurol.2016.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 10/21/2022]
Abstract
Multifocal motor neuropathy is a rare immune-mediated neuropathy characterized by progressive asymmetric weakness and atrophy without sensory abnormalities. Although disease onset is usually in adulthood, a few childhood-onset cases have been reported. Here, we report the case of an 8-year-old boy with multifocal motor neuropathy who presented with a slowly progressive left and distal upper limb weakness without sensory loss. The initial high-dose intravenous immunoglobulin treatment significantly improved left upper limb muscle weakness. Continued monthly intravenous immunoglobulin treatment gradually improved muscle strength for several months initially. While the muscle strength decreased slightly after 8 months of therapy, it was better than that before intravenous immunoglobulin treatment. One year and eight months after the initiation of treatment, serum testing for IgM antibodies to gangliosides, GM1 and GM2, was negative. This is the first pediatric report of the serum IgM autoantibodies positive to GM1 and GM2. The clinical course is similar to that of partial intravenous immunoglobulin responders among patients with adulthood-onset multifocal motor neuropathy. Since the symptoms plateaued after the initial intravenous immunoglobulin therapy, prognosis appears to be determined by the patient's initial response to intravenous immunoglobulin treatment.
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Affiliation(s)
- Hidetoshi Ishigaki
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Takuya Hiraide
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Yoshifumi Miyagi
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Taiju Hayashi
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Tomoko Matsubayashi
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Ayumi Shimoda
- Department of Rehabilitation, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kinki University School of Medicine, Osakasayama, Osaka, Japan
| | - Tokiko Fukuda
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan.
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Mathey EK, Park SB, Hughes RAC, Pollard JD, Armati PJ, Barnett MH, Taylor BV, Dyck PJB, Kiernan MC, Lin CSY. Chronic inflammatory demyelinating polyradiculoneuropathy: from pathology to phenotype. J Neurol Neurosurg Psychiatry 2015; 86:973-85. [PMID: 25677463 PMCID: PMC4552934 DOI: 10.1136/jnnp-2014-309697] [Citation(s) in RCA: 263] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 12/09/2014] [Accepted: 12/11/2014] [Indexed: 11/04/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an inflammatory neuropathy, classically characterised by a slowly progressive onset and symmetrical, sensorimotor involvement. However, there are many phenotypic variants, suggesting that CIDP may not be a discrete disease entity but rather a spectrum of related conditions. While the abiding theory of CIDP pathogenesis is that cell-mediated and humoral mechanisms act together in an aberrant immune response to cause damage to peripheral nerves, the relative contributions of T cell and autoantibody responses remain largely undefined. In animal models of spontaneous inflammatory neuropathy, T cell responses to defined myelin antigens are responsible. In other human inflammatory neuropathies, there is evidence of antibody responses to Schwann cell, compact myelin or nodal antigens. In this review, the roles of the cellular and humoral immune systems in the pathogenesis of CIDP will be discussed. In time, it is anticipated that delineation of clinical phenotypes and the underlying disease mechanisms might help guide diagnostic and individualised treatment strategies for CIDP.
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Affiliation(s)
- Emily K Mathey
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Susanna B Park
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia Neuroscience Research Australia & Prince of Wales Clinical School, University of New South Wales, Randwick, New South Wales, Australia
| | - Richard A C Hughes
- MRC Centre for Neuromuscular Diseases, Institute of Neurology, University College London, London, UK
| | - John D Pollard
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Patricia J Armati
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Sydney, New South Wales, Australia
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Matthew C Kiernan
- Brain and Mind Research Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Cindy S-Y Lin
- Faculty of Medicine, Department of Physiology, Translational Neuroscience Facility, School of Medical Sciences, University of New South Wales, Randwick, New South Wales, Australia
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Koga M, Takahashi M, Yokoyama K, Kanda T. Ambiguous value of anti-ganglioside IgM autoantibodies in Guillain-Barré syndrome and its variants. J Neurol 2015; 262:1954-60. [PMID: 26050638 DOI: 10.1007/s00415-015-7806-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 06/01/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022]
Abstract
Anti-ganglioside autoantibodies of the IgG type are detected in a half of patients with Guillain-Barré syndrome (GBS), and their detection strongly supports the diagnosis of GBS. In contrast, anti-ganglioside IgM antibodies are also often detected in GBS patients, but it remains unclear whether IgM antibodies indicate a diagnosis of GBS. We identified four GBS patients (3.3%) who tested positive for IgM antibodies but negative for IgG antibodies among 122 patients with GBS and its variants. These four patients were all adolescents or young adults (age 13-22 years), experienced preceding gastrointestinal symptoms, and had serological and/or bacterial evidence of recent Campylobacter jejuni enteritis. Serum IgG reacted strongly with the lipo-oligosaccharide (LOS) of the C. jejuni isolates from these patients' stool specimens. Thin-layer chromatography with immunostaining showed that their serum IgG reacted with resorcinol-positive portion of LOS, suggesting that these patients had IgG autoantibodies against sialic acid-containing epitopes, probably unrecognized ganglioside-like structures on the bacterial LOS. We also examined anti-ganglioside autoantibodies in 22 patients with C. jejuni enteritis without subsequent neurological disorders and detected IgM antibodies in seven (32%) patients. Our data indicate that anti-ganglioside IgM antibodies can be detected in C. jejuni enteritis without complication of GBS, and that the detection of anti-ganglioside IgM antibodies does not always support a diagnosis of GBS. IgG autoantibodies against unrecognized gangliosides might play a role in the development of disease in patients with GBS in whom only anti-ganglioside IgM antibodies are detected by routine clinical testing.
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Affiliation(s)
- Michiaki Koga
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Minami-kogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan,
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Campagnolo M, Ferrari S, Dalla Torre C, Cabrini I, Cacciavillani M, Lucchetta M, Ruggero S, Toffanin E, Cavallaro T, Briani C. Polyneuropathy with anti-sulfatide and anti-MAG antibodies: Clinical, neurophysiological, pathological features and response to treatment. J Neuroimmunol 2015; 281:1-4. [DOI: 10.1016/j.jneuroim.2015.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 02/28/2015] [Indexed: 10/23/2022]
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Sung WK, Jeong JU, Bang KT, Shin JH, Yoo JH, Kim NM, Park JH, Kim JH. Fibrillary glomerulonephritis combined with chronic inflammatory demyelinating polyneuropathy. Kidney Res Clin Pract 2015; 34:117-9. [PMID: 26484033 PMCID: PMC4570644 DOI: 10.1016/j.krcp.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 10/02/2014] [Accepted: 10/02/2014] [Indexed: 11/24/2022] Open
Abstract
A 58-yr-old man presented with leg edema and subacute weakness of his bilateral lower extremities. Urinary and serum immunoelectrophoresis revealed the presence of lambda-type Bence Jones proteins. He was ultimately diagnosed with monoclonal gammopathy of undetermined significance (MGUS). A renal biopsy specimen showed fibrillary glomerulonephritis (FGN), which was randomly arranged as 12–20 m nonbranching fibrils in the basement membranes. Immunofluorescence studies were negative for immunoglobulin (Ig)G, IgM, IgA, C3, and kappa light chains in the capillary walls and mesangial areas. A Congo red stain for amyloid was negative. Electromyography and nerve conduction velocity examinations results were compatible with the presence of demyelinating polyneuropathy. This case showed a rare combination of FGN, without Ig deposition, and MGUS combined with chronic inflammatory demyelinating polyneuropathy (CIDP).
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Affiliation(s)
- Woo Kyung Sung
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Jin Uk Jeong
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Ki Tae Bang
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Jong Ho Shin
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Ji Hyung Yoo
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Nak Min Kim
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Jun Hyung Park
- Department of Internal Medicine, Eulji University School of Medicine, Daejeon, Korea
| | - Joo Heon Kim
- Department of Pathology, Eulji University School of Medicine, Daejeon, Korea
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Giannotta C, Di Pietro D, Gallia F, Nobile-Orazio E. Anti-sulfatide IgM antibodies in peripheral neuropathy: to test or not to test? Eur J Neurol 2015; 22:879-82. [PMID: 25597226 DOI: 10.1111/ene.12658] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 11/28/2014] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Anti-sulfatide immunoglobulin M (IgM) antibodies have been associated with different forms of neuropathies but their diagnostic role in neuropathy remains unclear. METHODS The clinical association of increased titers of anti-sulfatide IgM antibodies in 570 patients with neuropathy and related disorders examined in our laboratory since 2004 was reviewed. Sera were tested by enzyme-linked immunosorbent assay at the initial serum dilution of 1:32,000 and titrated by serial two-fold dilution. In all positive patients IgM antibodies to myelin-associated glycoprotein (MAG) were also measured by western blot. RESULTS High titers of anti-sulfatide antibodies were found in 39 patients including 33 (85%) who also had anti-MAG IgM. Six patients did not have anti-MAG IgM including five in whom moderately increased anti-sulfatide titers were associated with different forms of neuropathy. One patient with a demyelinating neuropathy and IgM monoclonal gammopathy had markedly increased anti-sulfatide titers (1:256,000). CONCLUSIONS Increased titers of anti-sulfatide IgM antibodies are not infrequent in patients with neuropathy where they are often associated with a concomitant reactivity to MAG. A selective reactivity to sulfatide, however, is rarely found and is associated with different forms of neuropathy limiting its usefulness in the diagnosis of neuropathy.
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Affiliation(s)
- C Giannotta
- Second Neurology, Humanitas Clinical and Research Centre, Department of Medical Biotechnology and Translational Medicine, Milan University, Rozzano, Milan, Italy
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Talamo G, Mir MA, Pandey MK, Sivik JK, Raheja D. IgM MGUS associated with anti-MAG neuropathy: a single institution experience. Ann Hematol 2015; 94:1011-6. [DOI: 10.1007/s00277-014-2294-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
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Nobile-Orazio E, Giannotta C, Musset L, Messina P, Léger JM, Gallia F, Costa RG. Sensitivity and predictive value of anti-GM1/galactocerebroside IgM antibodies in multifocal motor neuropathy. J Neurol Neurosurg Psychiatry 2014; 85:754-8. [PMID: 23907602 DOI: 10.1136/jnnp-2013-305755] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increased titres of serum IgM antibodies to GM1 ganglioside are often associated with multifocal motor neuropathy (MMN). Testing for IgM antibodies to other antigens including GM2, the mixture of GM1 and galactocerebroside (GM1/GalC) and the disulfated heparin disaccharide NS6S were reported to increase the sensitivity of antibody testing in MMN even if it is unclear whether the specificity and positive (PPV) or negative predictive value (NPV) for MMN were also affected. METHODS We measured IgM antibodies to GM1, GM2, galactocerebroside, GM1/GalC and NS6S in 40 consecutive patients with MMN and 142 controls with other neuropathies or related diseases and compared their sensitivity, specificity and PPV for MMN. RESULTS With the only exception of anti-GM2 and, partially, anti-NS6S antibodies, IgM antibodies to the antigens tested were more frequent in MMN than in controls. Increased titres of anti-GM1 IgM were found in 48% of MMN patients with a specificity of 93% and PPV for MMN of 66%. Anti-GM1/GalC antibodies were present in all anti-GM1 positive MMN patients and in 11 additional patients (28%) with MMN raising the sensitivity of antibody testing to 75%. The specificity (85%) and PPV (59%) for MMN was, however, moderately reduced compared to anti-GM1 IgM, even if they rose with increasing anti-GM1/GalC titres. IgM antibodies to GM2, NS6S and galactocerebroside were found in 8%, 23% and 60% of MMN patients but had a low specificity and PPV for MMN. CONCLUSIONS Testing for anti-GM1/GalC IgM significantly increased the sensitivity of antibody testing in MMN compared to anti-GM1 alone (p=0.021) and may represent a preferred option for GM1 reactivity testing in MMN.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2° Neurology, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Claudia Giannotta
- 2° Neurology, Department of Medical Biotechnology and Translational Medicine, Milan University, Humanitas Clinical and Research Centre, Rozzano, Milan, Italy
| | - Lucile Musset
- Immunology Department, University Hospital Pitié-Salpêtrière, Paris, France
| | - Paolo Messina
- Laboratory of Neurological Disorders, IRCCS Mario Negri Institute for Pharmacological Research, Milan, Italy
| | - Jean-Marc Léger
- National Reference Centre for Neuromuscular Disease, the University Hospital Pitié-Salpêtrière, Paris, France
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Usuki S, O'Brien D, Rivner MH, Yu RK. A new approach to ELISA-based anti-glycolipid antibody evaluation of highly adhesive serum samples. J Immunol Methods 2014; 408:52-63. [PMID: 24861939 DOI: 10.1016/j.jim.2014.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 05/06/2014] [Accepted: 05/08/2014] [Indexed: 12/14/2022]
Abstract
The enzyme-linked immunosorbent assay (ELISA) is a standard immunoassay used in measuring antibody reactivity (expressed as titers) for glycosphingolipids (GSLs) such as gangliosides and sulfoglycolipids in the sera of patients with Guillain-Barré syndrome (GBS), variants of GBS, and chronic inflammatory demyelinating polyneuropathy (CIDP). In the present study, anti-GSL antibodies were evaluated using a new formula of affinity parametric complex (APC), calculated from limiting-dilution serum assay data, followed by affinity parametric complex criterion (APCC). Using assay results based on APCC, we analyzed serum samples categorized into acute inflammatory demyelinating polyneuropathy (AIDP), acute motor-sensory axonal neuropathy (AMSAN), CIDP, CIDP with myasthenia gravis (MG), and amyotrophic lateral sclerosis (ALS). We were able to determine the affinity strength of antibodies otherwise hidden in the non-specific background activity in highly adhesive serum samples. The thin-layer chromatography (TLC)-immuno-overlay method assured us that this new method is an accurate and reliable way for evaluating anti-GSL antibodies using ELISA serum sample data.
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Affiliation(s)
- Seigo Usuki
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA
| | - Dawn O'Brien
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA
| | - Michael H Rivner
- Department of Neurology, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA
| | - Robert K Yu
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA; Department of Neurology, Medical College of Georgia, Georgia Regents University, Augusta, GA 30912, USA.
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Renaud M, Aupy J, Camuset G, Collongues N, Chanson JB, de Seze J, Blanc F. Chronic Bickerstaff's encephalitis with cognitive impairment, a reality? BMC Neurol 2014; 14:99. [PMID: 24885623 PMCID: PMC4040113 DOI: 10.1186/1471-2377-14-99] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 04/01/2014] [Indexed: 11/24/2022] Open
Abstract
Background Bickerstaff’s encephalitis (BE) is an acute post-infectious demyelinating disease with albuminocytological dissociation. A chronic form has rarely been described previously. Case presentation A 44-year-old man was hospitalized for drowsiness, cognitive complaint limb weakness, ataxia and sensory disturbance after diarrhea. Neuropsychological evaluation showed slowing, memory and executive function impairment, while analysis of the CSF showed albuminocytological dissociation. Immunologic tests showed positive anti-ganglioside antibodies (anti-GM1 IgM, anti-GD1a IgG and anti-GD1b IgM). Brain MRI was normal but SPECT showed bilateral temporal and frontal hypoperfusion. Outcome under immunoglobulin treatment (IVIG) was favorable with an initial improvement but was marked by worsening after a few weeks. Consequently, the patient was treated with IVIG every 2 months due to the recurrence of symptoms after 6 weeks. Conclusion This case raises the question of the existence of a chronic form of BE with cognitive impairment, in the same way as chronic inflammatory demyelinating polyneuropathy is considered to be a chronic form of Guillain–Barré syndrome.
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Affiliation(s)
| | | | | | | | | | | | - Frédéric Blanc
- University Hospital of Strasbourg, Neuropsychology Unit, Neurology Service and CMRR (Centre Mémoire de Ressources et de Recherche), 1 avenue Molière, 67098 Strasbourg Cedex, France.
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Nobile-Orazio E, Gallia F. Multifocal motor neuropathy: current therapies and novel strategies. Drugs 2014; 73:397-406. [PMID: 23516024 DOI: 10.1007/s40265-013-0029-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Multifocal motor neuropathy (MMN) is a purely motor mononeuritis multiplex characterized by the presence of conduction block on motor but not on sensory nerves and by the presence of high titers of anti-GM1 antibodies. Several data point to a pathogenetic role of the immune system in this neuropathy, although this has not yet been proved. Several uncontrolled studies and randomized controlled trials have demonstrated the efficacy of therapy with high-dose intravenous immunoglobulin (IVIg) in MMN. However, this therapy has a short-lasting effect that needs to be maintained with periodic infusions. This can be partly overcome by the use of subcutaneous immunoglobulin (SCIg) at the same dose. The high cost and need for repeated infusions have led to the search for other immune therapies, the efficacy of which have not yet been confirmed in randomized trials. In addition, some therapies, including corticosteroids and plasma exchange, are not only ineffective but have been associated with clinical worsening. More recently, a number of novel therapies have been investigated in MMN, including interferon-β1a, the anti-CD20 monoclonal antibody rituximab and the complement inhibitor eculizumab. Preliminary data from open-label uncontrolled studies show that some patients improve after these therapies; however, randomized controlled trials are needed to confirm efficacy. Until then, IVIg (and SCIg) remains the mainstay of treatment in MMN, and the use of other immune therapies should only be considered for patients not responding to, or becoming resistant to, IVIg.
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Affiliation(s)
- Eduardo Nobile-Orazio
- Department of Medical Biotechnology and Translational Medicine (BIOMETRA), 2nd Neurology, Humanitas Clinical and Research Center, IRCCS Humanitas Clinical Institute, Milan University, Via Manzoni 56, Rozzano, 20089 Milan, Italy.
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Rojas-García R, Gallardo E, Illa I. Paraproteinemic neuropathies. Presse Med 2013; 42:e225-34. [PMID: 23618626 DOI: 10.1016/j.lpm.2013.02.329] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 02/04/2013] [Accepted: 02/12/2013] [Indexed: 12/13/2022] Open
Abstract
The term paraproteinemic neuropathy refers to a heterogeneous group of neuropathies, which share the common feature of a homogeneous immunoglobulin in the serum. The presence of a monoclonal gammopathy indicates an underlying clonal B-cell expansion, which may appear in the context of a lymphoproliferative disorder. If a neoplastic origin of the gammopathy is identified, the treatment should be targeted to the neoplasm. In most patients, however, the monoclonal gammopathy is not associated with malignant haematological disorders, and is defined as monoclonal gammopathy of undetermined significance.
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Affiliation(s)
- Ricard Rojas-García
- Neuromuscular Diseases Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
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Abstract
The identification of autoantibodies associated with dysimmune neuropathies was a major contribution to the characterization of peripheral nerve disorders, the understanding of their pathophysiology, and the clinical diagnosis of neuropathies. Antibodies directed to GM1, GQ1b, and disyalilated gangliosides, and anti-MAG antibodies are very useful in the diagnosis of acute or chronic motor or sensory-motor neuropathies with or without monoclonal IgM. Anti-onconeural anti-Hu and anti-CV2/CRMP antibodies allow when they are detected the diagnosis of paraneoplastic neuropathies. This chapter focuses on the description of these antibodies as diagnostic markers and on their immunopathogenesis. We give a background overview on the origin of these antibodies, their detection, and review those studies, which clearly show that these antibodies are capable of binding to the target tissues in peripheral nerve and thereby can exert a variety of pathophysiological effects. The corresponding electrophysiological and histological changes observed both in human and animal models are exemplified in order to get a better understanding of the immune mechanisms of these antibody-mediated neuropathies.
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Affiliation(s)
- Andreas Steck
- Department of Neurology, University Hospital Basel, Basel, Switzerland.
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Abstract
The association of neuropathy with monoclonal gammopathy has been known for several years, even if the clinical and pathogenetic relevance of this association is not completely defined. This is not a marginal problem since monoclonal gammopathy is present in 1-3% of the population above 50 years in whom it is often asymptomatic, and in at least 8% of patients is associated with a symptomatic neuropathy, representing one of the leading causes of neuropathy in aged people. Monoclonal gammopathy may result from malignant lymphoproliferative diseases including multiple myeloma or solitary plasmocytoma, Waldenström's macroglobulinemia (WM), other IgM-secreting lymphoma or chronic lymphocytic leukemia, and primary systemic amyloidosis (AL). In most instances it is not associated with any of these disorders and is defined monoclonal gammopathy of undetermined significance (MGUS) for its possible, though infrequent, evolution into malignant forms. Several data support the pathogenetic role of the monoclonal gammopathy in the neuropathy particularly when of IgM isotype where IgM reactivity to several neural antigens has been reported. Increased levels of VEGF have been implicated in POEMS syndrome. However, there are as yet no defined therapies for these neuropathies, as their efficacy has not been confirmed in randomized trials.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2nd Neurology, Department of Translational Medicine, Milan University, IRCCS Humanitas Clinical Institute, Rozzano, Milan, Italy.
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Galassi G, Girolami F. Acute-Onset Multifocal Motor Neuropathy (AMMN): How We Meet the Diagnosis. Int J Neurosci 2012; 122:413-22. [DOI: 10.3109/00207454.2012.677884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Peripheral neuropathy associated with monoclonal gammopathy is a rare but important cause of neuropathy that can herald serious underlying disease. IgM monoclonal gammopathy of undetermined significance (MGUS) is the most commonly found monoclonal gammopathy associated with neuropathy, with characteristic clinical, electrophysiologic, and pathologic features. The IgG and IgA monoclonal gammopathies are rarely associated with specific neuropathies. Standard immunomodulatory agents including steroids, intravenous immunoglobulin, and plasmapheresis have shown limited efficacy in IgM MGUS. Neuropathies associated with specific lymphoproliferative disorders may not respond to treatments aimed at that disorder. Case series had shown promising results with rituximab, a monoclonal antibody that targets the B cell surface antigen CD20 and results in a rapid and sustained depletion of B cells; however, two recent randomized controlled trials with rituximab failed to provide evidence of efficacy in primary outcome measures, despite reduction in antibody levels. Long-term studies looking at the association between specific immunologic markers and disease recurrence are needed to ultimately develop targeted therapies.
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Affiliation(s)
- Sindhu Ramchandren
- Department of Neurology, Wayne State University-Detroit Medical Center, 4201 St. Antoine UHC 8C.28, Detroit, MI 48201, USA.
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Galassi G, Girolami F, Ariatti A, Monelli M, Sola P. Fulminant multifocal motor neuropathy: a report of two cases. Int J Neurosci 2012; 122:395-400. [PMID: 22332970 DOI: 10.3109/00207454.2012.660587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Multifocal motor neuropathy (MMN) shows stepwise progression over decades. The multifocal weakness usually remains asymmetric, confined to distal limb muscles, while sparing cranial, phrenic, and sensory nerves. One electrophysiological hallmark is partial motor conduction block (CB) at sites not exposed to compression; whether CB is an essential feature remains debatable. High titer of anti-GM1 antibodies is found with figures usually between 40% and 50% of patients. Intravenous immuneglobulin (IVIg) is effective in almost 80%, but plasmapheresis and steroids are not. The condition is reported as lethal exceptionally, mimicking motor neuron diseases (MND). We have studied two patients who failed to respond to treatment and who died with respiratory failure; one of the two had high titer of IgM antibody to the ganglioside GM1. Our cases confirm that great attention should be paid in order to define the borderland between MMN and MND and the entity of their clinical and electrophysiological overlaps.
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Affiliation(s)
- Giuliana Galassi
- Departments of Neurosciences, University Hospital Modena, Italy.
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Huan MC, Bromberg M. Advances in the Laboratory Evaluation of Peripheral Neuropathies. Curr Neurol Neurosci Rep 2011; 12:84-91. [DOI: 10.1007/s11910-011-0239-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Vlam L, van der Pol WL, Cats EA, Straver DC, Piepers S, Franssen H, van den Berg LH. Multifocal motor neuropathy: diagnosis, pathogenesis and treatment strategies. Nat Rev Neurol 2011; 8:48-58. [PMID: 22105211 DOI: 10.1038/nrneurol.2011.175] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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De Paz R, Reach P, Viala K. [Practical role of neuro-immunology in the diagnosis and management of peripheral neuropathies]. Rev Med Interne 2011; 32:645-8. [PMID: 21890249 DOI: 10.1016/j.revmed.2011.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
Anti-glycolipid antibodies have emerged since a decade as a useful tool in the diagnosis of inflammatory neuropathies. These autoantibodies target various Schwann cells antigens, and are characterized by modest specificity and sensitivity, complex nomenclature and cross-reactions. For all these reasons, the use of anti-glycolipid antibodies measurement may be confusing. In this article, we describe the clinical manifestations associated with anti-glycolipid antibodies and propose guidelines for indication and interpretation of anti-glycolipids measurement.
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Affiliation(s)
- R De Paz
- Service de neurologie 1, hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France.
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Nobile-Orazio E, Giannotta C. Testing for anti-glycolipid IgM antibodies in chronic immune-mediated demyelinating neuropathies. J Peripher Nerv Syst 2011; 16 Suppl 1:18-23. [DOI: 10.1111/j.1529-8027.2011.00300.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Nobile-Orazio E. Update on neuropathies associated with monoclonal gammopathy of undetermined significance (2008-2010). J Peripher Nerv Syst 2011; 15:302-6. [PMID: 21199101 DOI: 10.1111/j.1529-8027.2010.00283.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Studies on paraproteinemic neuropathies have appeared in the last 2 years improving the diagnosis of these neuropathies, clarifying their pathogenesis, and informing practice by randomized clinical trial publications. Two recent randomized controlled trials with rituximab failed to provide evidence of efficacy in primary outcome measures, despite the fact that anti-myelin-associated glycoprotein (MAG) antibodies were reduced in most treated patients. This discrepancy, besides inducing the search for more effective therapy for this neuropathy, indicates that some aspects on the pathogenesis of this neuropathy probably need further clarification.
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Affiliation(s)
- Eduardo Nobile-Orazio
- 2nd Neurology, Department of Translational Medicine, IRCCS Humanitas Clinical Institute, Milan University, Rozzano, Milan, Italy.
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Larue S, Bombelli F, Viala K, Neil J, Maisonobe T, Bouche P, Musset L, Fournier E, Léger JM. Non-anti-MAG DADS neuropathy as a variant of CIDP: clinical, electrophysiological, laboratory features and response to treatment in 10 cases. Eur J Neurol 2010; 18:899-905. [PMID: 21199182 DOI: 10.1111/j.1468-1331.2010.03312.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Some patients within the spectrum of chronic inflammatory demyelinating polyradiculoneuropathies (CIDP) have distal acquired demyelinating symmetric (DADS) neuropathy, usually associated with anti-myelin-associated-glycoprotein (MAG) IgM monoclonal gammopathy. The aim of this retrospective study was to investigate patients with DADS neuropathy without anti-MAG antibodies, and study their response to immunotherapy. METHODS Patients were selected on the basis of (i) 'Definite CIDP' according to the EFNS/PNS Guideline criteria, (ii) The presence of disproportionately prolonged motor latencies resulting in a terminal latency index (TLI) ≤ 0.25 in at least two motor nerves and (iii) The absence of anti-MAG antibodies on ELISA. Response to immunotherapy was defined as persistent improvement by at least one point on the INCAT disability score. RESULTS Data from 146 CIDP patients were analysed, and 10 patients were included. Six had clinically pure sensory neuropathy, and four had sensorimotor neuropathy. Ataxia was present in nine patients, generalized areflexia in seven and postural tremor in two. Five of the 10 patients had abnormal sensory potentials only in the upper limbs. An associated condition was found in nine patients: two chronic lymphocytic leukaemias, four IgG monoclonal gammopathies (one associated with non-Hodgkin's lymphoma) and two IgM monoclonal gammopathies of unknown significance. Patients were mostly improved with intravenous immunoglobulin (IVIg), corticosteroids, plasma exchanges, or a combination thereof. CONCLUSION DADS neuropathy without anti-MAG antibodies is more likely to be considered a variant of CIDP. In addition, such patients should be systematically investigated for an associated haematological or immunological condition.
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Affiliation(s)
- S Larue
- Centre de Référence Maladies Neuromusculaires Rares, Hôpital Pitié-Salpêtrière and Université Paris VI, Paris, France
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Morphological Progression of Myelin Abnormalities in IgM-Monoclonal Gammopathy of Undetermined Significance Anti-Myelin-Associated Glycoprotein Neuropathy. J Neuropathol Exp Neurol 2010; 69:1143-57. [DOI: 10.1097/nen.0b013e3181fa44af] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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European Federation of Neurological Societies/Peripheral Nerve Society Guideline* on management of paraproteinemic demyelinating neuropathies. Report of a Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Socie. J Peripher Nerv Syst 2010; 15:185-95. [DOI: 10.1111/j.1529-8027.2010.00278.x] [Citation(s) in RCA: 189] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Demyelinating symmetric motor polyneuropathy with high titers of anti-GM1 antibodies. Muscle Nerve 2010; 42:604-8. [DOI: 10.1002/mus.21755] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Sim JE, Choi YC, Kim WJ. Facial Diplegia in Plasmodium vivax Malaria. J Clin Neurol 2010; 6:102-3. [PMID: 20607050 PMCID: PMC2895222 DOI: 10.3988/jcn.2010.6.2.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 09/03/2009] [Accepted: 09/03/2009] [Indexed: 11/17/2022] Open
Abstract
Background Facial diplegia has diverse etiologies, including viral and bacterial infections such as diphtheria, syphilis and Lyme disease, and also protozoal infection in very rarely cases. Case Report A 20-year-old male patient was admitted to our hospital due to bilateral weakness of the upper and lower facial muscles. Examination revealed that the patient had a facial diplegia of the peripheral type. A peripheral blood smear demonstrated the presence of the asexual trophozoite stage of Plasmodium vivax with ring-form trophozoites, which led to a diagnosis of malaria. A serum work-up revealed increased IgG titers of antibodies to myelin-associated glycoprotein and ganglioside GD1b. The patient was administered antimalarial treatment, 1 week after which he showed signs of recovery. To our knowledge, this is the first case of facial diplegia after malaria infection, providing evidence that the mechanism underlying the condition is related to immune-mediated disease. Conclusions Facial diplegia can manifest after P. vivax infection.
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Affiliation(s)
- Jae Eun Sim
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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