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Couto B, Galosi S, Steel D, Kurian MA, Friedman J, Gorodetsky C, Lang AE. Severe Acute Motor Exacerbations (SAME) across Metabolic, Developmental and Genetic Disorders. Mov Disord 2024. [PMID: 39119747 DOI: 10.1002/mds.29905] [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: 10/02/2023] [Revised: 06/08/2024] [Accepted: 06/13/2024] [Indexed: 08/10/2024] Open
Abstract
Acute presentation of severe motor disorders is a diagnostic and management challenge. We define severe acute motor exacerbations (SAME) as acute/subacute motor symptoms that persist for hours-to-days with a severity that compromise vital signs (temperature, breath, and heart rate) and bulbar function (swallowing/dysphagia). Phenomenology includes dystonia, choreoathetosis, combined movement disorders, weakness, and hemiplegic attacks. SAME can develop in diverse diseases and can be preceded by triggers or catabolic states. Recent descriptions of SAME in complex neurodevelopmental and epileptic encephalopathies have broadened appreciation of this presentation beyond inborn errors of metabolism. A high degree of clinical suspicion is required to identify appropriately targeted investigations and management. We conducted a comprehensive literature analysis of etiologies. Reported triggers are described and classified as per pathophysiological mechanism. A video of six cases displaying multiple SAME with diverse outcomes is provided. We identified 50 different conditions that manifest SAME, some associated with developmental regression. Etiologies include disorders of metabolism: energy substrate, amino acids, complex molecules, vitamins/cofactors, minerals, and neurotransmitters/synaptic vesicle cycling. Non-metabolic neurodegenerative and genetic disorders that present with movement disorders and epilepsy can additionally manifest SAME. A limited number of triggers are grouped here, together with an approach to investigations and general management strategies. Several neurogenetic and neurometabolic disorders manifest SAME. Identifying triggers can help in certain cases narrow the differential diagnosis and guide the expeditious application of targeted therapies to minimize adverse developmental and neurological consequences. This process may inform pathogenesis and eventually improve our understanding of the mechanisms that lead to the development of SAME. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Blas Couto
- Edmond J. Safra Program in Parkinson's Disease, Rossy PSP Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Instituto de Neurociencia Cognitiva y Traslacional, INECO-Favaloro-CONICET, Buenos Aires, Argentina
| | - Serena Galosi
- Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Dora Steel
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Manju A Kurian
- Molecular Neurosciences, Developmental Neurosciences, Zayed Centre for Research into Rare Disease in Children, UCL Great Ormond Street Institute of Child Health, London, United Kingdom
- Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
| | - Jennifer Friedman
- Departments of Neurosciences and Pediatrics, University of California San Diego, San Diego, California, USA
- Division of Neurology, Rady Children's Hospital; Rady Children's Institute for Genomic Medicine, San Diego, California, USA
| | - Carolina Gorodetsky
- Division of Neurology, Pediatric Deep Brain Stimulation Program, Movement Disorder and Neuromodulation Program at the Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Anthony E Lang
- Edmond J. Safra Program in Parkinson's Disease, Rossy PSP Centre and the Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
- Tanz Centre for Research in Neurodegenerative Disease, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University Health Network and the University of Toronto, Toronto, Ontario, Canada
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Rook J, Llufriu S, de Kok D, Rofes A. Language impairments in people with autoimmune neurological diseases: A scoping review. JOURNAL OF COMMUNICATION DISORDERS 2023; 106:106368. [PMID: 37717472 DOI: 10.1016/j.jcomdis.2023.106368] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/02/2023] [Accepted: 08/16/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Autoimmune neurological diseases (ANDs) are a specific type of autoimmune disease that affect cells within the central and peripheral nervous system. ANDs trigger various physical/neuropsychiatric symptoms. However, language impairments in people with ANDs are not well characterized. Here we aimed to determine the kinds of language impairment that most commonly emerge in 10 ANDs, the characteristics of the patients (demographic, neurological damage), and the assessment methods used. METHODS We followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR). PubMed and Google Scholar were searched. We used a list of search terms containing 10 types of ANDs (e.g., multiple sclerosis, acute disseminated encephalomyelitis) in combination with the terms aphasia, dysphasia, fluency, language, listening, morphology, phonology, pragmatics, reading, semantics, speaking, syntax, writing. The reference lists and citations of the relevant papers were also investigated. The type of AND, patient characteristics, neurological damage and examination technique, language tests administered, and main findings were noted for each study meeting the inclusion criteria. RESULTS We found 171 studies meeting our inclusion criteria. These comprised group studies and case studies. Language impairments differed largely among types of ANDs. Neurological findings were mentioned in most of the papers, but specific language tests were rarely used. CONCLUSIONS Language symptoms in people with ANDs are commonly reported. These are often not full descriptions or only focus on specific time points in the course of the disease. Future research needs to assess specific language functions in people with ANDs and relate their language impairments to brain damage at different stages of disease evolution.
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Affiliation(s)
- Janine Rook
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands; Research School of Behavioural and Cognitive Neurosciences, University of Groningen, Groningen, The Netherlands
| | - Sara Llufriu
- Center of Neuroimmunology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clinic Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Dörte de Kok
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands
| | - Adrià Rofes
- Center for Language and Cognition, University of Groningen, Groningen, The Netherlands.
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Chen LW, Cheng JF, Chang TM, Hsu MH, Huang CC, Chang YC. Prognostic factors for functional recovery in children with moderate to severe acute disseminated encephalomyelitis. Mult Scler Relat Disord 2022; 66:104056. [PMID: 35878513 DOI: 10.1016/j.msard.2022.104056] [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: 01/27/2022] [Revised: 06/25/2022] [Accepted: 07/11/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is an immune-mediated encephalopathy with heterogeneous disease courses. However, clinical characteristics for a prognostication of functional recovery from acute episodes of ADEM remain limited. The study aims to characterize the clinical presentations and neuroimaging findings of children with poor functional recoveries from acute episodes of moderate to severe ADEM. METHODS The multicenter retrospective cohort study included children under 18 years of age who presented with moderate to severe ADEM (modified Rankin Scale [mRS] ≥ 3 at nadir) from 2002 to 2019. Children were assigned to a good recovery group (mRS ≤ 2) and a poor recovery group (mRS ≥ 3) after mean 4.3 months of follow-up. The clinical presentations and the distribution of brain lesions on magnetic resonance imaging were compared between the two groups by the t-test for numerical variables and Fisher's exact test for categorical variables. Analyses of logistic regression were conducted and significant variables in the multivariate model were examined by the receiver operating characteristic curve for the prediction of functional recovery. RESULTS Among the 73 children with moderate to severe ADEM, 56 (77%) had good functional recoveries and 17 (23%) showed poor functional recoveries. Children with poor recoveries had a lower rate of prodromal headache (12% vs. 39%, p = 0.04), and presented with higher proportions of dystonia (29% vs. 9%, p = 0.046), myoclonus (24% vs. 2%, p = 0.009), and cerebellar lesions on neuroimages (59% vs. 23%, p = 0.01). The multivariate analyses identified that a lack of prodromal headache (OR 0.1, 95% CI 0.005 - 0.7, p = 0.06) and the presentations of myoclonus (OR 21.6, 95% CI 1.7 - 874, p = 0.04) and cerebellar lesions (OR 4.8, 95% CI 1.3 - 19.9, p = 0.02) were associated with poor functional recoveries. These three factors could prognosticate poor outcomes in children with moderate to severe ADEM (area under the receiver operating characteristic curve 0.80, 95% CI 0.68 - 0.93, p = 0.0002). CONCLUSION Nearly one-fourth of children with moderate to severe ADEM had a poor functional recovery from acute episodes, who were characterized by a lack of prodromal headache, the presentation of myoclonus, and the neuroimaging finding of cerebellar lesions. The clinical variables associated with poor functional recoveries could assist in the planning of immunotherapies during hospitalization for a better outcome in moderate to severe ADEM.
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Affiliation(s)
- Li-Wen Chen
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, North District, Tainan, Taiwan
| | - Ju-Fang Cheng
- Department of Pediatrics, Changhua Christian Children's Hospital, 320 Xuguang Road, Changhua City, Changhua County, Taiwan
| | - Tung-Ming Chang
- Department of Pediatrics, Changhua Christian Children's Hospital, 320 Xuguang Road, Changhua City, Changhua County, Taiwan; Department of Biological Science and Technology, College of Biological Science and Technology, National Yang Ming Chiao Tung University, 1001 Daxue Road, East District, Hsinchu, Taiwan
| | - Mei-Hsin Hsu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan
| | - Chao-Ching Huang
- Department of Pediatrics, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, 138 Sheng-Li Road, North District, Tainan, Taiwan; Department of Pediatrics, College of Medicine, Taipei Medical University, 50 Wu-Hsing Street, Taipei, Taiwan
| | - Ying-Chao Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 123 Dapi Road, Niaosong District, Kaohsiung City 833, Taiwan.
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Pediatric acute disseminated encephalomyelitis associated with myelin oligodendrocyte glycoprotein antibodies. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh211202024r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Myelin oligodendrocyte glycoprotein antibody associated
disorders (MOGAD) are immune-mediated inflammatory conditions of the central
nervous system (CNS) with a wide clinical phenotypic variability. In order
to further understand the possible phenotype of MOGAD here we report a
pediatric case of acute disseminated encephalomyelitis (ADEM) associated
with MOG antibodies. Case outline. A previously healthy four-month-old
infant presented due to a 1-day history of fever up to 39?C and vomiting. On
admission, she was encephalopathic. Repetitive and frequent stereotyped
dystonic movements were observed. Cerebrospinal fluid (CSF) examination
showed pleocytosis (lymphocytes were predominant) and proteinorachy. CSF
culture and virology results were negative. Serum MOG antibodies were
positive. A prolonged electroencephalography (EEG) showed continuous
high-amplitude slow rhythmic activity with captured stereotyped movement.
Epileptic discharges were not seen. Although magnetic resonance imaging
showed signs of acute demyelinating encephalomyelitis, our patient did not
have seizures, despite neuroimaging findings of cortical lesions. Acute
treatment with the corticosteroids led to excellent response with full
recovery. Conclusion. This case emphasizes the inclusion of the MOG
antibodies testing in the initial work-up in children presenting with acute
encephalopathy associated with demyelinating or encephalitic abnormalities
on brain and/or spinal magnetic resonance imaging even when the clinical
phenotype is unusual. The prompt diagnosis of MOGAD is relevant for accurate
disease monitoring and treatment strategies.
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Garone G, Graziola F, Grasso M, Capuano A. Acute Movement Disorders in Childhood. J Clin Med 2021; 10:jcm10122671. [PMID: 34204464 PMCID: PMC8234395 DOI: 10.3390/jcm10122671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/14/2022] Open
Abstract
Acute-onset movement disorders (MDs) are an increasingly recognized neurological emergency in both adults and children. The spectrum of possible causes is wide, and diagnostic work-up is challenging. In their acute presentation, MDs may represent the prominent symptom or an important diagnostic clue in a broader constellation of neurological and extraneurological signs. The diagnostic approach relies on the definition of the overall clinical syndrome and on the recognition of the prominent MD phenomenology. The recognition of the underlying disorder is crucial since many causes are treatable. In this review, we summarize common and uncommon causes of acute-onset movement disorders, focusing on clinical presentation and appropriate diagnostic investigations. Both acquired (immune-mediated, infectious, vascular, toxic, metabolic) and genetic disorders causing acute MDs are reviewed, in order to provide a useful clinician’s guide to this expanding field of pediatric neurology.
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Affiliation(s)
- Giacomo Garone
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- University Department of Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy
| | - Federica Graziola
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Melissa Grasso
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
| | - Alessandro Capuano
- Movement Disorders Clinic, Department of Neurosciences, Bambino Gesù Children’s Hospital, IRCCS, viale San Paolo 15, 00146 Rome, Italy; (G.G.); (F.G.); (M.G.)
- Correspondence:
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Hemram SK, Ghosh A, Annigeri S. Rare and Atypical Presentations of Acute Disseminated Encephalomyelitis in Children: A Case Series. J Trop Pediatr 2021; 67:6294509. [PMID: 34100092 DOI: 10.1093/tropej/fmab045] [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] [Indexed: 11/14/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is a monophasic demyelinating disorder of central nervous system occurring in children with a wide range of clinical manifestations after infection or vaccination. There are few case reports in literature, describing atypical presentations of ADEM with fever of unknown origin, autonomic dysfunction, complex movement disorders such as myoclonus, dystonia and chorea, acute psychosis and myocarditis. Here, we report four cases of ADEM with atypical features like uniocular blindness, myelin oligodendrocyte glycoprotein antibodies negative multiphasic disseminated encephalomyelitis, ADEM mimicking Guillain-Barre syndrome at presentation and isolated spinal ADEM. Treatment with high-dose steroids elicited an excellent neurological outcome in all patients. A high index of clinical suspicion along-with awareness of atypical features, magnetic resonance imaging and cerebrospinal fluid studies are of paramount importance in establishing ADEM diagnosis and initiation of early treatment for better outcome.
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Affiliation(s)
- Sunil Kumar Hemram
- Department of Pediatrics, Midnapore Medical College, West Bengal 721101, India
| | - Arindam Ghosh
- Department of Pediatrics, Midnapore Medical College, West Bengal 721101, India
| | - Saba Annigeri
- Department of Pediatrics, Midnapore Medical College, West Bengal 721101, India
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Foiadelli T, Gastaldi M, Scaranzin S, Franciotta D, Savasta S. Seizures and myelin oligodendrocyte glycoprotein (MOG) antibodies: Two paradigmatic cases and a review of the literature. Mult Scler Relat Disord 2020; 41:102011. [DOI: 10.1016/j.msard.2020.102011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
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Yılmaz Ü, Edizer S, Songür ÇY, Güzin Y, Durak FS. Atypical presentation of MOG-related disease: Slowly progressive behavioral and personality changes following a seizure. Mult Scler Relat Disord 2019; 36:101394. [PMID: 31525625 DOI: 10.1016/j.msard.2019.101394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/18/2019] [Accepted: 09/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Myelin Oligodendrocyte Glycoprotein (MOG) antibodies-related disease is mainly presented with acute disseminated encephalomyelitis (ADEM), recurrent optic neuritis, and neuromyelitis optica spectrum disorders (NMOSDs), however the complete clinical spectrum has not yet been defined. We describe an unusual presentation of MOG- related disease. A previously well 10-year-old girl admitted with a focal onset seizure. Neurological examination, electroencephalography, and brain magnetic resonance imaging (MRI) were normal. Following seizure episode she developed gradually increased behavioral and personality changes during a period of 2.5 months. Neurological examination was unremarkable except for drowsiness and minimal ataxia on tandem walking. Repeated brain MRI revealed hazy and poorly demarcated lesions with gadolinium enhancement in the basal ganglia, supratentorial white matter, cerebral peduncles, cerebellum, and servical spinal cord. Cerebrospinal fluid analyses (CSF) revealed 10 lymphocytes /µL, normal protein concentration and IgG index, and negative oligoclonal bands. Auto-antibodies against N-methyl-d-aspartate receptor and CASPR2 in CSF, and antibodies against aquaporin 4 in serum were negative. Analysis with a cell-based assay identified high serum titer of MOG antibodies (1:320). Following IVIG therapy, the patient showed complete clinical recovery within a week with no further relaps for the following 6-month period. CONCLUSION Slowly progressive behavioral and personality changes following a seizure may be a manifestation of MOG-related disease in children.
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Affiliation(s)
- Ünsal Yılmaz
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey.
| | - Selvinaz Edizer
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Çisel Yazan Songür
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - Yiğithan Güzin
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Fatma Sibel Durak
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Child and Adolescent Psychiatry, Izmir, Turkey
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Marignier R. Unusual presentations of MOG antibody-associated central nervous system demyelination: Expanding the spectrum. Mult Scler 2018; 25:128-129. [DOI: 10.1177/1352458518804127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Romain Marignier
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Centre Hospitalier Universitaire de Lyon, Lyon, France
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