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Noioso CM, Bevilacqua L, Acerra GM, Valle PD, Serio M, Pecoraro A, Rienzo A, De Marca U, De Biasi G, Vinciguerra C, Piscosquito G, Toriello A, Tozza S, Barone P, Iovino A. The spectrum of anti-GQ1B antibody syndrome: beyond Miller Fisher syndrome and Bickerstaff brainstem encephalitis. Neurol Sci 2024:10.1007/s10072-024-07686-3. [PMID: 38987510 DOI: 10.1007/s10072-024-07686-3] [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: 01/18/2024] [Accepted: 07/03/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Since the initial identification of Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE),significant milestones have been achieved in understanding these diseases.Discoveries of common serum antibodies (IgG anti-GQ1b), antecedent infections, neurophysiological data, andneuroimaging suggested a shared autoimmune pathogenetic mechanism rather than distinct pathogenesis, leadingto the hypothesis that both diseases are part of a unified syndrome, termed "Fisher-Bickerstaff syndrome". The subsequent identification of atypical anti-GQ1b-positive forms expanded the classification to a broader condition known as "Anti-GQ1b-Antibody syndrome". METHODS An exhaustive literature review was conducted, analyzing a substantial body of research spanning from the initialdescriptions of the syndrome's components to recent developments in diagnostic classification and researchperspectives. RESULTS Anti-GQ1b syndrome encompasses a continuous spectrum of conditions defined by a common serological profilewith varying degrees of peripheral (PNS) and central nervous system (CNS) involvement. MFS and BBE represent theopposite ends of this spectrum, with MFS primarily affecting the PNS and BBE predominantly involving the CNS.Recently identified atypical forms, such as acute ophthalmoparesis, acute ataxic neuropathy withoutophthalmoparesis, Guillain-Barré syndrome (GBS) with ophthalmoparesis, MFS-GBS and BBE-GBS overlap syndromes,have broadened this spectrum. CONCLUSION This work aims to provide an extensive, detailed, and updated overview of all aspects of the anti-GQ1b syndromewith the intention of serving as a stepping stone for further shaping thereof. Special attention was given to therecently identified atypical forms, underscoring their significance in redefining the boundaries of the syndrome.
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Affiliation(s)
- Ciro Maria Noioso
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy.
| | - Liliana Bevilacqua
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Gabriella Maria Acerra
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Paola Della Valle
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Marina Serio
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Agnese Pecoraro
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Annalisa Rienzo
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Umberto De Marca
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Giuseppe De Biasi
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Claudia Vinciguerra
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Antonella Toriello
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Paolo Barone
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Aniello Iovino
- Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
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Hawkes MA, Wijdicks EFM. Improving Outcome in Severe Myasthenia Gravis and Guillain-Barré Syndrome. Semin Neurol 2024; 44:263-270. [PMID: 38560985 DOI: 10.1055/s-0044-1785509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
When progressive and severe, myasthenia gravis and Guillain-Barré syndrome may have the potential for fatal and unfavorable clinical outcomes. Regardless of important differences in their clinical course, the development of weakness of oropharyngeal muscles and respiratory failure with requirement of mechanical ventilation is the main driver of poor prognosis in both conditions. The need for prolonged mechanical ventilation is particularly relevant because it immobilizes the patient and care becomes extraordinarily complex due to daily risks of systemic complications. Additionally, patients with myasthenia gravis often require long-term immunosuppressive treatments with associated toxicity and infectious risks. Unlike myasthenia gravis, the recovery period is prolonged in Guillain-Barré syndrome, but often favorable, even in the more severely affected patients. Outcome, for a large part, is determined by expert neurocritical care.
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Affiliation(s)
- Maximiliano A Hawkes
- Department of Neurology, Neurocritical Care Services, Mayo Clinic, Rochester, Minnesota
| | - Eelco F M Wijdicks
- Department of Neurology, Neurocritical Care Services, Mayo Clinic, Rochester, Minnesota
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Coly M, Adams D, Attarian S, Bouhour F, Camdessanché JP, Carey G, Cauquil C, Chanson JB, Chrétien P, Créange A, Delmont E, Fargeot G, Frachet S, Gendre T, Kuntzer T, Labeyrie C, Maisonobe T, Michaud M, Moulin M, Nicolas G, Noury JB, Péréon Y, Puma A, Sole G, Taithe F, Tard C, Théaudin M, Timsit S, Venditti L, Echaniz-Laguna A. Clinical, paraclinical and outcome features of 166 patients with acute anti-GQ1b antibody syndrome. J Neurol 2024:10.1007/s00415-024-12410-4. [PMID: 38767661 DOI: 10.1007/s00415-024-12410-4] [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: 01/31/2024] [Revised: 04/24/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND & PURPOSE In this retrospective study, we aimed at defining the clinical, paraclinical and outcome features of acute neurological syndromes associated with anti-GQ1b antibodies. RESULTS We identified 166 patients with neurological symptoms appearing in less than 1 month and anti-GQ1b antibodies in serum between 2012 and 2022. Half were female (51%), mean age was 50 years (4-90), and the most frequent clinical features were areflexia (80% of patients), distal upper and lower limbs sensory symptoms (78%), ophthalmoplegia (68%), sensory ataxia (67%), limb muscle weakness (45%) and bulbar weakness (45%). Fifty-three patients (32%) presented with complete (21%) and incomplete (11%) Miller Fisher syndrome (MFS), thirty-six (22%) with Guillain-Barre syndrome (GBS), one (0.6%) with Bickerstaff encephalitis (BE), and seventy-three (44%) with mixed MFS, GBS & BE clinical features. Nerve conduction studies were normal in 46% of cases, showed demyelination in 28%, and axonal loss in 23%. Anti-GT1a antibodies were found in 56% of cases, increased cerebrospinal fluid protein content in 24%, and Campylobacter jejuni infection in 7%. Most patients (83%) were treated with intravenous immunoglobulins, and neurological recovery was complete in 69% of cases at 1 year follow-up. One patient died, and 15% of patients relapsed. Age > 70 years, initial Intensive Care Unit (ICU) admission, and absent anti-GQ1b IgG antibodies were predictors of incomplete recovery at 12 months. No predictors of relapse were identified. CONCLUSION This study from Western Europe shows acute anti-GQ1b antibody syndrome presents with a large clinical phenotype, a good outcome in 2/3 of cases, and frequent relapses.
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Affiliation(s)
- Martin Coly
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- Sorbonne University, 75013, Paris, France
| | - David Adams
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
| | - Shahram Attarian
- Reference Centre for Neuromuscular Diseases PACA RARE, Filnemus, EURO-NMD, CHU Timone, 13005, Marseille, France
| | - Françoise Bouhour
- Reference Centre for Neuromuscular Diseases PACA RARE, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Bron Cedex, France
| | | | - Guillaume Carey
- Centre de Référence Des Maladies Neuromusculaires Nord/Est/Ile-de-France, Neurology Department, U1172, CHU Lille, 59000, Lille, France
| | - Cécile Cauquil
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, European Reference Network for Neuromuscular Diseases EURO-NMD, University Hospital of Strasbourg, 67098, Strasbourg, France
| | - Pascale Chrétien
- Clinical Immunology Laboratory, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- Paris University, CNRS, INSERM, UTCBS, Paris, France
- Pathology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
| | - Alain Créange
- Neurology Department, Créteil University Hospital, UPEC, 94010, Créteil, France
| | - Emilien Delmont
- Reference Centre for Neuromuscular Diseases PACA RARE, Filnemus, EURO-NMD, CHU Timone, 13005, Marseille, France
| | - Guillaume Fargeot
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
| | - Simon Frachet
- Neurology Department, Limoges University Hospital, 87042, Limoges, France
| | - Thierry Gendre
- Neurology Department, Créteil University Hospital, UPEC, 94010, Créteil, France
| | - Thierry Kuntzer
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
| | - Céline Labeyrie
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France
| | - Thierry Maisonobe
- Department of Clinical Neurophysiology, Pitié-Salpêtrière University Hospital, 75013, Paris, France
| | - Maud Michaud
- Neurology Department, NEIDF Reference Center, Nancy University Hospital, 54000, Nancy, France
| | - Maximilien Moulin
- Neurology Department, Reims University Hospital, 51092, Reims, France
| | - Guillaume Nicolas
- Nord-Est/Ile-de-France Neuromuscular Reference Center, Neurology Department, Raymond Poincaré Hospital, UVSQ Paris-Saclay University, Garches, France
| | - Jean-Baptiste Noury
- Centre de Référence Des Maladies Neuromusculaires AOC, INSERM, LBAI, UMR1227, CHRU de Brest, Brest, France
| | - Yann Péréon
- Reference Centre for Neuromuscular Disorders AOC Filnemus, Euro-NMD, Hôtel-Dieu, CHU Nantes, 44000, Nantes, France
| | - Angela Puma
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, Pasteur 2 Hospital, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Guilhem Sole
- Reference Centre for Neuromuscular Diseases AOC, Filnemus, Euro-NMD, Neurology and Neuromuscular Diseases Department, Hôpital Pellegrin, CHU de Bordeaux, 33076, Bordeaux, France
| | - Frédéric Taithe
- Neurology Department, Clermont-Ferrand University Hospital, 63058, Clermont-Ferrand, France
| | - Céline Tard
- Centre de Référence Des Maladies Neuromusculaires Nord/Est/Ile-de-France, Neurology Department, U1172, CHU Lille, 59000, Lille, France
| | - Marie Théaudin
- Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, 1011, Lausanne, Switzerland
| | - Serge Timsit
- Centre de Référence Des Maladies Neuromusculaires AOC, INSERM, LBAI, UMR1227, CHRU de Brest, Brest, France
| | - Laura Venditti
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- Neurology Department, Bicêtre University Hospital, 94276, Le Kremlin-Bicêtre, France.
- French National Reference Center for Rare Neuropathies (CERAMIC), 94276, Le Kremlin-Bicêtre, France.
- INSERM U1195, Paris-Saclay University, 94276, Le Kremlin-Bicêtre, France.
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Rathi R, Harjpal P. Rehabilitation of a 51-Year-Old Patient With Miller Fisher Syndrome: A Case Report. Cureus 2024; 16:e56056. [PMID: 38618435 PMCID: PMC11009827 DOI: 10.7759/cureus.56056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
Miller Fisher syndrome is a rare and atypical variation of Guillain-Barré syndrome, which includes the clinical triad of areflexia, ataxia, and ophthalmoplegia. Miller Fisher syndrome is commonly associated with the involvement of the lower cranial and facial nerves. Miller Fisher syndrome is one of the types of Guillain-Barré syndrome. Guillain-Barré syndrome has been defined to be the foremost incapacitating form of neurological disease following the disease polio. Guillain-Barré syndrome is a broad category that encompasses several types of acute immune-mediated polyneuropathies, the most common of which is acute inflammatory demyelinating polyradiculoneuropathy. Here, we describe a case report of a 51-year-old patient who displayed the characteristic symptoms of Miller Fisher syndrome. We also describe the patient's clinical course, diagnostic method, and therapy. This case demonstrates the value of early detection, quick action in treating Miller Fisher syndrome, and the possibility of full recovery with adequate therapy. Techniques utilized in physical therapy emphasize performing everyday tasks along with strengthening muscles.
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Affiliation(s)
- Radhika Rathi
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Department of Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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5
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Oh AJ, Bonelli L, Spiegel SJ. Miller Fisher, Mydriasis, and Moderna. J Neuroophthalmol 2024; 44:e192-e193. [PMID: 36862501 DOI: 10.1097/wno.0000000000001827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Affiliation(s)
- Angela J Oh
- Department of Ophthalmology (AJO, SS, LB), Jules Stein Eye Institute, University of California, Los Angeles, Los Angeles, California; and Department of Neuro-Ophthalmology (SS), University of California, Irvine, Irvine, California
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Takemoto K, Kawahara M, Atagi K. Recurrent Guillain-Barré Syndrome Associated with the Second Episode of Campylobacter jejuni Infection. Intern Med 2023; 62:3037-3041. [PMID: 36858520 PMCID: PMC10641182 DOI: 10.2169/internalmedicine.1094-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/18/2023] [Indexed: 03/03/2023] Open
Abstract
Guillain-Barré syndrome (GBS) cases are generally monophasic, and recurrence is rare. However, the pathogenesis and pathophysiology of recurrent GBS remain to be fully elucidated. There are few detailed reports of patients who have been infected twice with Campylobacter jejuni and have developed GBS twice. We herein report a case of recurrent GBS in a 21-year-old man with a history of GBS caused by C. jejuni infection at 19 years old. Although our patient was reinfected with C. jejuni, several different anti-ganglioside antibodies were identified, and the clinical manifestations were more severe than those in the first GBS episode. We compared the anti-ganglioside antibodies and nerve conduction studies findings between the two GBS episodes. This case suggested that different antibodies are involved and produce different symptoms even when C. jejuni infection is the trigger in recurrent episodes.
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Affiliation(s)
- Kiyoshi Takemoto
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
| | - Makoto Kawahara
- Department of Neurology, Nara Prefecture General Medical Center, Japan
| | - Kazuaki Atagi
- Division of Critical Care Medicine, Nara Prefecture General Medical Center, Japan
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7
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Noioso CM, Bevilacqua L, Acerra GM, Della Valle P, Serio M, Vinciguerra C, Piscosquito G, Toriello A, Barone P, Iovino A. Miller Fisher syndrome: an updated narrative review. Front Neurol 2023; 14:1250774. [PMID: 37693761 PMCID: PMC10484709 DOI: 10.3389/fneur.2023.1250774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction Miller Fisher syndrome (MFS) is considered a rare variant of Guillain-Barré syndrome (GBS), a group of acute-onset immune-mediated neuropathies characterized by the classic triad of ataxia, areflexia, and ophthalmoparesis. The present review aimed to provide a detailed and updated profile of all aspects of the syndrome through a collection of published articles on the subject, ranging from the initial description to recent developments related to COVID-19. Methods We searched PubMed, Scopus, EMBASE, and Web of Science databases and gray literature, including references from the identified studies, review studies, and conference abstracts on this topic. We used all MeSH terms pertaining to "Miller Fisher syndrome," "Miller Fisher," "Fisher syndrome," and "anti-GQ1b antibody." Results An extensive bibliography was researched and summarized in the review from an initial profile of MFS since its description to the recent accounts of diagnosis in COVID-19 patients. MFS is an immune-mediated disease with onset most frequently following infection. Anti-ganglioside GQ1b antibodies, detected in ~85% of patients, play a role in the pathogenesis of the syndrome. There are usually no abnormalities in MFS through routine neuroimaging. In rare cases, neuroimaging shows nerve root enhancement and signs of the involvement of the central nervous system. The most consistent electrophysiological findings in MFS are reduced sensory nerve action potentials and absent H reflexes. Although MFS is generally self-limited and has excellent prognosis, rare recurrent forms have been documented. Conclusion This article gives an updated narrative review of MFS with special emphasis on clinical characteristics, neurophysiology, treatment, and prognosis of MFS patients.
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Affiliation(s)
- Ciro Maria Noioso
- Neurology Unit, University Hospital “San Giovanni di Dio e Ruggi d'Aragona”, University of Salerno, Salerno, Italy
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Baars AE, Kuitwaard K, de Koning LC, Luijten LWG, Kok WM, Eftimov F, Wieske L, Goedee HS, van der Pol WL, Blomkwist-Markens PH, Horemans AMC, Jacobs BC, van Doorn PA. SARS-CoV-2 Vaccination Safety in Guillain-Barré Syndrome, Chronic Inflammatory Demyelinating Polyneuropathy, and Multifocal Motor Neuropathy. Neurology 2023; 100:e182-e191. [PMID: 36127144 DOI: 10.1212/wnl.0000000000201376] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 08/23/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There are concerns on the safety of SARS-CoV-2 vaccination in patients with a history of Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), and multifocal motor neuropathy (MMN). The aim of this study was to determine the risk of recurrence of GBS and exacerbations of CIDP or MMN after SARS-CoV-2 vaccination. METHODS We conducted a prospective, multicenter cohort study from January 2021 to August 2021. Patients known in 1 of 3 Dutch University Medical Centers with research focus on immune-mediated neuropathy and members of the Dutch Patient Association for Neuromuscular Diseases were invited to participate if they were 18 years or older and diagnosed with GBS, CIDP, or MMN. Participants completed a series of questionnaires at 4 different time points: study baseline (1), within 48 hours before any SARS-CoV-2 vaccination (2 and 3, if applicable), and 6 weeks after their last vaccination (4). Participants unwilling to get vaccinated completed the last questionnaire (4) 4 months after study baseline. We assessed recurrences of GBS, any worsening of CIDP or MMN-related symptoms, treatment alterations, and hospitalization. RESULTS Of 1,152 individuals to whom we sent the questionnaires, 674 (59%) signed informed consent. We excluded 153 individuals, most often because they had already received a SARS-CoV-2 vaccination or had had the infection (84%) before study baseline. Of 521 participants included in analyses, 403 (81%) completed the last questionnaire (time point 4). None of 162 participants with a history of GBS had a recurrence after vaccination. Of 188 participants with CIDP, 10 participants (5%) reported a worsening of symptoms within 6 weeks after vaccination. In 5 (3%) of these patients, maintenance treatment was modified. Two of 53 participants with MMN (4%) reported a worsening of symptoms, and treatment modification was reported by 1 participant. DISCUSSION We found no increased risk of GBS recurrence and a low to negligible risk of worsening of CIDP or MMN-related symptoms after SARS-CoV-2 vaccination. Based on our data, SARS-CoV-2 vaccination in patients with these immune-mediated neuropathies seems to be safe.
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Affiliation(s)
- Adája E Baars
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Krista Kuitwaard
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Laura C de Koning
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Linda W G Luijten
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W Maaike Kok
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Filip Eftimov
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Luuk Wieske
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - H Stephan Goedee
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - W Ludo van der Pol
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Patricia H Blomkwist-Markens
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Anja M C Horemans
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Bart C Jacobs
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Pieter A van Doorn
- From the Department of Neurology (A.E.B., K.K., L.C.K., L.W.G.L., W.M.K., B.C.J., P.A.D.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (K.K.), Albert Schweitzer Hospital, Dordrecht; Department of Neurology (L.W.G.L.), St. Elisabeth-TweeSteden Hospital, Tilburg; Department of Neurology (F.E., L.W.), Amsterdam University Medical Center, University of Amsterdam; Department of Neurology and Neurosurgery (H.S.G., W.L.P.), Brain Center University Medical Center Utrecht; Dutch Patient Organization for Neuromuscular Diseases (P.H.B.-M., A.M.C.H.), Baarn; and Department of Immunology (B.C.J.), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Bhatia SS, Canepa C, Notarianni A. Bickerstaff’s brainstem encephalitis mimicking herpetic encephalomyelitis in a liver transplant patient with anti-GQ1b antibodies. BMJ Case Rep 2022; 15:15/12/e251784. [DOI: 10.1136/bcr-2022-251784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A woman in her late 70s with a history of liver transplant presented with ophthalmoplegia, ataxia, areflexia, positive Babinski’s sign and reduced consciousness. This followed an antecedent illness in the form of a herpes zoster infection. MRI of the brain/spinal cord, cerebrospinal fluid analysis with viral PCR and routine blood tests were normal, and tacrolimus neurotoxicity was ruled out. Serum anti-GQ1b antibodies were positive. A diagnosis of Bickerstaff’s brainstem encephalitis was made, forming part of the continuum that involves Miller-Fisher syndrome, entitled the ‘anti-GQ1b syndrome’. Complete recovery ensued without intravenous immunoglobulins or plasma exchange. The role of monitoring anti-ganglioside pattern change to predict or confirm disease recurrence and disease severity is further discussed.
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10
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Boob MA, Dadgal R, Salphale VG. Emphasis on the Optimal Functional Recovery Through a Structured Inpatient Rehabilitation Program Along With a Home Exercise Regime in an Individual With Miller-Fisher Syndrome: A Case Report. Cureus 2022; 14:e29919. [DOI: 10.7759/cureus.29919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/04/2022] [Indexed: 11/06/2022] Open
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11
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Ooi ST, Ahmad A, Yaakub A. Recurrent Miller Fisher Syndrome. Cureus 2022; 14:e26192. [PMID: 35891880 PMCID: PMC9306407 DOI: 10.7759/cureus.26192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2022] [Indexed: 11/20/2022] Open
Abstract
Miller Fisher syndrome (MFS) is an uncommon systemic autoimmune condition. Recurrent Miller Fisher syndrome is extremely rare. We want to highlight a rare case of recurrent Miller Fisher syndrome, which manifested as external and internal ophthalmoplegia, areflexia, and ataxia following an episode of upper respiratory tract infection (URTI). The patient developed a recurrent attack of Miller Fisher syndrome two months later with only internal and external ophthalmoplegia symptoms. Both episodes wholly resolved in a month without treatment. Miller Fisher syndrome can mimic various other neurological illnesses. Therefore, diagnosing this disease is often challenging. However, prompt diagnosis and management can be achieved with awareness of this rare illness.
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12
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Wang S, Luo Z, Peng T. Serum thyroid-stimulating hormone is an independent risk factor of recurrent Guillain-Barré syndrome. Muscle Nerve 2022; 65:688-692. [PMID: 35342963 DOI: 10.1002/mus.27539] [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: 11/16/2021] [Revised: 03/21/2022] [Accepted: 03/22/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION/AIMS Guillain-Barré syndrome (GBS) is generally considered to be monophasic, but some patients have recurrences. The purpose of this study was to clarify the possible link between thyroid parameters and recurrent GBS (RGBS) patients in China. METHODS In this retrospective study we enrolled patients who were admitted to the Department of Neurology of The First Affiliated Hospital of Zhengzhou University from 2014 to 2020 and fulfilled the diagnostic criteria of GBS or Miller Fisher syndrome. We evaluated clinical characteristics; cerebrospinal fluid parameters; and serum levels of thyroid-stimulating hormone (TSH), free thyroxine, and free triiodothyronine in 320 individuals, including 302 with monophasic GBS and 18 with recurrent GBS. RESULTS Serum levels of TSH in monophasic GBS patients were significantly lower than those in RGBS patients (P < .001), whereas FT3 levels were higher in the monophasic GBS group (P = .022). Age at onset, incidence of antecedent illness, time from onset to nadir, proportion with acute inflammatory demyelinating polyradiculoneuropathy, and Hughes Functional Grading Scale score at nadir were statistically significant between monophasic GBS patients and RGBS patients (P < .05). The multivariate regression analysis revealed that antecedent illness, AIDP, and high TSH were independent risk factors for RGBS. Our receiver-operating characteristic curve analysis showed that the risk of recurrence in GBS patients increases when the TSH concentration is higher than 3.87 μIU/mL. DISCUSSION Our results demonstrate an association between TSH and RGBS. Oxidative stress is one of the possible interpretations for this association.
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Affiliation(s)
- Shi Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhiya Luo
- Department of Otolaryngology, The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tao Peng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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13
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Wu X, Wang Y, Xi ZQ. Clinical and antibodies analysis of anti-GQ1b antibody syndrome: a case series of 15 patients. Acta Neurol Belg 2022:10.1007/s13760-022-01940-1. [PMID: 35399126 PMCID: PMC8995142 DOI: 10.1007/s13760-022-01940-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 12/01/2022]
Abstract
Objectives To investigate the clinical manifestations, immunity, laboratory test, treatment and prognosis of patients with anti-GQ1b antibody syndrome in Chongqing, China. Methods We reviewed 15 patients with positive anti-ganglioside antibodies in the First Affiliated Hospital of Chongqing Medical University from 2016 to 2019. Results Fifteen patients were included in the study (mean age, 54.4 years; age range, 27 to 80 years; 9 men (60%)). Ten patients presented with a history of preinfection, including flu-like syndrome (n = 6, 60%), upper respiratory tract infection (URTI) (n = 3, 30%), and digestive tract infection (GI) (n = 1, 10%). The most common manifestation was ophthalmoplegia (n = 13, 86.67%), followed by weakness (n = 12, 80%), ataxia (n = 11, 73.3%), paresthesia (n = 8, 53.33%) and hypersomnolence (n = 5, 33.33%). All 15 patients underwent antibody testing. Eight patients (53.33%, 7 men (87.5%)) of whom only have positive immunoglobulin G (IgG) against anti-GQ1b antibody while seven (46.67%, 2 men (28.57%)) were positive for multiple anti-ganglioside antibodies apart from anti-GQ1b antibodies. Nine patients (60%) received intravenous immunoglobulin (IVIG) therapy, four (26.67%) received plasma exchange (PE) and two (13.33%) received steroid therapy. Three patients were lost to follow-up at 6 months, 1 patient (6.67%) had persistent back numbness, and the other 11 patients (73.33%) had fully recovered. Conclusion The clinical subtype of anti-GQ1b antibody syndrome correlates with the type of anti-ganglioside antibody. Patients who test positive for only anti-GQ1b antibody are more likely to be men. Most patients exhibit a unidirectional course with a good prognosis, but anti-GQ1b antibody syndrome is also associated with a risk of recurrence.
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Affiliation(s)
- Xiaohui Wu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 You Yi Road, Chongqing, 400016, China
| | - Yuzhu Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 You Yi Road, Chongqing, 400016, China
| | - Zhi-Qin Xi
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, 1 You Yi Road, Chongqing, 400016, China.
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15
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Roberts M, Jin P, Shin S, Dhamoon M. Readmissions After Guillain-Barre Syndrome: Nationally Representative Data. J Clin Neuromuscul Dis 2021; 22:183-191. [PMID: 34019002 DOI: 10.1097/cnd.0000000000000319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVES We aimed to obtain nationally representative data on hospital readmission rates after Guillain-Barre syndrome (GBS). METHODS International Classification of Disease, Ninth Revision codes from the 2013 National Readmissions Database identified adult GBS admissions, comorbidities, and readmission diagnoses. Logistic regression estimated odds ratios (ORs) for readmission. RESULTS Of 2109 GBS admissions identified, 20.8% were readmitted within 1 year and 12.2% within 30 days. Age did not predict readmission. Plasmapheresis use showed a nonsignificant trend toward readmission versus intravenous immunoglobulin use [OR 1.43, 95% confidence interval (CI) 1.00-2.051, P = 0.050]. Respiratory failure (OR 1.70, 95% CI 1.23-2.35, P = 0.0014), heart failure (OR 2.14, 95% CI 1.25-3.66, P = 0.0057), and renal failure (OR 2.00, 95% CI 1.20-3.32, P = 0.0078) predicted readmission. Top readmission diagnoses included GBS or chronic inflammatory demyelinating polyneuropathy (42.0%) and sepsis (3.5%). CONCLUSIONS One-fifth of GBS patients were readmitted within 1 year. Comorbid illnesses and respiratory complications increased a readmission risk but age did not.
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Affiliation(s)
- Mallory Roberts
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - Peter Jin
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Susan Shin
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
| | - Mandip Dhamoon
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY; and
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Barbagallo G, Caggiula M, Lupo A, Rizzo A, My F, Marulli D, Barbarini L. Recurrent Miller-Fisher syndrome overlapping Guillain-Barrè syndrome and Bickerstaff brainstem encephalitis: A case report. Clin Neurol Neurosurg 2021; 206:106691. [PMID: 34022690 DOI: 10.1016/j.clineuro.2021.106691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/11/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Abstract
Miller-Fisher syndrome (MFS) together with Guillan-Barré syndrome (GBS) and Bickerstaff brainstem encephalitis (BBE) are considered to form a continuous clinical spectrum of the same disease, possibly affecting the peripheral and/or central nervous systems, with monophasic symptoms. The frequency of overlapping clinical signs and the risk of recurrence are independent and very low, but no cases of GQ1b-seropositive recurrent MFS overlapping with GBS and BBE have been described so far. Here, we describe for the first time an atypical case of recurrent GQ1b-seropositive MFS overlapping GBS and BBE, 12 years after a previous GQ1b-seronegative typical MFS episode. Our case expands the clinical spectrum of recurrent MFS, and it should prompt clinicians to investigate the presence of anti-ganglioside antibodies in recurrent MFS even when these were negative in the previous episode, especially in those presenting with overlapping spectrum symptoms and a critically ill picture during the second episode.
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Affiliation(s)
| | | | - Angela Lupo
- Division of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Annalisa Rizzo
- Division of Neurology, Vito Fazzi Hospital, Lecce, Italy
| | - Filomena My
- Division of Neurology, Vito Fazzi Hospital, Lecce, Italy
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Relapsing Bickerstaff Brainstem Encephalitis After Autologous Stem Cell Transplant. J Clin Neuromuscul Dis 2021; 21:225-229. [PMID: 32453098 DOI: 10.1097/cnd.0000000000000282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bickerstaff brainstem encephalitis, widely considered to be associated with Miller Fisher and Guillain-Barré syndromes, is a rare disease state defined by the triad of ophthalmoplegia, ataxia, and decreased consciousness. The presence of central nervous system involvement, commonly in the form of impaired arousal, solidifies it as a unique entity. We present a case of this rare syndrome after autologous stem cell transplant.
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18
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Classic and overlapping Miller-Fisher syndrome: clinical and electrophysiological features in Mexican adults. Neurol Sci 2021; 42:4225-4229. [PMID: 33594537 DOI: 10.1007/s10072-020-05029-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022]
Abstract
Classic and overlapping Miller-Fisher syndrome (MFS) have divergent clinical courses. Few studies have addressed the electrophysiological evaluation of MFS patients, most of them carried out in Asia. This work describes and compares their clinical and neurophysiological characteristics. From a Guillain-Barré syndrome (GBS) patient cohort, we made a selection of twenty MFS cases. We defined classic and overlapping MFS, as stated by Wakerley et al. (Nat Rev Neurol 10(9):537-544, 2014). We describe and compare clinical, biochemical, and electrodiagnostic parameters between groups. Seventy-five percent were men, mean age was 42.2 ± 13.6 years, and 45% had a Hughes score ≥ 3. MFS/GBS was the most frequent clinical subtype with 50%. Almost one-third had unaltered electrophysiological studies. Comparative analysis between groups showed statistically significant differences in length of stay, dysautonomia presence, and treatment type. Kaplan-Meier survival analysis showed that 100% of the patients had an independent walk at 3 months. This study reports Mexican MFS patient's characteristics and represents the most extensive case series in Latin America. We observed a high proportion of overlapping syndromes, a good recovery profile, and no significant severe complications.
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Morena J, Elsheikh B, Hoyle JC. Recurrent Miller Fisher: A Case Report Along With a Literature and an EMG/NCS Review. Neurohospitalist 2021; 11:263-266. [PMID: 34163555 DOI: 10.1177/1941874420987053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
MFS has been reported to recur in 10-12% of patients. There may be a genetic component related to HLA-DR2. Anti-GAD antibodies can be present in MFS along with anti-GQ1b. Common EMG/NCS associations consist of a predominantly axonal, sensory polyneuropathy and absent H reflexes. A 32-year-old female with a history of hypothyroidism presented to our institution twice with symptoms of diplopia, lower extremity weakness and distal paresthesias occurring a year apart. She had ophthalmoplegia, reduced reflexes, and ataxia on exam. CSF showed a borderline elevated protein of 47 and white blood cells <3. She was positive for anti-GQ1b both times. Her anti-GAD65 antibody was elevated during both admissions. EMG/NCS on her first admission revealed comparatively reduced sensory nerve action potentials (SNAPs) and a normal blink reflex. Her SNAPs improved on the second admission, however, the EMG was performed only 2 days after the onset of her symptoms, limiting some early findings that may have not matured electrophysiologically. She was treated with IVIG on both occasions with rapid recovery within 5 days. This case highlights the fact that MFS can be recurrent. It also provides further evidence that anti-GAD antibodies may be associated with MFS. Reported findings of the blink reflex in MFS are diverse and further data is needed to determine if certain findings are more predominant than others. Treatment typically consists of IVIG, though steroids may also be considered for recurrence. Prognosis is generally favorable, regardless of treatment.
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Affiliation(s)
- Jonathan Morena
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - Bakri Elsheikh
- Department of Neurology, The Ohio State University, Columbus, OH, USA
| | - J Chad Hoyle
- Department of Neurology, The Ohio State University, Columbus, OH, USA
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Palakkuzhiyil N, Taggu A, Saleem S, Uvais NA. Anti-GQ1b IgG and Anti GD1b IgG Positive Recurrent Miller Fisher Syndrome. Ann Indian Acad Neurol 2020; 23:729-730. [PMID: 33623289 PMCID: PMC7887503 DOI: 10.4103/aian.aian_253_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 08/10/2020] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Alai Taggu
- Department of Critical Care, Al Qusais, Dubai, United Arab Emirates
| | - Sharmina Saleem
- Department of Pathology and Laboratory Medicine, Al Qusais, Dubai, United Arab Emirates
| | - N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
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21
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López-Hernández JC, Colunga-Lozano LE, Garcia-Trejo S, Gomez-Figueroa E, Delgado-Garcia G, Bazán-Rodríguez L, Cervantes-Uribe R, Burgos-Centeno J, Fernandez-Valverde F, Vargas-Cañas ES. Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with Guillain-Barré syndrome, a single center experience. J Clin Neurosci 2020; 80:292-297. [PMID: 32674942 DOI: 10.1016/j.jocn.2020.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/12/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The clinical characteristics of electrophysiological subtypes and prognostic factors of Mexican adults diagnosed with Guillain-Barré Syndrome (GBS) have not been described. MATERIALS AND METHODS A single center, ambispective, cohort study was performed (2015-2019). GBS was defined following the Asbury and Cornblath criteria. Electrodiagnosis was made according to Hadden criteria. Clinical, biochemical and electrodiagnostic parameters were described, compared and analyzed using a multivariate model. Only patients who completed a 3-month follow-up were included. RESULTS 137 GBS patients (92 males; mean age 46.6 ± 16.6).132 (96.3%) underwent an electrodiagnostic assessment.68 (51.5%) were classified as axonal GBS, with further classified into two groups: acute motor axonal neuropathy (AMAN) 45.4%, and acute motor and sensory axonal neuropathy (AMSAN) 8,6%. The following characteristics were lower in the AMAN group: Medical Research Counsel sumscore (MRC) 30.1 ± 16.3 vs 36.4 ± 14.4, unilateral facial palsy 10% vs 25.9% and albuminocytologic dissociation 41.3% vs. 71.7%.Multivariate analysis found AMAN as an independent predictor of an unfavorable outcome OR: 3.34 (p = 0.03) CONCLUSIONS: AMAN subtype is the most frequent presentation of GBS in Mexican adult patients and an independent predictor of inability to walk independently at 3 months after discharge.
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Affiliation(s)
| | | | - Sofia Garcia-Trejo
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Enrique Gomez-Figueroa
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - Lisette Bazán-Rodríguez
- Department of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Roberto Cervantes-Uribe
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Jorge Burgos-Centeno
- Department of Clincal Neuphysiology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | | | - Edwin Steven Vargas-Cañas
- Neuromuscular Disease Clinic, National Institute of Neurology and Neurosurgery, Mexico City, Mexico.
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A Probable Case of Recurrent Bickerstaff Brainstem Encephalitis With Fulminant Course in a Pediatric Patient. Neurologist 2020; 25:14-16. [PMID: 31876654 DOI: 10.1097/nrl.0000000000000255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Bickerstaff brainstem encephalitis is a rare, often postinfectious, syndrome characterized by the clinical triad of ophthalmoplegia, ataxia, and altered consciousness. Here, we present a probable case of recurrent, pediatric Bickerstaff encephalitis, whereby the patient acutely developed loss of consciousness and eventually brain death despite optimal management. CASE REPORT A 3-year-old male patient initially presented to the emergency department with progressive ataxia, following history of upper respiratory tract infection. He deteriorated within 12 hours of hospitalization, requiring cardiopulmonary resuscitation. The patient had decreased consciousness thereafter, showing minimal signs of brain activity. He was then deemed to be suffering a second episode of Bickerstaff encephalitis, the first being a year prior, and intravenous immunoglobulins were administered immediately. Magnetic resonance imaging of the brain on day 2 of admission showed signs of diffuse, bilateral encephalitis in the brainstem, thalami, and basal ganglia. Brain death was confirmed on day 11 of admission, following 2 brain death examinations. CONCLUSION Although Bickerstaff brainstem encephalitis tends to involve the brainstem, outcomes of brain death have been rarely reported, even more so in the pediatric age group. This case report sheds light on, possibly, the first reported fatality of Bickerstaff encephalitis among children.
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Mayer JE, McNamara CA, Mayer J. Miller Fisher syndrome and Guillain-Barré syndrome: dual intervention rehabilitation of a complex patient case. Physiother Theory Pract 2020; 38:245-254. [DOI: 10.1080/09593985.2020.1736221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Jill E. Mayer
- Department of Physical Therapy, Ithaca College, Ithaca, NY, USA
| | | | - John Mayer
- Inpatient Therapy Department, Cayuga Medical Center, Ithaca, NY, USA
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Shang P, Zhu M, Wang Y, Zheng X, Wu X, Zhu J, Feng J, Zhang HL. Axonal variants of Guillain-Barré syndrome: an update. J Neurol 2020; 268:2402-2419. [PMID: 32140865 DOI: 10.1007/s00415-020-09742-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 12/11/2022]
Abstract
Axonal variants of Guillain-Barré syndrome (GBS) mainly include acute motor axonal neuropathy, acute motor and sensory axonal neuropathy, and pharyngeal-cervical-brachial weakness. Molecular mimicry of human gangliosides by a pathogen's lipooligosaccharides is a well-established mechanism for Campylobacter jejuni-associated GBS. New triggers of the axonal variants of GBS (axonal GBS), such as Zika virus, hepatitis viruses, intravenous administration of ganglioside, vaccination, and surgery, are being identified. However, the pathogenetic mechanisms of axonal GBS related to antecedent bacterial or viral infections other than Campylobacter jejuni remain unknown. Currently, autoantibody classification and serial electrophysiology are cardinal approaches to differentiate axonal GBS from the prototype of GBS, acute inflammatory demyelinating polyneuropathy. Newly developed technologies, including metabolite analysis, peripheral nerve ultrasound, and feature selection via artificial intelligence are facilitating more accurate diagnosis of axonal GBS. Nevertheless, some key issues, such as genetic susceptibilities, remain unanswered and moreover, current therapies bear limitations. Although several therapies have shown considerable benefits to experimental animals, randomized controlled trials are still needed to validate their efficacy.
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Affiliation(s)
- Pei Shang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Mingqin Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Ying Wang
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiangyu Zheng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Xiujuan Wu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jie Zhu
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Jiachun Feng
- Department of Neurology, First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Shuangqing Road 83#, Beijing, 100085, China.
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Ayas ZÖ, Aras YG, Güngen BD. An Unusual Recurrence of Miller Fisher Syndrome: Three Times in Eight Years. ACTA ACUST UNITED AC 2020; 57:78-79. [PMID: 32110156 DOI: 10.29399/npa.22871] [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: 08/18/2017] [Accepted: 12/12/2017] [Indexed: 11/07/2022]
Abstract
Miller Fisher Syndrome (MFS) is an acute, autoimmune polyneuropathy usually associated with a good prognosis which is clinically characterized by ataxia, ophtalmoplegia, and areflexia. MFS has a monophasic course, double recurrence can be seen in rare cases. But three attacks are very rare. In this article, we discussed a rare case of MFS and approach to the treatment that recurred 3 times within a period of 8 years. It is emphasized that MFS cases may occur a recurring pattern, and plasma exchange should be definitely tried as a therapeutic approach when clinical deterioration occurs under intravenous immunoglobulin (IVIg) therapy.
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Affiliation(s)
- Zeynep Özözen Ayas
- Sakarya University Training and Research Hospital, Department of Neurology, Sakarya, Turkey
| | - Yeşim Güzey Aras
- Sakarya University Training and Research Hospital, Department of Neurology, Sakarya, Turkey
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Fang X, Huda R. Acute Flaccid Myelitis: Current Status and Diagnostic Challenges. J Clin Neurol 2020; 16:376-382. [PMID: 32657057 PMCID: PMC7354978 DOI: 10.3988/jcn.2020.16.3.376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/15/2020] [Accepted: 01/17/2020] [Indexed: 01/07/2023] Open
Abstract
Acute flaccid myelitis (AFM) is a sudden-onset polio-like neuromuscular disability found commonly in young children. There is an increasing incidence of confirmed AFM cases in the USA and other countries in recent years, and in association with nonpolio enterovirus infection. This represents a significant challenge to clinicians and causes significant concern to the general public. Acute flaccid paralysis (AFP) is the long-known limb paralytic syndrome caused by a viral pathogen. AFM is a subset of AFP that is also characterized by a limb paralytic condition, but it has certain distinct features such as lesions in magnetic resonance imaging of the spinal cord gray matter. AFM leads to spinal cord, brainstem, or motor neuron dysfunction. The clinical phenotypes, pathology, and patient presentation of AFM closely mimic AFP. This article provides a concise overview of our current understanding of AFM and the clinical features that distinguish AFM from AFP and similar other neurological infectious and autoimmune diseases or disorders. We also discuss the diagnosis, clinical pathology, possible pathogenetic mechanisms, and currently available therapies.
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Affiliation(s)
- Xiang Fang
- Department of Neurology, University of Texas Medical Branch, Galveston, TX, USA.
| | - Ruksana Huda
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, USA.
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Vaccines and the risk of Guillain-Barré syndrome. Eur J Epidemiol 2019; 35:363-370. [PMID: 31858323 DOI: 10.1007/s10654-019-00596-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/11/2019] [Indexed: 02/05/2023]
Abstract
The role of vaccination in the development of Guillain-Barré syndrome (GBS) is controversial, although cases of GBS have been reported following a wide range of vaccines. A nested case-control study was conducted between January 2011 and December 2015 in three Chinese cities. Four controls were matched to a case by gender, age, address and index date. An independent expert committee validated the diagnoses of cases and controls according to the Brighton Collaboration GBS case definition. Data on vaccinations were obtained from computerized vaccination records. Causal relations were assessed by conditional logistic regression. 1056 cases of GBS and 4312 controls were included in the analyses. Among paediatric and adult population, adjusted ORs for GBS occurrence within 180 days following vaccination were 0.94 (95% CI 0.54-1.62) and 1.09 (95% CI 0.88-1.32), respectively. No increased risk of GBS was detected for vaccination against hepatitis B, influenza, hepatitis A, varicella, rabies, polio(live), diphtheria, pertuss(acellular), tetanusis, measles, mumps, rubella, Japanese Encephalitis, and meningitis vaccines. Adjusted ORs for the recurrence of GBS after vaccination among paediatric and adult population were 0.85 (95% CI 0.07-9.50) and 1.18 (95% CI 0.49-2.65), respectively. In this large retrospective study, we did not find evidence of an increased risk of GBS and its recurrence among either paediatric (≤ 18 years) or adult (> 18 years) individuals within the 180 days following vaccinations of any kind, including influenza vaccination.
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Abstract
PURPOSE OF REVIEW The clinical presentation of Guillain-Barré syndrome (GBS) is highly variable, which can make the diagnosis challenging. Intravenous immunoglobulin (IVIg) and plasma exchange are the cornerstones of treatment since decades. But despite these treatments, 25% initially progress in muscle weakness, 25% require artificial ventilation, 20% is still not able to walk independently after 6 months, and 2-5% die, emphasizing the need for better treatment. We summarize new developments regarding the diagnosis, prognosis, and management of GBS. RECENT FINDINGS GBS is a clinical diagnosis that can be supported by cerebrospinal fluid examination and nerve conduction studies. Nerve ultrasound and MRI are potentially useful techniques to diagnose inflammatory neuropathies. Several novel infections have recently been associated to GBS. Evidence from experimental studies and recent phase 2 clinical trials suggests that complement inhibition combined with IVIg might improve outcome in GBS, but further studies are warranted. Prognostic models could guide the selection of patients with a relatively poor prognosis that might benefit most from additional IVIg or otherwise intensified treatment. SUMMARY New diagnostic tools may help to have early and accurate diagnosis in difficult GBS cases. Increased knowledge on the pathophysiology of GBS forms the basis for development of new, targeted, and personalized treatments that hopefully improve outcome.
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Anti-ganglioside complex antibody profiles in a recurrent complicated case of GQ1b-seronegative miller fisher syndrome and Bickerstaff brainstem encephalitis: a case report. BMC Neurol 2018; 18:72. [PMID: 29792178 PMCID: PMC5966867 DOI: 10.1186/s12883-018-1077-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 05/16/2018] [Indexed: 02/07/2023] Open
Abstract
Background Guillain-Barré syndrome (GBS), Miller Fisher syndrome (MFS) and Bickerstaff brainstem encephalitis (BBE) are a group of autoimmune neurological disorders (GBS spectrum disorder) that rarely recur. Recently, anti-ganglioside complex antibodies (GSC-Abs) were identified in patients with GBS spectrum disorder. However, there has been no case report describing GSC-Abs profiles in a recurrent case showing different phenotypes. Case presentation We report the case of a 33-year-old male patient with GQ1b-seronegative BBE-GBS after two prior episodes of MFS-GBS. Our patient showed ophthalmoplegia, ataxia, areflexia and a weakness of the extremities (MFS and GBS symptoms) in all episodes. In the episode reported here, our patient showed disturbed consciousness and an extensor response to cutaneous plantar stimulation was observed (BBE symptoms), with severe disability and requirement for artificial respiration management. GSC-Abs detected in previous episodes were also detected in the subsequent episodes, while new GSC-Abs emerged in each episode. Interestingly, whereas antibodies to GA1/GQ1b and GA1/GT1a, which are commonly identified in patients with GBS, MFS or BBE, appeared in all episodes, antibodies to GD1a/GD1b and GD1b/GT1b, which are predominantly associated with severe disability and the requirement for artificial respiration management in GBS, emerged for the first time in this episode. Conclusion This study reports novel phenomena about the GSC-Abs profiles and its relationship with clinical features in a case with recurrent GBS spectrum disorder, showing different phenotypes in different episodes. Further studies are required to reveal the significance of the GSC-Abs profiles in recurrent GBS spectrum disorder.
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Takahashi H, Kimura T, Yuki N, Yoshioka A. An Adult Case of Recurrent Guillain-Barré Syndrome with Anti-galactocerebroside Antibodies. Intern Med 2018; 57:409-412. [PMID: 29093388 PMCID: PMC5827325 DOI: 10.2169/internalmedicine.8941-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/15/2017] [Indexed: 11/06/2022] Open
Abstract
A 79-year-old woman with a history of Guillain-Barré syndrome (GBS) developed somnolence and tetraparesis after pneumonia. Based on clinical and laboratory findings, she was diagnosed with complications of acute inflammatory demyelinating polyneuropathy (AIDP) and acute disseminated encephalomyelitis (ADEM). Anti-galactocerebroside (Gal-C) IgG antibodies were detected in her serum. Cases of recurrent GBS in patients who are positive for this antibody are extremely rare. The anti-Gal-C IgG antibodies likely played an important role in the pathogenesis of the AIDP and ADEM.
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Affiliation(s)
- Hisashi Takahashi
- Department of Neurology, National Hospital Organization Maizuru Medical Center, Japan
| | - Tadashi Kimura
- Department of Neurology, National Hospital Organization Maizuru Medical Center, Japan
| | - Natsuko Yuki
- Department of Neurology, National Hospital Organization Maizuru Medical Center, Japan
| | - Akira Yoshioka
- Department of Clinical Research, National Hospital Organization Maizuru Medical Center, Japan
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Abstract
A man aged 30 years presented to the emergency department (ED) with ataxia, areflexia, facial weakness, ophthalmoplegia, extremity weakness and back pain for 4 days. 4 days prior to attending the ED, the patient had suffered from diarrhoea for 2 weeks. The diagnosis of Miller Fisher syndrome was performed on the dual basis of clinical features in addition to an investigations report. Nerve conduction studies and anti-GQ1b IgG antibody analysis were requested. Once IgA deficiency was ruled out, the patient was started on intravenous immunoglobulin (400 mg/kg/day).
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Affiliation(s)
- Suresh Kumar Gupta
- Department of Internal Medicine/Geriatrics, Forest Glen Medical Center, Silver Spring, Tennessee, USA
| | - Kunal Kishor Jha
- Critical Care Medicine, Geisinger Medical Center, Danville, Pennsylvania, USA
| | - Mhd Diaa Chalati
- Department of Internal Medicine, University of Sharjah College of Medicine, Sharjah, United Arab Emirates
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