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Marrie RA, Maxwell CJ, Rotstein DL, Tsai CC, Tremlett H. Prodromes in demyelinating disorders, amyotrophic lateral sclerosis, Parkinson disease, and Alzheimer's dementia. Rev Neurol (Paris) 2024; 180:125-140. [PMID: 37567819 DOI: 10.1016/j.neurol.2023.07.002] [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: 05/29/2023] [Revised: 06/24/2023] [Accepted: 07/03/2023] [Indexed: 08/13/2023]
Abstract
A prodrome is an early set of symptoms, which indicates the onset of a disease; these symptoms are often non-specific. Prodromal phases are now recognized in multiple central nervous system diseases. The depth of understanding of the prodromal phase varies across diseases, being more nascent for multiple sclerosis for example, than for Parkinson disease or Alzheimer's disease. Key challenges when identifying the prodromal phase of a disease include the lack of specificity of prodromal symptoms, and consequent need for accessible and informative biomarkers. Further, heterogeneity of the prodromal phase may be influenced by age, sex, genetics and other poorly understood factors. Nonetheless, recognition that an individual is in the prodromal phase of disease offers the opportunity for earlier diagnosis and with it the opportunity for earlier intervention.
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Affiliation(s)
- R A Marrie
- Departments of Internal Medicine and Community Health Sciences, Rady Faculty of Health Sciences, Max-Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
| | - C J Maxwell
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - D L Rotstein
- Department of Medicine, University of Toronto, 6, Queen's Park Crescent West, 3rd floor, M5S 3H2 Toronto, Ontario, Canada; Saint-Michael's Hospital, 30, Bond Street, M5B 1W8 Toronto, Ontario, Canada
| | - C-C Tsai
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - H Tremlett
- Faculty of Medicine (Neurology), University of British Columbia, Vancouver, BC, Canada
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Zhang Y, Chen H, Shi Z, Du Q, Qiu Y, Zhao Z, Wang J, Yan C, Zhang Q, Yang M, Zhou H. AQP4-IgG may cause muscle damage in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 42:102126. [PMID: 32413837 DOI: 10.1016/j.msard.2020.102126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/31/2020] [Accepted: 04/12/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Muscle damage has been found in patients with neuromyelitis optica spectrum disorder (NMOSD), but whether this damage is related to aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) is uncertain. The aim of this study was to investigate the relationship between AQP4-IgG and muscle damage. METHODS From January 2009 to May 2019, we prospectively screened 1209 Chinese Han patients with acute transverse myelitis (ATM). Ultimately, we included 203 ATM patients in the cohort study and compared log serum creatine kinase (sCK) levels between positive and negative AQP4-IgG statuses. RESULTS Among all ATM patients, the mean log sCK levels of AQP4-IgG-positive patients were higher than those of AQP4-IgG-negative patients (4.46 ± 0.10 vs. 4.16 ± 0.06, p < 0.001). In addition, among ATM patients diagnosed with NMOSD, the mean log sCK levels of AQP4-IgG-positive patients were higher than those of AQP4-IgG-negative patients (4.46 ± 0.10 vs. 4.05 ± 0.13, p = 0.025). The number of extremely high sCK values (sCK values > 300 IU/L) was significantly higher in ATM patients positive for AQP4-IgG than in those negative for AQP4-IgG (p = 0.020). Furthermore, multivariable linear regression model analysis showed that male sex (coefficient [95% CI] = 0.548 [0.286, 0.809], p < 0.001), serum AQP4-IgG (coefficient [95% CI] = 0.462 [0.237, 0.687], p < 0.001), and combined connective tissue disease (CTD) (coefficient [95% CI] = -0.686 [-1.145, -0.226], p = 0.004) were independent predictors of log sCK levels. CONCLUSIONS Our study suggests that muscle damage in NMOSD patients may be associated with AQP4-IgG.
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Affiliation(s)
- Ying Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Qin Du
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Yuhan Qiu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Zhengyang Zhao
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Jiancheng Wang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Chao Yan
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China; Department of Neurology, Zigong Fourth People's Hospital, Zigong, Sichuan Province, China
| | - Qin Zhang
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Mu Yang
- Sichuan Cancer Hospital and Research Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan Province, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China.
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