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Korinthenberg R, Eckenweiler M, Fuchs H. Severe Locked-In-Like Guillain-Barré's Syndrome: Dilemmas in Diagnosis and Treatment. Neuropediatrics 2021; 52:19-26. [PMID: 33111302 DOI: 10.1055/s-0040-1715480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Guillain-Barré's syndrome in childhood can follow an atypical course, increasing the challenges in diagnosis and decisions regarding immunomodulatory treatment. Here, we report the case of on a 13-year-old boy with acute onset Guillain-Barré's syndrome progressing over 40 days to a very severe, locked-in-like syndrome despite intensive immunomodulatory treatment. After a plateau phase lasting 3 months and characterized by fluctuating signs of ongoing inflammatory disease activity, we were prompted to perform repeated and maintenance immunomodulatory treatment, which resulted in a continuous and nearly complete recovery of function. Atypical features at disease onset, the severe "total" loss of all peripheral and cranial nerve function, and an apparent late response to treatment give rise to reviewing the dilemmas of diagnosis and treatment in such severe and protracted courses of Guillain-Barré syndrome.
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Affiliation(s)
- Rudolf Korinthenberg
- Department of Neuropediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Matthias Eckenweiler
- Department of Neuropediatrics and Muscular Disorders, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
| | - Hans Fuchs
- Department of Pediatrics and Adolescent Medicine, Faculty of Medicine, University Medical Center, University of Freiburg, Freiburg, Germany
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2
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Moritz CP, Tholance Y, Stoevesandt O, Ferraud K, Camdessanché JP, Antoine JC. CIDP Antibodies Target Junction Proteins and Identify Patient Subgroups: An Autoantigenomic Approach. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/2/e944. [PMID: 33408168 PMCID: PMC7862091 DOI: 10.1212/nxi.0000000000000944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To discover systemic characteristics in the repertoires of targeted autoantigens in chronic inflammatory demyelinating polyneuropathy (CIDP), we detected the entire autoantigen repertoire of patients and controls and analyzed them systematically. METHODS We screened 43 human serum samples, of which 22 were from patients with CIDP, 12 from patients with other neuropathies, and 9 from healthy controls via HuProt Human Proteome microarrays testing about 16,000 distinct human bait proteins. Autoantigen repertoires were analyzed via bioinformatical autoantigenomic approaches: principal component analysis, analysis of the repertoire sizes in disease groups and clinical subgroups, and overrepresentation analyses using Gene Ontology and PantherDB. RESULTS The autoantigen repertoires enabled the identification of a subgroup of 10/22 patients with CIDP with a younger age at onset and a higher frequency of mixed motor and sensory CIDP. IV immunoglobulin therapy responders targeted 3 times more autoantigens than nonresponders. No CIDP-specific autoantibody is present in all patients; however, anchoring junction components were significantly targeted by 86.4% of patients with CIDP. There are potential novel CIDP-specific autoantigens such as the myelination- or axo-glial structure-related proteins actin-related protein 2/3 complex subunit 1B, band 4.1-like protein 2, cadherin-15, cytohesin-1, epidermal growth factor receptor, ezrin, and radixin. CONCLUSIONS The repertoire of targeted autoantigens of patients with CIDP differs in a systematic degree from those of controls. Systematic autoantigenomic approaches can help to understand the disease and to discover novel bioinformatical tools and novel autoantigen panels to improve diagnosis, treatment, prognosis, or patient stratification.
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Affiliation(s)
- Christian P Moritz
- From the Department of Neurology (C.P.M., K.F., J.-P.C., J.-C.A.), and Department of Biochemistry (Y.T.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (C.P.M., Y.T., J.-P.C., J.-C.A.), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, University of Lyon, University Jean-Monnet, Saint-Étienne, France; and Cambridge Protein Arrays Ltd. (O.S.), Babraham Research Campus, United Kingdom.
| | - Yannick Tholance
- From the Department of Neurology (C.P.M., K.F., J.-P.C., J.-C.A.), and Department of Biochemistry (Y.T.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (C.P.M., Y.T., J.-P.C., J.-C.A.), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, University of Lyon, University Jean-Monnet, Saint-Étienne, France; and Cambridge Protein Arrays Ltd. (O.S.), Babraham Research Campus, United Kingdom
| | - Oda Stoevesandt
- From the Department of Neurology (C.P.M., K.F., J.-P.C., J.-C.A.), and Department of Biochemistry (Y.T.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (C.P.M., Y.T., J.-P.C., J.-C.A.), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, University of Lyon, University Jean-Monnet, Saint-Étienne, France; and Cambridge Protein Arrays Ltd. (O.S.), Babraham Research Campus, United Kingdom
| | - Karine Ferraud
- From the Department of Neurology (C.P.M., K.F., J.-P.C., J.-C.A.), and Department of Biochemistry (Y.T.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (C.P.M., Y.T., J.-P.C., J.-C.A.), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, University of Lyon, University Jean-Monnet, Saint-Étienne, France; and Cambridge Protein Arrays Ltd. (O.S.), Babraham Research Campus, United Kingdom
| | - Jean-Philippe Camdessanché
- From the Department of Neurology (C.P.M., K.F., J.-P.C., J.-C.A.), and Department of Biochemistry (Y.T.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (C.P.M., Y.T., J.-P.C., J.-C.A.), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, University of Lyon, University Jean-Monnet, Saint-Étienne, France; and Cambridge Protein Arrays Ltd. (O.S.), Babraham Research Campus, United Kingdom
| | - Jean-Christophe Antoine
- From the Department of Neurology (C.P.M., K.F., J.-P.C., J.-C.A.), and Department of Biochemistry (Y.T.), University Hospital of Saint-Etienne; Synaptopathies and Autoantibodies (C.P.M., Y.T., J.-P.C., J.-C.A.), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, University of Lyon, University Jean-Monnet, Saint-Étienne, France; and Cambridge Protein Arrays Ltd. (O.S.), Babraham Research Campus, United Kingdom
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3
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Fisse AL, Motte J, Grüter T, Sgodzai M, Pitarokoili K, Gold R. Comprehensive approaches for diagnosis, monitoring and treatment of chronic inflammatory demyelinating polyneuropathy. Neurol Res Pract 2020; 2:42. [PMID: 33324942 PMCID: PMC7722337 DOI: 10.1186/s42466-020-00088-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common chronic inflammatory neuropathy. CIDP is diagnosed according to the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria, which combine clinical features with the electrophysiological evidence of demyelination. However, firstly, diagnosis is challenging, as some patients e.g. with severe early axonal damage do not fulfil the criteria. Secondly, objective and reliable tools to monitor the disease course are lacking. Thirdly, about 25% of CIDP patients do not respond to evidence-based first-line therapy. Recognition of these patients is difficult and treatment beyond first-line therapy is based on observational studies and case series only. Individualized immunomodulatory treatment does not exist due to the lack of understanding of essential aspects of the underlying pathophysiology. Novel diagnostic imaging techniques and molecular approaches can help to solve these problems but do not find enough implementation. This review gives a comprehensive overview of novel diagnostic techniques and monitoring approaches for CIDP and how these can lead to individualized treatment and better understanding of pathophysiology.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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4
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Oh SJ, Lu L, Alsharabati M, Morgan MB, King P. Chronic inflammatory axonal polyneuropathy. J Neurol Neurosurg Psychiatry 2020; 91:1175-1180. [PMID: 32917820 DOI: 10.1136/jnnp-2020-323787] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Chronic inflammatory axonal polyneuropathy (CIAP) is defined on the basis of the clinical, electrophysiological and nerve biopsy findings and therapeutic responses of 'immunotherapy responding chronic axonal polyneuropathy (IR-CAP)'. METHODS The diagnosis of IR-CAP was made when all of three of the following mandatory criterion were met: (1) acquired, chronic progressive or relapsing symmetrical or asymmetrical polyneuropathy with duration of progression >2 months; (2) electrophysiological evidence of axonal neuropathy in at least two nerves without any evidence of 'strict criteria of demyelination'; and (3) definite responsiveness to immunotherapy. RESULTS Thirty-three patients with IR-CAP showed similar clinical features of chronic inflammatory demyelinating polyneuropathy (CIDP) except 'motor neuropathy subtype'. High spinal fluid protein was found in 27/32 (78%) cases. 'Inflammatory axonal neuropathy' was proven in 14 (45%) of 31 sural nerve biopsies. DISCUSSIONS IR-CAP could well be 'axonal CIDP' in view of clinical similarity, but not proven as yet. Thus, IR-CAP is best described as CIAP, a distinct entity that deserves its recognition in view of responsiveness to immunotherapy. CONCLUSION Diagnosis of CIAP can be made by additional documentation of 'inflammation' by high spinal fluid protein or nerve biopsy in addition to the first two diagnostic criteria of IR-CAP.
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Affiliation(s)
- Shin J Oh
- Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | | | | | - Peter King
- Neurology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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5
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Vallat JM, Duchesne M, Magy L. Biopsia del nervo periferico. Neurologia 2020. [DOI: 10.1016/s1634-7072(20)44225-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Jennane S, Hasnaoui N, Mehdi ME, Maaroufi HE, Messaoudi N, Mikdame M, Doghmi K. [Chronic paraneoplastic inflammatory demyelinating polyradiculoneuritis secondary to nasal natural killer lymphoma]. Pan Afr Med J 2020; 36:303. [PMID: 33282086 PMCID: PMC7687485 DOI: 10.11604/pamj.2020.36.303.17772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 07/24/2020] [Indexed: 12/04/2022] Open
Abstract
Nous rapportons un cas unique d´une polyradiculonévrite inflammatoire démyélinisante chronique paranéoplasique secondaire à un lymphome non hodgkinien T de type natural killer nasal.
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Affiliation(s)
- Selim Jennane
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
| | - Nawal Hasnaoui
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
| | - Mahtat El Mehdi
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
| | - Hicham El Maaroufi
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
| | - Nezha Messaoudi
- Laboratoire d´Hématologie, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
| | - Mohamed Mikdame
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
| | - Kamal Doghmi
- Service d´Hématologie Clinique, Hôpital Militaire d´Instruction Mohammed V, Université Mohammed V, Rabat, Maroc
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7
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Karri M, Ramasamy B. Isolated unilateral palatal and vocal cord palsy as an initial presentation of chronic inflammatory demyelinating polyradiculoneuropathy. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2019. [DOI: 10.1186/s41983-019-0133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired autoimmune disease of the peripheral nervous system. Its clinical presentation and excellent response to steroids is a hallmark to the disease entity. It is usually a straight forward diagnosis in typical cases. Atypical CIDP often is of diagnostic concern and has been a challenge for practising neurologists.
Case description
Here, we present a 56-year old female presented with isolated left palatal palsy preceded by a short febrile illness. Clinically consistent with post-infectious bulbar palsy, she was treated with intravenous pulse steroids and antibiotics. She had progressive disease and later developed quadriparesis with neck flexor weakness with progressive bulbar weakness and hypercapnic respiratory failure.
Discussion and evaluation
MRI whole spine with contrast showed nerve root enhancement. Nerve conduction studies of all four limbs and LP and CSF analysis were consistent with CIDP. She was treated with intravenous immunoglobulin (0.4 g/kg for five consecutive days). She showed mild improvement of symptoms initially and later had deterioration of symptoms within a week interval. She received two doses of Rituximab of 1 gram each within 3 weeks apart, after which she has gradual improvement. She was able to tolerate orally and able to walk without support following 1 month after treatment, and there were no further relapses except for the persistence of minor sensory symptoms after 6 months of follow-up.
Conclusion
Isolated cranial nerve involvement presenting as CIDP is a rare entity. Intravenous immunoglobulin and newer immunosuppressants like CD-20 monoclonal antibodies like rituximab have a significant role in the treatment.
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8
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Jomier F, Bousson V, Viala K, Péréon Y, Magot A, Cauquil C, Bouhour F, Vial C, Bedat-Millet AL, Taithe F, Bresch S, Siri A, Kubis N, Lozeron P. Prospective study of the additional benefit of plexus magnetic resonance imaging in the diagnosis of chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2019; 27:181-187. [PMID: 31348848 DOI: 10.1111/ene.14053] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/22/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Hypertrophy/signal hyperintensity and/or gadolinium enhancement of plexus structures on magnetic resonance imaging (MRI) are observed in two-thirds of cases of typical chronic inflammatory demyelinating polyneuropathy (CIDP). The objective of our study was to determine the additional benefit of plexus MRI in patients referred to tertiary centers with baseline clinical and electrophysiological characteristics suggestive of typical or atypical CIDP. METHODS A total of 28 consecutive patients with initial suspicion of CIDP were recruited in nine centers and followed for 2 years. Plexus MRI data from the initial assessment were reviewed centrally. Physicians blinded to the plexus MRI findings established the final diagnosis (CIDP or neuropathy of another cause). The proportion of patients with abnormal MRI was analyzed in each group. RESULTS Chronic inflammatory demyelinating polyneuropathy was confirmed in 14 patients (50%), as were sensorimotor CIDP (n = 6), chronic immune sensory polyradiculoneuropathy (n = 2), motor CIDP (n = 1) and multifocal acquired demyelinating sensory and motor neuropathy (n = 5). A total of 37 plexus MRIs were performed (17 brachial, 19 lumbosacral and 8 in both localizations). MRI was abnormal in 5/37 patients (14%), all of whom were subsequently diagnosed with CIDP [5/14(36%)], after an atypical baseline presentation. With plexus MRI results masked, non-invasive procedures confirmed the diagnosis of CIDP in all but one patient [1/14 (7%)]. Knowledge of the abnormal MRI findings in the latter could have prevented nerve biopsy being performed. CONCLUSION Systematic plexus MRI in patients with initially suspected CIDP provides little additional benefit in confirming the diagnosis of CIDP.
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Affiliation(s)
- F Jomier
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France
| | - V Bousson
- Service de Radiologie Ostéoarticulaire, AP-HP, Hôpital Lariboisière, Paris, France
| | - K Viala
- Département de Neurophysiologie Clinique, Hôpital Pitié-Salpêtrière, Paris, France
| | - Y Péréon
- Centre de Référence Maladies Neuromusculaires, CHU Nantes, Nantes, France.,Université de Nantes, Nantes, France
| | - A Magot
- Centre de Référence Maladies Neuromusculaires, CHU Nantes, Nantes, France
| | - C Cauquil
- Service de Neurologie, CHU Bicêtre, Le Kremlin-Bicêtre, France.,Centre National de Référence pour la Neuropathie Amyloïde Familiale, CHU Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - F Bouhour
- Service de Neurologie, Hospices Civils de Lyon, Lyon, France
| | - C Vial
- Service de Neurologie, Hospices Civils de Lyon, Lyon, France
| | | | - F Taithe
- Service de Neurologie, CHU Gabriel Montpied, Clermont Ferrand, France.,Clermont Université, Université d'Auvergne, Clermont-Ferrand, France
| | - S Bresch
- Service de Neurologie, CHU de Nice, Nice, France
| | - A Siri
- Service de Neurologie, CHRU de Nancy, Nancy, France
| | - N Kubis
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France.,U1148-Laboratory for Vascular and Translational Science, INSERM, Université de Paris, Paris, France
| | - P Lozeron
- Service de Physiologie Clinique-Explorations Fonctionnelles, AP-HP, Hôpital Lariboisière, Paris, France.,U1148-Laboratory for Vascular and Translational Science, INSERM, Université de Paris, Paris, France
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9
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Bril V, Blanchette CM, Noone JM, Runken MC, Gelinas D, Russell JW. The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy. J Diabetes Complications 2016; 30:1401-7. [PMID: 27389526 PMCID: PMC5528142 DOI: 10.1016/j.jdiacomp.2016.05.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/03/2016] [Accepted: 05/06/2016] [Indexed: 12/13/2022]
Abstract
PURPOSE We reviewed the literature on chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetes mellitus (DM) and explored real-world data on the prevalence and treatment of CIDP within DM. METHODS A literature search of Scopus was performed for the terms chronic inflammatory demyelinating polyradiculoneuropathy, chronic inflammatory demyelinating polyneuropathy, CIDP, and prevalence, incidence, epidemiology, or diabetes; peripheral neuropathy and prevalence or diabetes. We also searched through the reference lists of the resulting publications for additional findings that may have been missed. Additional publications on guidelines for the diagnosis of CIDP and diabetic neuropathy were also included. A descriptive analysis of the 2009-2013 PharMetrics Plus™ Database was performed to estimate the prevalence and treatment of CIDP within the DM population. RESULTS There is an increasing body of literature suggesting that the prevalence of CIDP tends to be higher in diabetic patients, especially in those of older age. Our real-world data seem to support published findings from the literature. For the total cohort (N=101,321,694), the percent prevalence of CIDP (n=8,173) was 0.008%; DM (n=4,026,740) was 4%. The percent prevalence of CIDP without DM (n=5,986) was 0.006%; CIDP with DM (n=2,187) was 9-fold higher at 0.054%. For patients >50years old, there was a significantly higher percentage of CIDP with DM than CIDP without DM. Approximately 50% of CIDP patients were treated with IVIg, 23%-24% with steroids, 1%-2% with PE, and 20%-23% received no treatment. CONCLUSIONS In addition to the growing evidence of higher prevalence of CIDP in DM, our findings reinforce the need for heightened awareness of the association of CIDP and DM.
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Affiliation(s)
- Vera Bril
- Division of Neurology, University of Toronto, 200 Elizabeth St, 5EC-309, TGH, Toronto, ON, M5G 2C4, Canada
| | - Christopher M Blanchette
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - Joshua M Noone
- Department of Public Health Sciences, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC 28223, USA
| | - M Chris Runken
- Department of Medical Affairs, Grifols, 79 TW Alexander Dr. Bldg 4101 Research Commons, Research Triangle Park, NC 27709, USA
| | - Deborah Gelinas
- Department of Medical Affairs, Grifols, 79 TW Alexander Dr. Bldg 4101 Research Commons, Research Triangle Park, NC 27709, USA
| | - James W Russell
- Department of Neurology, University of Maryland School of Medicine, and VA Maryland Health Care System, 110S Paca Street, 3S-129, Baltimore, MD, 21201, USA.
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10
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Khadilkar S, Patel B, Mansukhani KA, Jaggi S. Two cases of chronic immune sensorimotor polyradiculopathy: Expanding the spectrum of chronic immune polyradiculopathies. Muscle Nerve 2016; 55:135-137. [PMID: 27530499 DOI: 10.1002/mus.25360] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/18/2016] [Accepted: 07/27/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Immune-mediated demyelinating radiculopathies restricted to proximal sensory or motor roots are uncommon. METHODS We report the clinical, electrophysiological, biochemical, and radiological features in 2 patients with chronic immune sensorimotor polyradiculopathy (CISMP). RESULTS The patients presented with sensory ataxia, weakness of the lower limbs, and areflexia. Electrophysiological studies revealed involvement of proximal sensorimotor roots, as evidenced by changes in somatosensory evoked potentials, F-waves, and H-reflexes. In contrast, the distal nerve segments were normal. Magnetic resonance neurography findings of thickened and enhanced roots supported the electrophysiological findings. The response to immunosuppressive therapy was favorable in both patients. CONCLUSION The findings from these 2 patients further expand the knowledge spectrum of immune polyradiculopathies. Muscle Nerve 55:135-137, 2017.
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Affiliation(s)
- Satish Khadilkar
- Department of Neurology, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | - Bhagyadhan Patel
- Department of Neurology, Grant Medical College and Sir J.J. Group of Hospitals, Mumbai, India
| | | | - Sunila Jaggi
- Department of Radiology, Bombay Hospital and Medical Research Centre, Mumbai, India
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11
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Faucard R, Madeira A, Gehin N, Authier FJ, Panaite PA, Lesage C, Burgelin I, Bertel M, Bernard C, Curtin F, Lang AB, Steck AJ, Perron H, Kuntzer T, Créange A. Human Endogenous Retrovirus and Neuroinflammation in Chronic Inflammatory Demyelinating Polyradiculoneuropathy. EBioMedicine 2016; 6:190-198. [PMID: 27211560 PMCID: PMC4856744 DOI: 10.1016/j.ebiom.2016.03.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Human endogenous retroviruses HERV-W encode a pro-inflammatory protein, named MSRV-Env from its original identification in Multiple Sclerosis. Though not detected in various neurological controls, MSRV-Env was found in patients with chronic inflammatory demyelinating polyradiculoneuropathies (CIDPs). This study investigated the expression of MSRV in CIDP and evaluated relevant MSRV-Env pathogenic effects. METHODS 50 CIDP patients, 19 other neurological controls (ONDs) and 65 healthy blood donors (HBDs) were recruited from two different countries. MSRV-env and -pol transcripts, IL6 and CXCL10 levels were quantified from blood samples. MSRV-Env immunohistology was performed in distal sensory nerves from CIDP and neurological controls biopsies. MSRV-Env pathogenic effects and mode of action were assayed in cultured primary human Schwann cells (HSCs). FINDINGS In both cohorts, MSRV-env and -pol transcripts, IL6 positivity prevalence and CXCL10 levels were significantly elevated in CIDP patients when compared to HBDs and ONDs (statistically significant in all comparisons). MSRV-Env protein was detected in Schwann cells in 5/7 CIDP biopsies. HSC exposed to or transfected with MSRV-env presented a strong increase of IL6 and CXCL10 transcripts and protein secretion. These pathogenic effects on HSC were inhibited by GNbAC1, a highly specific and neutralizing humanized monoclonal antibody targeting MSRV-Env. INTERPRETATION The present study showed that MSRV-Env may trigger the release of critical immune mediators proposed as instrumental factors involved in the pathophysiology of CIDP. Significant MSRV-Env expression was detected in a significant proportion of patients with CIDP, in which it may play a role according to its presently observed effects on Schwann cells along with previously known effects on immune cells. Experimental results also suggest that a biomarker-driven therapeutic strategy targeting this protein with a neutralizing antibody such as GNbAC1 may offer new perspectives for treating CIDP patients with positive detection of MSRV-Env expression. FUNDING Geneuro-Innovation, France.
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Affiliation(s)
| | | | | | - François-Jérôme Authier
- Reference Center for Neuromuscular Diseases, Department of Pathology, Henri Mondor Hospital, Créteil, France; INSERM U955-Team 10 Biology of the Neuromuscular System, Paris Est-Creteil University, Créteil, France
| | | | - Catherine Lesage
- Department of Neurology, Henri Mondor Hospital, APHP, Université Paris Est, Créteil, France
| | | | | | | | | | | | - Andreas J Steck
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Switzerland
| | - Hervé Perron
- GeNeuro Innovation, France; GeNeuro SA, (Geneva), Switzerland.
| | - Thierry Kuntzer
- Department of Clinical Neuroscience, Lausanne University Hospital (CHUV), Switzerland
| | - Alain Créange
- Department of Neurology, Henri Mondor Hospital, APHP, Université Paris Est, Créteil, France
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12
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Wang Z, Chen S, Zhou T, Su L, Ling Z, Fan J, Chen W, Du H, Lu J, Xu Y, Tan Z, Yang H, Hu X, Li C, Yan X, Hu G, Liu C, Yin Y. Comparison of Saline-Irrigated Catheter vs. Temperature-Controlled Catheter for Renal Denervation in a Canine Model. Am J Hypertens 2015; 28:1434-43. [PMID: 25934968 DOI: 10.1093/ajh/hpv051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Accepted: 12/30/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The effectiveness of catheter-based renal denervation (RDN) remains controversial. Although the reasons for this have not yet been elucidated, ineffective denervation appears to be an important factor. The present study aimed to investigate the difference in RDN between a saline-irrigated catheter (SIC) and a temperature-controlled catheter (TCC). METHODS Dogs (n = 6) from the Kunming province in Chinese were ablated; the SIC was introduced into the right renal artery, while the TCC was introduced into the left renal artery. After 6 months, histopathology and renal angiography were performed, and the change in neural density was evaluated using morphometric software. The average values of heart rate (HR), blood pressure (BP), and catecholamine metabolites were assessed at baseline and follow-up. RESULTS Histopathology showed nerve demyelination and denaturation, as well as interstitial hyperplasia, although these changes were more pronounced when the SIC was used. The change in neural density was greater and ablation was deeper when the SIC was used. Intimal hyperplasia was greater when the TCC was used, whereas medial hyperplasia was greater when the SIC was used. A trend toward a decrease in HR, BP, metanephrine, and normetanephrine between baseline and follow-up was observed. CONCLUSIONS Our findings suggest that SIC ablation results in more extensive neural degeneration, deeper penetration, and less extensive intimal hyperplasia than TCC ablation for RDN.
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Affiliation(s)
- Zhenglong Wang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | | | - Tingquan Zhou
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Su
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyu Ling
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinqi Fan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weijie Chen
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Huaan Du
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jiayi Lu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanping Xu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhen Tan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hanxuan Yang
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyu Hu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chengzhi Li
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xue Yan
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Guangxin Hu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chang Liu
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuehui Yin
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China;
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13
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The diagnosis of chronic inflammatory demyelinating polyneuropathy: a Delphi-method approach. J Neurol 2013; 260:3015-22. [DOI: 10.1007/s00415-013-7100-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 09/04/2013] [Accepted: 09/06/2013] [Indexed: 10/26/2022]
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14
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Tanaka K, Mori N, Yokota Y, Suenaga T. MRI of the cervical nerve roots in the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy: a single-institution, retrospective case-control study. BMJ Open 2013; 3:e003443. [PMID: 23996823 PMCID: PMC3758976 DOI: 10.1136/bmjopen-2013-003443] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To systematically evaluate the usefulness of assessing the cervical nerve roots by MRI for the diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). DESIGN Single-institution, retrospective case-control study. SETTING A regional referral hospital. PARTICIPANTS We retrospectively enrolled 15 consecutive patients with CIDP who satisfied the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) typical and definite criteria and underwent cervical MRI. 30 control patients who had also undergone cervical MRI were included, matched with regard to sex, age and MRI system. The diagnoses of the control patients included cervical spondylosis (n=19), cervical spine trauma (n=2), infection (n=1), malignancies (n=4), demyelinating disorders (n=2) and neurodegenerative disorders (n=2). MEASUREMENT A radiologist determined the C5-C8 root diameters on the coronal short tau inversion recovery (STIR) images. Signal intensities of these roots were quantified as nerve-to-muscle contrast-to-noise ratios (CNRs), which were calculated using mean signal intensities of the roots and sternocleidomastoid muscle as well as SD of background noise. Statistical analyses were performed to determine the diagnostic accuracy of the diameters and nerve-to-muscle CNRs. Another radiologist reviewed MRI for ensuring reproducibility. RESULTS The root diameters showed no significant differences between the patients with CIDP and control patients. The nerve-to-muscle CNRs were significantly higher in the patients with CIDP. We defined the sum of nerve-to-muscle CNRs of C5-C8 roots as the CNR score to serve as an index of overall signal intensity. The area under the receiver operating characteristic curve of CNR scores was 0.731. The reproducibility of the assessment procedure was satisfactory. CONCLUSIONS Our results suggest that assessment of the cervical nerve roots by MRI is useful for CIDP diagnosis when the signal intensities, rather than the diameters, are paid more attention on STIR images.
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Affiliation(s)
- Kanta Tanaka
- Department of Neurology, Tenri Hospital, Tenri, Japan
| | - Nobuyuki Mori
- Department of Radiology, Tenri Hospital, Tenri, Japan
| | - Yusuke Yokota
- Department of Radiology, Tenri Hospital, Tenri, Japan
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15
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Cifuentes-Diaz C, Dubourg O, Irinopoulou T, Vigny M, Lachkar S, Decker L, Charnay P, Denisenko N, Maisonobe T, Léger JM, Viala K, Hauw JJ, Girault JA. Nodes of ranvier and paranodes in chronic acquired neuropathies. PLoS One 2011; 6:e14533. [PMID: 21267074 PMCID: PMC3022580 DOI: 10.1371/journal.pone.0014533] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 12/10/2010] [Indexed: 11/18/2022] Open
Abstract
Chronic acquired neuropathies of unknown origin are classified as chronic inflammatory demyelinating polyneuropathies (CIDP) and chronic idiopathic axonal polyneuropathies (CIAP). The diagnosis can be very difficult, although it has important therapeutic implications since CIDP can be improved by immunomodulating treatment. The aim of this study was to examine the possible abnormalities of nodal and paranodal regions in these two types of neuropathies. Longitudinal sections of superficial peroneal nerves were obtained from biopsy material from 12 patients with CIDP and 10 patients with CIAP and studied by immunofluorescence and in some cases electron microscopy. Electron microscopy revealed multiple alterations in the nodal and paranodal regions which predominated in Schwann cells in CIDP and in axons in CIAP. In CIDP paranodin/Caspr immunofluorescence was more widespread than in control nerves, extending along the axon in internodes where it appeared intense. Nodal channels Nav and KCNQ2 were less altered but were also detected in the internodes. In CIAP paranodes, paranodin labeling was irregular and/or decreased. To test the consequences of acquired primary Schwann cells alteration on axonal proteins, we used a mouse model based on induced deletion of the transcription factor Krox-20 gene. In the demyelinated sciatic nerves of these mice we observed alterations similar to those found in CIDP by immunofluorescence, and immunoblotting demonstrated increased levels of paranodin. Finally we examined whether the alterations in paranodin immunoreactivity could have a diagnosis value. In a sample of 16 biopsies, the study of paranodin immunofluorescence by blind evaluators led to correct diagnosis in 70 ± 4% of the cases. This study characterizes for the first time the abnormalities of nodes of Ranvier in CIAP and CIDP, and the altered expression and distribution of nodal and paranodal proteins. Marked differences were observed between CIDP and CIAP and the alterations in paranodin immunofluorescence may be an interesting tool for their differential diagnosis.
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Affiliation(s)
- Carmen Cifuentes-Diaz
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche en Santé (UMR-S) 839, Paris, France
- Université Pierre et Marie Curie (UPMC), Paris, France
- Institut du Fer à Moulin, Paris, France
| | - Odile Dubourg
- Laboratoire de Neuropathologie Raymond-Escourolle, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Consultation de Pathologie Neuromusculaire, Centre de Référence de Paris Est, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Theano Irinopoulou
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche en Santé (UMR-S) 839, Paris, France
- Université Pierre et Marie Curie (UPMC), Paris, France
- Institut du Fer à Moulin, Paris, France
| | - Marc Vigny
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche en Santé (UMR-S) 839, Paris, France
- Université Pierre et Marie Curie (UPMC), Paris, France
- Institut du Fer à Moulin, Paris, France
| | - Sylvie Lachkar
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche en Santé (UMR-S) 839, Paris, France
- Université Pierre et Marie Curie (UPMC), Paris, France
- Institut du Fer à Moulin, Paris, France
| | - Laurence Decker
- Institut de Biologie de l'Ecole Normale Supérieure (IBENS), Inserm U1024, Centre National de la Recherche Scientifique (CNRS) UMR 8197, Ecole Normale Supérieure, Paris, France
| | - Patrick Charnay
- Institut de Biologie de l'Ecole Normale Supérieure (IBENS), Inserm U1024, Centre National de la Recherche Scientifique (CNRS) UMR 8197, Ecole Normale Supérieure, Paris, France
| | - Natalia Denisenko
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche en Santé (UMR-S) 839, Paris, France
- Université Pierre et Marie Curie (UPMC), Paris, France
- Institut du Fer à Moulin, Paris, France
| | - Thierry Maisonobe
- Laboratoire de Neuropathologie Raymond-Escourolle, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Fédération de Neurophysiologie Clinique and Fédération de Neurologie, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Jean-Marc Léger
- Consultation de Pathologie Neuromusculaire, Centre de Référence de Paris Est, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Karine Viala
- Fédération de Neurophysiologie Clinique and Fédération de Neurologie, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Jean-Jacques Hauw
- Université Pierre et Marie Curie (UPMC), Paris, France
- Laboratoire de Neuropathologie Raymond-Escourolle, Pitié-Salpêtrière Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Antoine Girault
- Institut National de la Santé et de la Recherche Médicale (Inserm), Unité Mixte de Recherche en Santé (UMR-S) 839, Paris, France
- Université Pierre et Marie Curie (UPMC), Paris, France
- Institut du Fer à Moulin, Paris, France
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16
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Current world literature. Curr Opin Neurol 2009; 22:554-61. [PMID: 19755870 DOI: 10.1097/wco.0b013e3283313b14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Vallat JM, Vital A, Magy L, Martin-Negrier ML, Vital C. An update on nerve biopsy. J Neuropathol Exp Neurol 2009; 68:833-44. [PMID: 19606069 DOI: 10.1097/nen.0b013e3181af2b9c] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Indications for nerve biopsy have decreased during the last 20 years. For the most part, this is a result of progress in the application of molecular biologic diagnostic testing for genetic peripheral neuropathies (PNs) and the increasing use of skin biopsy. The latter is primarily used to evaluate small-fiber PN, although it rarely discloses the specific etiology of a PN. Nerve biopsies are usually performed on either the sural or the superficial peroneal nerve, the latter in combination with removal of portions of the peroneus brevis muscle. The definite diagnosis of vasculitic lesions can be readily established on small paraffin-embedded nerve biopsy samples, although in some cases, the characteristic lesions are only apparent in muscle specimens. Other nerve specimens are routinely fixed in buffered glutaraldehyde and prepared for semithin sections and electron microscopy; frozen specimens are used for immunofluorescence studies. Electron microscopy is of great value in some cases of chronic inflammatory demyelinating polyneuropathies, monoclonal gammopathy, and storage diseases. Because more than 30 genes may be involved in genetic PNs, analysis of nerve lesions can direct the search for mutations in specific genes. Electron microscopy immunocytochemistry is mandatory in some cases of monoclonal dysglobulinemia. Thus, nerve biopsy is still of value in specific circumstances when it is performed by trained physicians and examined in a laboratory with expertise in nerve pathology.
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Affiliation(s)
- Jean-Michel Vallat
- Centre de Référence National Neuropathies Périphériques Rares, Neurology Department, University Hospital, Limoges Cedex, France.
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Steck AJ, Czaplinski A, Renaud S. Inflammatory demyelinating neuropathies and neuropathies associated with monoclonal gammopathies: treatment update. Neurotherapeutics 2008; 5:528-34. [PMID: 19019303 PMCID: PMC4514701 DOI: 10.1016/j.nurt.2008.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This review focuses on recent data regarding inflammatory demyelinating neuropathies and neuropathies associated with monoclonal gammopathies. We describe both acute and chronic inflammatory neuropathies, and we discuss conditions ranging from mostly cell-mediated to antibody-mediated disorders. These diseases are characterized by proximal and distal sensory motor involvement. Treatments are based on immune-modulation and/or immune-suppression. Work-up sequence and therapeutical modes are discussed in the light of recently published data, with a special interest on new treatment modalities.
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Affiliation(s)
- Andreas J Steck
- Department of Neurology, University of Basel, Basel, Switzerland.
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