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Hoshina Y, Wong KH, Galli J, Bacharach R, Klein J, Lebiedz-Odrobina D, Rose JW, Trump B, Hull C, Greenlee JE, Clardy SL. Neurologic involvement in seronegative primary Sjögren's syndrome with positive minor salivary gland biopsy: a single-center experience. Front Neurol 2023; 14:1174116. [PMID: 37360347 PMCID: PMC10289021 DOI: 10.3389/fneur.2023.1174116] [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: 02/25/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Objective To assess the demographics, neurologic manifestations, comorbidities, and treatment of patients with seronegative primary Sjögren's syndrome (pSS). Patients and methods We conducted a retrospective chart review on patients with seronegative pSS evaluated by a neurologist at the University of Utah Health between January 2010 and October 2018. The diagnosis was based on characteristic symptoms, positive minor salivary gland biopsy according to the American-European Consensus Group 2002 criteria, and seronegative antibody status. Results Of 45 patients who met the study criteria, 42 (93.3%) were Caucasian, and 38 (84.4%) were female. The patients' mean age at diagnosis was 47.8 ± 12.6 (range 13-71) years. Paresthesia, numbness and dizziness, and headache were noted in 40 (88.9%), 39 (86.7%), and 36 patients (80.0%), respectively. Thirty-four patients underwent brain magnetic resonance imaging. Of these, 18 (52.9%) showed scattered nonspecific periventricular and subcortical cerebral white matter T2/fluid-attenuated inversion recovery hyperintense foci. Twenty-nine patients (64.4%) presented to the neurology clinic prior to pSS diagnosis, and the median delay in diagnosis from the first neurology clinic visit was 5 (interquartile ranges 2.0-20.5) months. Migraine and depression were the most common comorbidities in 31 patients (68.9%). Thirty-six patients received at least one immunotherapy, and 39 were on at least one medication for neuropathic pain. Conclusion Patients often display various nonspecific neurological symptoms. Clinicians should express a high degree of skepticism regarding seronegative pSS and consider minor salivary gland biopsy to avoid delaying diagnosis, as undertreatment can affect patients' quality of life.
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Affiliation(s)
- Yoji Hoshina
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Ka-Ho Wong
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Jonathan Galli
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Rae Bacharach
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- Department of Neurology, Penn State Health, Hershey, PA, United States
| | - Julia Klein
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Dorota Lebiedz-Odrobina
- Department of Medicine, Division of Rheumatology, University of Utah, Salt Lake City, UT, United States
| | - John W. Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Bryan Trump
- School of Dentistry, University of Utah, Salt Lake City, UT, United States
| | - Christopher Hull
- Department of Dermatology, University of Utah, Salt Lake City, UT, United States
| | - John E. Greenlee
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
| | - Stacey L. Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
- George E. Wahlen Veterans Affairs Medical Center, Salt Lake City, UT, United States
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Módis LV, Aradi Z, Horváth IF, Bencze J, Papp T, Emri M, Berényi E, Bugán A, Szántó A. Central Nervous System Involvement in Primary Sjögren's Syndrome: Narrative Review of MRI Findings. Diagnostics (Basel) 2022; 13:diagnostics13010014. [PMID: 36611306 PMCID: PMC9818673 DOI: 10.3390/diagnostics13010014] [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: 10/20/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Central nervous system (CNS) involvement is one of the numerous extraglandular manifestations of primary Sjögren's syndrome (pSS). Moreover, neurological complaints precede the sicca symptoms in 25-60% of the cases. We review the magnetic resonance imaging (MRI) lesions typical for pSS, involving the conventional examination, volumetric and morphometric studies, diffusion tensor imaging (DTI) and resting-state fMRI. The most common radiological lesions in pSS are white matter hyperintensities (WMH), scattered alterations hyperlucent on T2 and FLAIR sequences, typically located periventricularly and subcortically. Cortical atrophy and ventricular dilatation can also occur in pSS. Whilst these conditions are thought to be more common in pSS than healthy controls, DTI and resting-state fMRI alterations demonstrate evident microstructural changes in pSS. As pSS is often accompanied by cognitive symptoms, these MRI alterations are expectedly related to them. This relationship is not clearly delineated in conventional MRI studies, but DTI and resting-state fMRI examinations show more convincing correlations. In conclusion, the CNS manifestations of pSS do not follow a certain pattern. As the link between the MRI lesions and clinical manifestations is not well established, more studies involving larger populations should be performed to elucidate the correlations.
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Affiliation(s)
- László V. Módis
- Department of Behavioural Sciences, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
- Correspondence: ; Tel.: +36-52-411-600 (ext. 55252)
| | - Zsófia Aradi
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - Ildikó Fanny Horváth
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - János Bencze
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Tamás Papp
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Miklós Emri
- Division of Nuclear Medicine and Translational Imaging, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Ervin Berényi
- Division of Radiology and Imaging Science, Department of Medical Imaging, Faculty of General Medicine, University of Debrecen, Nagyerdei körút 98, HU-4032 Debrecen, Hungary
| | - Antal Bugán
- Department of Behavioural Sciences, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
| | - Antónia Szántó
- Division of Clinical Immunology, Department of Internal Medicine, Faculty of General Medicine, University of Debrecen, Móricz Zsigmond krt. 22, HU-4032 Debrecen, Hungary
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Zippel CL, Beider S, Kramer E, Konen FF, Seeliger T, Skripuletz T, Hirsch S, Jablonka A, Witte T, Sonnenschein K, Ernst D. Premature stroke and cardiovascular risk in primary Sjögren's syndrome. Front Cardiovasc Med 2022; 9:1048684. [PMID: 36588566 PMCID: PMC9794609 DOI: 10.3389/fcvm.2022.1048684] [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: 09/19/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Primary Sjögren's syndrome (pSS) is associated with an increased prevalence of traditional risk factors and cardiovascular diseases (CVDs). The study aimed to identify specific risk factors for CVD in pSS patients. Methods PSS patients with and without CVD were compared. All patients fulfilled the EULAR/ACR classification criteria. Patients with CVD presented at least one of the following manifestations: myocardial infarction, transient ischemic attacks, ischemic or hemorrhagic stroke, peripheral artery disease, coronary artery disease, and carotid plaques. Data were collected by a standardized protocol and review of medical records. Results 61/312 (19.6%) pSS patients presented with CVD. Traditional risk factors such as hypertension, hypercholesterinemia and diabetes (p < 0.05), pSS manifestations, in particular vasculitis (p = 0.033) and Raynaud's phenomenon (p = 0.018) were associated with CVD. Among patients with ischemic events (28/312, 9%), particularly cerebrovascular disease (n = 12/28, 42.9%), correlations with increased EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) (p = 0.039) and EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI) (p = 0.048) were observed. Age at first cerebrovascular event was 55.2 [48.9-69.6] years. Multivariate analysis confirmed hypertension [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.87-7.18, p < 0.001], hypercholesterinemia (OR 3.1, 95% CI 1.63-5.72, p < 0.001), male gender (OR 0.4, 95% CI 0.17-0.78, p = 0.009), Raynaud's phenomenon (OR 2.5, 95% CI 1.28-4.82, p = 0.007), and CNS involvement (OR 2.7, 95% CI 1.00-7.15, p = 0.048) as independent CVD predictors. Conclusion Raynaud's phenomen as well as vasculitis and high ESSDAI have shown a significant association to CVD. PSS patients with cerebrovascular events were younger than expected. Knowledge about risk factors may help clinicians to identify pSS patients at risk for CVD. After diagnosis of pSS, patients should be screened for risk factors such as hypertension and receive appropriate therapy to prevent or at least reduce sequelae such as infarction. However, further investigations are necessary in order to achieve a reliable risk stratification for these patients.
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Affiliation(s)
- Clara L. Zippel
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Sonja Beider
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Emelie Kramer
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Franz F. Konen
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Tabea Seeliger
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Stefanie Hirsch
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Alexandra Jablonka
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | - Torsten Witte
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany
| | | | - Diana Ernst
- Department of Rheumatology and Immunology, Hannover Medical School, Hannover, Germany,*Correspondence: Diana Ernst
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Suresh H, Mithani K, Brar K, Yan H, Strantzas S, Vandenberk M, Sharma R, Yau I, Go C, Pang E, Kerr E, Ochi A, Otsubo H, Jain P, Donner E, Snead OC, Ibrahim GM. Brainstem Associated Somatosensory Evoked Potentials and Response to Vagus Nerve Stimulation: An Investigation of the Vagus Afferent Network. Front Neurol 2022; 12:768539. [PMID: 35250790 PMCID: PMC8895499 DOI: 10.3389/fneur.2021.768539] [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] [Received: 08/31/2021] [Accepted: 12/22/2021] [Indexed: 12/05/2022] Open
Abstract
Despite decades of clinical usage, selection of patients with drug resistant epilepsy who are most likely to benefit from vagus nerve stimulation (VNS) remains a challenge. The mechanism of action of VNS is dependent upon afferent brainstem circuitry, which comprises a critical component of the Vagus Afferent Network (VagAN). To evaluate the association between brainstem afferent circuitry and seizure response, we retrospectively collected intraoperative data from sub-cortical recordings of somatosensory evoked potentials (SSEP) in 7 children with focal drug resistant epilepsy who had failed epilepsy surgery and subsequently underwent VNS. Using multivariate linear regression, we demonstrate a robust negative association between SSEP amplitude (p < 0.01), and seizure reduction. There was no association between SSEP latency and seizure outcomes. Our findings provide novel insights into the mechanism of VNS and inform our understanding of the importance of brainstem afferent circuitry within the VagAN for seizure responsiveness following VNS.
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Affiliation(s)
- Hrishikesh Suresh
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Karim Mithani
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Karanbir Brar
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Han Yan
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Samuel Strantzas
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mike Vandenberk
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Roy Sharma
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ivanna Yau
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Christina Go
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Pang
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Kerr
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Ayako Ochi
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Hiroshi Otsubo
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Puneet Jain
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Elizabeth Donner
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
| | - O. Carter Snead
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurology, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - George M. Ibrahim
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
- Program in Neuroscience and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Division of Neurosurgery, Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- Institute of Medical Science, University of Toronto, Toronto, ON, Canada
- *Correspondence: George M. Ibrahim
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Waliszewska-Prosół M, Sebastian A, Wiland P, Budrewicz S, Dziadkowiak E, Ejma M. Brainstem auditory evoked potentials in patients with primary Sjögren's syndrome without central nervous system involvement. Clin Rheumatol 2020; 40:991-997. [PMID: 32809145 PMCID: PMC7895790 DOI: 10.1007/s10067-020-05344-5] [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: 07/02/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Primary Sjögren's syndrome (pSS) is an autoimmune, multisystem exocrinopathy characterized by dysfunction of the exocrine glands. Central nervous system (CNS) involvement is estimated to be present in 10-60% patients with pSS. The present study aimed to evaluate brainstem auditory evoked potentials (BAEP) in pSS patients without central nervous system involvement, and without otolaryngological abnormalities. METHOD Thirty-six pSS patients (35 women, 1 man, mean age 48 years old) and 40 healthy volunteers were investigated. BAEP, brain imaging, laboratory parameters, and clinical neurological and otolaryngological examinations were performed. RESULTS Abnormal BAEP were recorded in 16.7% patients. The mean wave BAEP I and V latency and mean wave III-V and I-V interpeak latencies were significantly longer in pSS patients than the controls. There were no statistically significant correlations between BAEP parameters and laboratory tests. None of the patients was found having the abnormalities on brain imaging. CONCLUSIONS This study confirms that in pSS patients without clinical central nervous system impairment, auditory pathway disturbances could be found. Disorders of brain bioelectrical activity may be a consequence of ongoing autoimmune process. Key Points • BAEP abnormalities confirmed the clinically observed involvement of the central nervous system in patients with pSS. • Brain bioelectrical activity dysfunctions in pSS patients may be a consequence of ongoing inflammatory and/or immunological processes.
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Affiliation(s)
| | - Agata Sebastian
- Department of Rheumatology and Internal Diseases, Wrocław Medical University, Borowska 213, 50-556, Wrocław, Polska
| | - Piotr Wiland
- Department of Rheumatology and Internal Diseases, Wrocław Medical University, Borowska 213, 50-556, Wrocław, Polska
| | - Sławomir Budrewicz
- Department of Neurology, Wrocław Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Edyta Dziadkowiak
- Department of Neurology, Wrocław Medical University, Borowska 213, 50-556, Wrocław, Poland
| | - Maria Ejma
- Department of Neurology, Wrocław Medical University, Borowska 213, 50-556, Wrocław, Poland
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