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Acerra GM, Bevilacqua L, Noioso CM, Valle PD, Serio M, Vinciguerra C, Piscosquito G, Toriello A, Vegezzi E, Gastaldi M, Barone P, Iovino A. Anti-pan-neurofascin nodopathy: cause of fulminant neuropathy. Neurol Sci 2024; 45:1755-1759. [PMID: 38190082 DOI: 10.1007/s10072-023-07297-4] [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: 09/11/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Abstract
Autoimmune nodopathies are inflammatory diseases of the peripheral nervous system with clinical and neurophysiological peculiar characteristics. In this nosological category, we find patients with autoantibodies against Neurofascin 140/186 and 155, Contactin1, and Caspr1 directed precisely towards nodal and paranodal structures. These antibodies are extremely rare and cause severe clinical symptoms. We describe the clinical case of a patient with autoimmune nodopathy caused by the coexistence of anti-neurofascin (NF) 186/140 and 155, characterized by progressive weakness in all limbs leading to tetraplegia, involving cranial nerves, and respiratory insufficiency. Response to first-line treatments was good followed by rapid dramatic clinical relapse. There are few reported cases of anti-pan NF neuropathy in the literature, and they present a clinical phenotype similar to our patient. In these cases, early recognition of clinical red flags of nodopathies and serial neurophysiological studies can facilitate the diagnosis. However, the severe clinical relapse suggests a possible early use of immunosuppressive therapies for this rare category of patients.
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Affiliation(s)
- Gabriella Maria Acerra
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy.
| | - Liliana Bevilacqua
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Ciro Maria Noioso
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Paola Della Valle
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Marina Serio
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Claudia Vinciguerra
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Giuseppe Piscosquito
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Antonella Toriello
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Elisa Vegezzi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Paolo Barone
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
| | - Aniello Iovino
- Department of Medicine and Surgery, Neurology Unit, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", University of Salerno, Salerno, Italy
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Fu J, Zhao C, Hou G, Liu X, Zheng M, Zhang Y, Zhang S, Zheng D, Zhang Y, Huang X, Ye S, Fan D. A case report of neuronal intranuclear inclusion disease with paroxysmal peripheral neuropathy-like onset lacking typical signs on diffusion-weighted imaging. Front Neurol 2023; 14:1117243. [PMID: 36846128 PMCID: PMC9950388 DOI: 10.3389/fneur.2023.1117243] [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: 12/06/2022] [Accepted: 01/24/2023] [Indexed: 02/12/2023] Open
Abstract
Background Neuronal intranuclear inclusion disease (NIID) is a slowly progressive neurodegenerative disease characterized by eosinophilic hyaline intranuclear inclusions and the GGC repeats in the 5'-untranslated region of NOTCH2NLC. The prevalent presence of high-intensity signal along the corticomedullary junction on diffusion-weighted imaging (DWI) helps to recognize this heterogeneous disease despite of highly variable clinical manifestations. However, patients without the typical sign on DWI are often misdiagnosed. Besides, there are no reports of NIID patients presenting with paroxysmal peripheral neuropathy-like onset to date. Case presentation We present a patient with NIID who suffered recurrent transient numbness in arms for 17 months. Magnetic resonance imaging (MRI) showed diffuse, bilateral white matter lesions without typical subcortical DWI signals. Electrophysiological studies revealed mixed demyelinating and axonal sensorimotor polyneuropathies involving four extremities. After excluding differential diagnosis of peripheral neuropathy through body fluid tests and a sural nerve biopsy, NIID was confirmed by a skin biopsy and the genetic analysis of NOTCH2NLC. Conclusion This case innovatively demonstrates that NIID could manifest as paroxysmal peripheral neuropathy-like onset, and addresses the electrophysiological characteristics of NIID in depth. We broaden the clinical spectrum of NIID and provide new insights into its differential diagnosis from the perspective of peripheral neuropathy.
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Affiliation(s)
- Jiayu Fu
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Chen Zhao
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Guanghao Hou
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiaoxuan Liu
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Mei Zheng
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Yingshuang Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shuo Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Danfeng Zheng
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Yixuan Zhang
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Xiao Huang
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Shan Ye
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, Beijing, China,Beijing Municipal Key Laboratory of Biomarker and Translational Research in Neurodegenerative Diseases, Beijing, China,*Correspondence: Dongsheng Fan ✉
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Laughlin RS, Rubin DI. Electrodiagnosis. Neurol Clin 2022; 41:45-60. [DOI: 10.1016/j.ncl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Bu Y, Prince J, Mojtahed H, Kimball D, Shah V, Coleman T, Sarkar M, Rao R, Huang M, Schwindt P, Borna A, Lerman I. Peripheral Nerve Magnetoneurography With Optically Pumped Magnetometers. Front Physiol 2022; 13:798376. [PMID: 35370794 PMCID: PMC8975546 DOI: 10.3389/fphys.2022.798376] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Electrodiagnosis is routinely integrated into clinical neurophysiology practice for peripheral nerve disease diagnoses, such as neuropathy, demyelinating disorders, nerve entrapment/impingement, plexopathy, or radiculopathy. Measured with conventional surface electrodes, the propagation of peripheral nerve action potentials along a nerve is the result of ionic current flow which, according to Ampere’s Law, generates a small magnetic field that is also detected as an “action current” by magnetometers, such as superconducting quantum interference device (SQUID) Magnetoencephalography (MEG) systems. Optically pumped magnetometers (OPMs) are an emerging class of quantum magnetic sensors with a demonstrated sensitivity at the 1 fT/√Hz level, capable of cortical action current detection. But OPMs were ostensibly constrained to low bandwidth therefore precluding their use in peripheral nerve electrodiagnosis. With careful OPM bandwidth characterization, we hypothesized OPMs may also detect compound action current signatures consistent with both Sensory Nerve Action Potential (SNAP) and the Hoffmann Reflex (H-Reflex). In as much, our work confirms OPMs enabled with expanded bandwidth can detect the magnetic signature of both the SNAP and H-Reflex. Taken together, OPMs now show potential as an emerging electrodiagnostic tool.
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Affiliation(s)
- Yifeng Bu
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Jacob Prince
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Hamed Mojtahed
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Donald Kimball
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | | | - Todd Coleman
- Department of Bioengineering, Stanford University, Stanford, CA, United States
| | - Mahasweta Sarkar
- Electrical and Computer Engineering Department, San Diego State University, Stanford, CA, United States
| | - Ramesh Rao
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
| | - Mingxiong Huang
- Department of Radiology, Radiology Imaging Laboratory, University of California San Diego, San Diego, CA, United States
| | - Peter Schwindt
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, United States
| | - Amir Borna
- Quantum Information Sciences, Sandia National Laboratories, Albuquerque, NM, United States
| | - Imanuel Lerman
- Jacobs School of Engineering, Electrical and Computer Engineering, University of California San Diego, San Diego, CA, United States
- Department of Anesthesiology, Center for Pain Medicine, University of California San Diego, San Diego, CA, United States
- Veterans Health Administration, VA San Diego, Center for Stress and Mental Health, San Diego, CA, United States
- *Correspondence: Imanuel Lerman,
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