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Zhang W, Tao W, Wang J, Nie P, Duan L, Yan L. A study on the role of serum uric acid in differentiating acute inflammatory demyelinating polyneuropathy from acute-onset chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16222. [PMID: 38356316 DOI: 10.1111/ene.16222] [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: 09/18/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE Clinical symptoms and laboratory indices for acute inflammatory demyelinating polyneuropathy (AIDP), a variant of Guillain-Barré syndrome, and acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) were analyzed to identify factors that could contribute to early differential diagnosis. METHODS A retrospective chart review was performed on 44 AIDP and 44 A-CIDP patients looking for any demographic characteristics, clinical manifestations or laboratory parameters that might differentiate AIDP from acutely presenting CIDP. RESULTS In Guillain-Barré syndrome patients (N = 63), 69.84% (N = 44) were classified as having AIDP, 19.05% (N = 12) were found to have acute motor axonal neuropathy, 6.35% (N = 4) were found to have acute motor and sensory axonal neuropathy, and 4.76% (N = 3) were found to have Miller Fisher syndrome. Serum uric acid (UA) was higher in A-CIDP patients (329.55 ± 72.23 μmol/L) than in AIDP patients (221.08 ± 71.32 μmol/L) (p = 0.000). Receiver operating characteristic analyses indicated that the optimal UA cutoff was 283.50 μmol/L. Above this level, patients were more likely to present A-CIDP than AIDP (specificity 81.80%, sensitivity 81.80%). During the follow-up process, serum samples were effectively collected from 19 AIDP patients during the rehabilitation phase and 28 A-CIDP patients during the remission stage, and it was found that UA levels were significantly increased in A-CIDP (remission) (298.9 ± 90.39 μmol/L) compared with AIDP (rehabilitation) (220.1 ± 108.2 μmol/L, p = 0.009). CONCLUSION These results suggest that serum UA level can help to differentiate AIDP from A-CIDP with high specificity and sensitivity, which is helpful for early diagnosis and guidance of treatment.
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Affiliation(s)
- Weiyun Zhang
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Wen Tao
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jun Wang
- Key Lab of Modern Toxicology, Ministry of Education, and Department of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ping Nie
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lihui Duan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lanyun Yan
- Department of Neurology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
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Sarıkaya Uzan G, Vural A, Yüksel D, Aksoy E, Öztoprak Ü, Canpolat M, Öztürk S, Yıldırım Ç, Güleç A, Per H, Gümüş H, Okuyaz Ç, Çobanoğulları Direk M, Kömür M, Ünalp A, Yılmaz Ü, Bektaş Ö, Teber S, Aliyeva N, Olgaç Dündar N, Gençpınar P, Gürkaş E, Keskin Yılmaz S, Kanmaz S, Tekgül H, Aksoy A, Öz Tuncer G, Acar Arslan E, Tosun A, Ayanoğlu M, Kızılırmak AB, Yousefi M, Bodur M, Ünay B, Hız Kurul S, Yiş U. Pediatric-Onset Chronic Inflammatory Demyelinating Polyneuropathy: A Multicenter Study. Pediatr Neurol 2023; 145:3-10. [PMID: 37245275 DOI: 10.1016/j.pediatrneurol.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND To evaluate the clinical features, demographic features, and treatment modalities of pediatric-onset chronic inflammatory demyelinating polyneuropathy (CIDP) in Turkey. METHODS The clinical data of patients between January 2010 and December 2021 were reviewed retrospectively. The patients were evaluated according to the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society Guideline on the management of CIDP (2021). In addition, patients with typical CIDP were divided into two groups according to the first-line treatment modalities (group 1: IVIg only, group 2: IVIg + steroid). The patients were further divided into two separate groups based on their magnetic resonance imaging (MRI) characteristics. RESULTS A total of 43 patients, 22 (51.2%) males and 21 (48.8%) females, were included in the study. There was a significant difference between pretreatment and post-treatment modified Rankin scale (mRS) scores (P < 0.05) of all patients. First-line treatments include intravenous immunoglobulin (IVIg) (n = 19, 44.2%), IVIg + steroids (n = 20, 46.5%), steroids (n = 1, 2.3%), IVIg + steroids + plasmapheresis (n = 1, 2.3%), and IVIg + plasmapheresis (n = 1, 2.3%). Alternative agent therapy consisted of azathioprine (n = 5), rituximab (n = 1), and azathioprine + mycophenolate mofetil + methotrexate (n = 1). There was no difference between the pretreatment and post-treatment mRS scores of groups 1 and 2 (P > 0.05); however, a significant decrease was found in the mRS scores of both groups with treatment (P < 0.05). The patients with abnormal MRI had significantly higher pretreatment mRS scores compared with the group with normal MRI (P < 0.05). CONCLUSIONS This multicenter study demonstrated that first-line immunotherapy modalities (IVIg vs IVIg + steroids) had equal efficacy for the treatment of patients with CIDP. We also determined that MRI features might be associated with profound clinical features, but did not affect treatment response.
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Affiliation(s)
- Gamze Sarıkaya Uzan
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
| | - Atay Vural
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey; Department of Neurology, Koç University School of Medicine, İstanbul, Turkey
| | - Deniz Yüksel
- Faculty of Medicine, Department of Pediatric Neurology, Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Erhan Aksoy
- Faculty of Medicine, Department of Pediatric Neurology, Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ülkühan Öztoprak
- Faculty of Medicine, Department of Pediatric Neurology, Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Canpolat
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Selcan Öztürk
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Çelebi Yıldırım
- Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ayten Güleç
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hüseyin Per
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Gümüş
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Çetin Okuyaz
- Division of Child Neurology, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Meltem Çobanoğulları Direk
- Division of Child Neurology, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Mustafa Kömür
- Division of Child Neurology, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Aycan Ünalp
- Division of Pediatric Neurology, Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Division of Pediatric Neurology, Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Ömer Bektaş
- Division of Child Neurology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Division of Child Neurology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nargiz Aliyeva
- Division of Pediatric Neurology, Department of Pediatrics, University of Health Sciences Tepecik Research and Training Hospital, İzmir, Turkey
| | - Nihal Olgaç Dündar
- Division of Child Neurology, Department of Pediatrics, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Pınar Gençpınar
- Division of Child Neurology, Department of Pediatrics, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Esra Gürkaş
- Department of Pediatric Neurology, Children's Hospital, Ankara City Hospital, Ankara, Turkey
| | - Sanem Keskin Yılmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Seda Kanmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hasan Tekgül
- Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Aksoy
- Division of Child Neurology, Department of Pediatrics, On Dokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Gökçen Öz Tuncer
- Division of Child Neurology, Department of Pediatrics, On Dokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Elif Acar Arslan
- Division of Child Neurology, Department of Pediatrics, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ayşe Tosun
- Division of Child Neurology, Department of Pediatrics, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Müge Ayanoğlu
- Division of Child Neurology, Department of Pediatrics, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Burak Kızılırmak
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Mohammadreza Yousefi
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Muhittin Bodur
- Division of Child Neurology, Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Bülent Ünay
- Gülhane Faculty of Medicine, Department of Pediatric Neurology, University of Health Sciences, Ankara, Turkey
| | - Semra Hız Kurul
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Uluç Yiş
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Alessandro L, Pastor Rueda JM, Wilken M, Querol L, Marrodán M, Acosta JN, Rivero A, Barroso F, Farez MF. Differences between acute-onset chronic inflammatory demyelinating polyneuropathy and acute inflammatory demyelinating polyneuropathy in adult patients. J Peripher Nerv Syst 2018; 23:154-158. [PMID: 29603827 DOI: 10.1111/jns.12266] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022]
Abstract
Acute inflammatory demyelinating polyneuropathy (AIDP) and acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) are conditions presenting overlapping clinical features during early stages (first 4 weeks), although the latter may progress after 8 weeks. The aim of this study was to identify predictive factors contributing to their differential diagnosis. Clinical records of adult patients with AIDP or A-CIDP diagnosed at our institution between January 2006 and July 2017 were retrospectively reviewed. Demographic characteristics, clinical manifestations, cerebrospinal-fluid (CSF) findings, treatment and clinical evolution were analyzed. Nerve conduction studies were performed in all patients with at least 12 months follow-up. A total of 91 patients were included (AIDP, n = 77; A-CIDP, n = 14). The median age was 55.5 years in patients with A-CIDP vs 43 years in AIDP (P = .07). The history of diabetes mellitus was more frequent in A-CIDP (29% vs 8%, P = .04). No significant differences between groups were observed with respect to: human immunodeficiency virus (HIV) status, presence of auto-immune disorder or oncologic disease. Cranial, motor and autonomic nerve involvement rates were similar in both groups. Patients in the A-CIDP group showed higher frequency of proprioceptive disturbances (83% vs 28%; P < .001), sensory ataxia (46% vs 16%; P = .01), and the use of combined immunotherapy with corticoids (29% vs 3%; P = .005). There were no significant differences in CSF findings, intensive care unit (ICU) admission, or mortality rates. During the first 8 weeks both entities are practically indistinguishable. Alterations in proprioception could suggest A-CIDP. Searching for markers that allow early differentiation could favor the onset of corticotherapy without delay.
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Affiliation(s)
- Lucas Alessandro
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - José M Pastor Rueda
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Miguel Wilken
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Luis Querol
- Department of Neurology, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - Mariano Marrodán
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Julián N Acosta
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Alberto Rivero
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Fabio Barroso
- Department of Neurology, Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases (CIEN), Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina.,Center for Epidemiology, Biostatistics, and Public Health (CEBES), Raúl Carrea Institute for Neurological Research (FLENI), Buenos Aires, Argentina
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Bonin S, Zanotta N, Sartori A, Bratina A, Manganotti P, Trevisan G, Comar M. Cerebrospinal Fluid Cytokine Expression Profile in Multiple Sclerosis and Chronic Inflammatory Demyelinating Polyneuropathy. Immunol Invest 2017; 47:135-145. [DOI: 10.1080/08820139.2017.1405978] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Serena Bonin
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Nunzia Zanotta
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
| | - Arianna Sartori
- Unit of Neurology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alessio Bratina
- Unit of Neurology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Unit of Neurology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Giusto Trevisan
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Unit of Neurology, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Manola Comar
- Department of Medical Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste, Italy
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Kuitwaard K, Fokkink WJR, Brusse E, Vrancken AFJE, Eftimov F, Notermans NC, van der Kooi AJ, Merkies ISJ, Jacobs BC, van Doorn PA. Maintenance IV immunoglobulin treatment in chronic inflammatory demyelinating polyradiculoneuropathy. J Peripher Nerv Syst 2017; 22:425-432. [PMID: 29092099 DOI: 10.1111/jns.12242] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 12/27/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients treated with intravenous immunoglobulin (IVIg) usually start with a standard dosage of 2 g/kg bodyweight. Only a minority of patients has a sustained improvement, and most require ongoing maintenance treatment. Preferred IVIg regimens, however, vary considerably between doctors and at present it is unknown which is optimal. As there are also large differences in IVIg dosage and interval requirements between patients, optimal IVIg maintenance treatment of CIDP is even more complex. The lack of evidence-based guidelines on how IVIg maintenance treatment should be administered may potentially lead to under- or overtreatment of this expensive therapy. We provide an overview of published practical IVIg maintenance treatment regimens, IVIg maintenance schedules used in randomized controlled trials and one based upon our own long-term experience on how this treatment could be given in CIDP.
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Affiliation(s)
- Krista Kuitwaard
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Neurology, Albert Schweitzer Hospital, Dordrecht, The Netherlands
| | - Willem-Jan R Fokkink
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands.,Department of Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Esther Brusse
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Alexander F J E Vrancken
- Department of Neurology, Brain Center Rudolf Magnus University, Medical Center Utrecht, Utrecht, The Netherlands
| | - Filip Eftimov
- Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands
| | - Nicolette C Notermans
- Department of Neurology, Brain Center Rudolf Magnus University, Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Ingemar S J Merkies
- Department of Neurology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Neurology, St. Elisabeth Hospital, Willemstad, Curacao
| | - 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
| | - Pieter A van Doorn
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Levine AA, Levine TD, Clarke K, Saperstein D. Renal and hematologic side effects of long-term intravenous immunoglobulin therapy in patients with neurologic disorders. Muscle Nerve 2017; 56:1173-1176. [PMID: 28520084 DOI: 10.1002/mus.25693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2017] [Indexed: 01/25/2023]
Abstract
INTRODUCTION For patients receiving intravenous immunoglobulin (IVIg), renal and hemolytic side effects are well recognized. However, there are very few data on the effects of chronic IVIg therapy. METHODS We retrospectively analyzed laboratory data on 166 patients who received IVIg for 12 months with a dose range of 0.441-2.58 g/kg/month, measuring changes in hematocrit and glomerular filtration (GFR) rates at 6 and 12 months. RESULTS Of the 2,232 infusions, there were no incidents of clinical hemolysis. However, after 12 months of treatment, 21% of patients had a ≥3-g/dl decline in hematocrit and 10% had a ≥20% decline in GFR. DISCUSSION No clinically significant hemolysis was observed in patients receiving chronic IVIg therapy. However, a significant number of patients had a decline in hematocrit and/or GFR while on therapy. This emphasizes the need for observation of hematologic and renal function in patients treated with chronic IVIg. Muscle Nerve 56: 1173-1176, 2017.
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Affiliation(s)
- Aidan A Levine
- Phoenix Neurological Associates, 5090 North 40th Street, Suite 250, Phoenix, Arizona, USA
| | - Todd D Levine
- Phoenix Neurological Associates, 5090 North 40th Street, Suite 250, Phoenix, Arizona, USA
| | - Kathie Clarke
- Phoenix Neurological Associates, 5090 North 40th Street, Suite 250, Phoenix, Arizona, USA
| | - David Saperstein
- Phoenix Neurological Associates, 5090 North 40th Street, Suite 250, Phoenix, Arizona, USA
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