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Abstract
PURPOSE OF REVIEW Autoimmune neuromyotonia encompasses a group of rare immune-mediated neurological disorders frequently associated with anti-contactin-associated protein-like 2 (CASPR2) antibodies and featuring clinical and electrical signs of peripheral nerve hyperexcitability (PNH). We aim to summarize the current knowledge on immune-mediated neuromyotonia, focusing on clinical presentations, pathophysiology, and management. RECENT FINDINGS Neuromyotonia is a major feature of several autoimmune neurological syndromes characterized by PNH with or without central neurological system involvement. Experimental and clinical evidence suggest that anti-CASPR2 antibodies are directly pathogenic in autoimmune neuromyotonia patients. SUMMARY Neuromyotonia, a form of PNH, is a major feature in several syndromes associated with anti-CASPR2 antibodies, including cramp-fasciculation syndrome, Isaacs syndrome, Morvan syndrome, and autoimmune limbic encephalitis. Diagnosis relies on the identification of motor, sensory, and autonomic signs of PNH along with other neurological symptoms, anti-CASPR2 antibody-positivity, and of characteristic electroneuromyographic abnormalities. Paraneoplastic associations with thymoma are possible, especially in Morvan syndrome. Patients usually respond to immune-active treatments, including steroids, intravenous immunoglobulins, plasma exchanges, and rituximab.
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Affiliation(s)
- Louis Comperat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
| | - Antoine Pegat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- Electroneuromyography and Neuromuscular Diseases Unit, Pierre Wertheimer Hospital, Hospices Civils de Lyon
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université Claude Bernard Lyon 1
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- Synaptopathies and Autoantibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université Claude Bernard Lyon 1
- Department of Neurology, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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2
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Nonaka T, Ebisu I, Ohashi I, Shizukawa H, Shimohama S. [Morvan syndrome associated with unresectable thymoma responsive to chemotherapy: a case report]. Rinsho Shinkeigaku 2022; 62:615-620. [PMID: 35871563 DOI: 10.5692/clinicalneurol.cn-001729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
A 51-year-old Japanese man presenting with a several-month history of parasomnia, orthostatic hypotension and generalized myokymia was admitted to our hospital. He had a past medical history of unresectable recurrent thymoma, but chemotherapy for thymoma was discontinued according to the patient's decision four years before this hospitalization, and the thymoma had enlarged. He exhibited symptoms of the peripheral nervous system (myokymia), central nervous system (parasomnia, short-term memory impairment), and autonomic nervous system (orthostatic hypotension), and his serum was positive for voltage-gated potassium channel (VGKC)-complex antibodies. Based on the above findings, Morvan syndrome was diagnosed. Resumption of chemotherapy for thymoma resulted in shrinkage of the thymoma accompanied by remission of Morvan syndrome. Subsequently, discontinuation of chemotherapy led to aggravation of thymoma with recurrence of Morvan syndrome. This clinical course suggests a strong correlation between the disease activity of thymoma and Morvan syndrome. In the present case of Morvan syndrome associated with unresectable thymoma, chemotherapy contributed to the remission of Morvan syndrome. Our patient suggests a possibility that chemotherapy for thymoma is a useful treatment for Morvan syndrome.
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Affiliation(s)
| | - Ikumi Ebisu
- Department of Neurology, Sapporo-Kosei General Hospital
| | - Ikkei Ohashi
- Department of Neurology, Sapporo-Kosei General Hospital
| | | | - Shun Shimohama
- Department of Neurology, Sapporo Medical University School of Medicine
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Suzuki D, Suzuki Y, Sato D, Kikuchi K, Kanauchi N, Nishida A, Ohta Y. Morvan Syndrome Converted from Isaacs' Syndrome after Thymectomy with Positivity for Both Anti-LGI1 and Anti-CASPR2 Antibodies. Intern Med 2022; 61:1443-1445. [PMID: 34670891 PMCID: PMC9152873 DOI: 10.2169/internalmedicine.8145-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Anti-voltage-gated potassium channel complex antibodies-mediated disorder includes Isaacs' syndrome, which is characterized by neuromyotonia, and Morvan syndrome, which is characterized by neuromyotonia, encephalopathy and autonomic dysfunction. We herein report a patient with Morvan syndrome that converted from Isaacs' syndrome after thymectomy. The patient first presented with myospasm in all extremities and positivity for both anti-leucine-rich glioma inactivated 1 (LGI1) and anti-contactin-associated protein like 2 (CASPR2) antibodies and subsequently developed encephalopathy after thymectomy, which was successfully improved by immunotherapy. This is the first case of Morvan syndrome wherein thymectomy worsened Isaacs' syndrome, suggesting that immunotherapy should be considered for Isaacs' syndrome accompanied by positivity for both anti-LGI1 and anti-CASPR2 antibodies to prevent worsening to Morvan syndrome.
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Affiliation(s)
- Daisuke Suzuki
- Department of Neurology, Nihonkai General Hospital, Japan
| | | | - Daisuke Sato
- Department of Neurology, Nihonkai General Hospital, Japan
| | - Kenji Kikuchi
- Department of Neurology, Nihonkai General Hospital, Japan
| | - Naoki Kanauchi
- Department of Respiratory Surgery, Nihonkai General Hospital, Japan
| | - Akiko Nishida
- Department of Pathology, Nihonkai General Hospital, Japan
| | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University Faculty of Medicine, Japan
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Xhaxho S, Vyshka G, Muharremi E, Kruja J. A case report of Morvan syndrome. Oxf Med Case Reports 2021; 2021:omab064. [PMID: 34408887 DOI: 10.1093/omcr/omab064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/31/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Authors describe the case of a 22-year-old Caucasian male who presented acutely with psychomotor agitation, insomnia and muscle twitching with painful cramps. Autonomic symptoms were as well present, with profuse sweating, blood pressure fluctuations and tachycardia. He presented a miliary rash in his left forearm as well as in the neck. Electromyography documented myokymic movements bilaterally at both gastrocnemii and pretibial muscles. Brain imaging had no abnormalities, and anti-LGI1 and anti-CASPR2 resulted positive; this data together with electrophysiological findings suggested a Morvan syndrome. High-dose steroid therapy and plasma exchange improved substantially the clinical picture of the patient.
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Affiliation(s)
- Sokrat Xhaxho
- Service of Neurology, University Hospital Center 'Mother Theresa', Tirana, Albania
| | - Gentian Vyshka
- Faculty of Medicine, Biomedical and Experimental Department, University of Medicine, Tirana, Albania
| | - Eti Muharremi
- Service of Neurology, University Hospital Center 'Mother Theresa', Tirana, Albania
| | - Jera Kruja
- Service of Neurology, University Hospital Center 'Mother Theresa', Tirana, Albania.,Faculty of Medicine, University of Medicine, Tirana, Albania
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Zhang SJ, Xue YY, Yu H, Tao QQ. Morvan syndrome associated with LGI1 antibody: a case report. BMC Neurol 2021; 21:185. [PMID: 33941099 PMCID: PMC8091679 DOI: 10.1186/s12883-021-02205-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/16/2021] [Indexed: 12/02/2022] Open
Abstract
Background Morvan syndrome (MoS) is a rare autoimmune syndrome associated with antibodies against two kinds of potassium channel proteins, contactin associated protein-like 2 (CASPR2) and leucine-rich glioma inactivated protein 1 (LGI1). MoS patients with only LGI1-antibody seropositivity have rarely been reported. Here, we describe a 64-year-old male MoS patient with only LGI1-antibody seropositivity. Case presentation A 64-year-old male patient was referred to our hospital due to limb pain, widespread myokymia, insomnia, constipation, and hyperhidrosis for 1 month. The patient was diagnosed with MoS based on the clinical symptoms and positive LGI1-antibody in serum. He was treated with intravenous immunoglobulin (IVIG), intravenous methylprednisolone followed by oral prednisone, and other drugs for symptomatic relief. Several days later, myokymia and insomnia symptoms improved. After 60 days of follow-up, all the drugs had been stopped for 2 weeks, and the patient achieved complete remission without any medical side effects. Conclusion We report the clinical characteristics of a Chinese MoS patient with only LGI1-antibody seropositivity, and further support the view that non-neoplasm MoS patients respond well to immunotherapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02205-9.
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Affiliation(s)
- Shui-Jing Zhang
- Department of Neurology,The Third Affiliated Hospital of Zhejiang Chinese Medical University and Zhejiang Rehabilitation Medical Center, Hangzhou, China.,Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Yan-Yan Xue
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Hao Yu
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing-Qing Tao
- Department of Neurology and Research Center of Neurology in Second Affiliated Hospital, Key Laboratory of Medical Neurobiology of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China.
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Panchin Y, Kovalzon VM. Total Wake: Natural, Pathological, and Experimental Limits to Sleep Reduction. Front Neurosci 2021; 15:643496. [PMID: 33897357 PMCID: PMC8058214 DOI: 10.3389/fnins.2021.643496] [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: 12/18/2020] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Sleep is not considered a pathological state, but it consumes a third of conscious human life. This share is much more than most optimistic life extension forecasts that biotechnologies or experimental and medical interventions can offer. Are there insurmountable physical or biological limitations to reducing the duration of sleep? How far can it be avoided without fatal consequences? What means can reduce the length of sleep? It is widely accepted that sleep is necessary for long-term survival. Here we review the limited yet intriguing evidence that is not consistent with this notion. We concentrate on clinical cases of complete and partial loss of sleep and on human mutations that result in a short sleep phenotype. These observations are supported by new animal studies and are discussed from the perspective of sleep evolution. Two separate hypotheses suggest distinct approaches for remodeling our sleep machinery. If sleep serves an unidentified vital physiological function, this indispensable function has to be identified before "sleep prosthesis" (technical, biological, or chemical) can be developed. If sleep has no vital function, but rather represents a timing mechanism for adaptive inactivity, sleep could be reduced by forging the sleep generation system itself, with no adverse effects.
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Affiliation(s)
- Yuri Panchin
- Institute for Information Transmission Problems, Russian Academy of Sciences, Moscow, Russia
- Department of Mathematical Methods in Biology, Belozersky Institute, Lomonosov Moscow State University, Moscow, Russia
| | - Vladimir M. Kovalzon
- Institute for Information Transmission Problems, Russian Academy of Sciences, Moscow, Russia
- Severtsov Institute of Ecology and Evolution, Russian Academy of Sciences, Moscow, Russia
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Singh R, Das P, Kaur U, Misra A, Choudhury A, Manna S, Gaude R, Gautam D, Gambhir IS, Chakrabarti SS. Morvan's syndrome-is a pathogen behind the curtain? Neurol Sci 2018; 39:1965-1969. [PMID: 30090985 DOI: 10.1007/s10072-018-3515-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022]
Abstract
Morvan's syndrome is a rare syndrome of likely autoimmune etiology characterized by peripheral nerve hyperexcitability, dysautonomia, insomnia, and fluctuating delirium with prominent hallucinations. Since its first mention in 1890, less than 100 cases have been described in literature. The largest existing review includes details of 29 cases. This case series describes 4 cases (M = 4) of Morvan's syndrome which presented between May and November 2017 to a single tertiary care referral teaching hospital in north India. All the four patients manifested behavioral abnormalities, sleep disturbances, hallucinations, autonomic dysfunction, and clinical signs of peripheral nerve hyperexcitability, mostly as myokymia. Two of the patients had Anti-CASPR2 (contactin-associated protein 2) antibodies. Three of them had electromyography features of peripheral nerve hyperexcitability and only one had elevated cerebrospinal fluid protein level. We hypothesize that Morvan's syndrome and other less characterized autoimmune encephalitis/peripheral nervous system syndromes may have infectious triggers. A possible viral trigger may result in generation of autoantibodies which result in the typical manifestations. We base these hypotheses on the finding of four cases of an orphan disease within a short period of time in a limited geographical distribution.
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Affiliation(s)
- Rohit Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pritam Das
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Upinder Kaur
- Department of Pharmacology (Previously Division of Geriatrics), Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anamika Misra
- Geriatric Research Lab, Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ashis Choudhury
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sukdev Manna
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rohit Gaude
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepak Gautam
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Indrajeet Singh Gambhir
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sankha Shubhra Chakrabarti
- Department of Geriatric Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India.
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Abstract
PURPOSE OF REVIEW Peripheral nerve hyperexcitability (PNH) syndromes are divided into primary and secondary groups based on the presence or absence of demonstrable peripheral nerve disease. In this review, we systematically evaluate the evidence for current therapies and supportive managements based on autoimmune, paraneoplastic, and genetic components in pathophysiology reported in the literature. RECENT FINDINGS Current therapy options are based on symptomatic management as well as focusing the underlying immune/genetic/paraneoplastic pathology by immunosuppressants, chemotherapy, and surgery. Further research is desired to provide treatment options geared specifically towards addressing PNH. Supportive care can also be an area for future research.
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Galié E, Renna R, Plantone D, Pace A, Marino M, Jandolo B, Koudriavtseva T. Paraneoplastic Morvan's syndrome following surgical treatment of recurrent thymoma: A case report. Oncol Lett 2016; 12:2716-2719. [PMID: 27698847 DOI: 10.3892/ol.2016.4922] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/03/2016] [Indexed: 01/17/2023] Open
Abstract
Morvan's syndrome (MoS) is a rare, complex neurological disorder characterized by neuromyotonia, neuropsychiatric features, dysautonomia and neuropathic pain. The majority of MoS cases have a paraneoplastic aetiology, usually occurring prior to the diagnosis of the underlying tumour and showing improvement following its treatment. The present study reports the case of a 35-year-old Caucasian male patient who was diagnosed with stage IVA thymoma. Thymectomy, lung resection, diaphragmatic pleurectomy and pericardio-phrenectomy were performed 6 months after neoadjuvant chemotherapy. The pathological evaluation revealed a type B2-B3 thymoma with focal squamous differentiation. Two years later, the patient underwent new surgical treatment for a local recurrence of the same histological type, and 4 weeks later, the patient presented with complex neurological symptoms compatible with MoS, including neuromyotonia, neuropsychiatric features, dysautonomia and neuropathic pain. Electromyography was compatible with a diagnosis of neuromyotonia. Brain magnetic resonance imaging scan and tests for serum anti-acetylcholine receptor, anti-striated muscle antibodies and anti-30-kDa titin fragment antibodies were all negative, whereas tests for anti-voltage-gated potassium channel (VGKC)-complex antibodies (333.3 pmol/l), anti-leucine-rich glioma inactivated protein 1 and anti-contactin-associated protein-like 2 antibodies were positive. The patient underwent 3 cycles of intravenous administration of immunoglobulins (0.4 g/kg/day for 5 days every 4 weeks) with little clinical and electrophysiological improvement. We speculated that the late onset of the symptoms in the present patient may have been triggered by an increase in the serum level of anti-VGKC antibody, which was caused by the surgery performed for the treatment of recurrent thymoma. To the best of our knowledge, the present report is the first case of MoS associated with this histological type of thymoma uncommonly occurring upon surgical treatment of recurrent thymoma.
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Affiliation(s)
- Edvina Galié
- Unit of Neurology, Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, I-00144 Rome, Italy
| | - Rosaria Renna
- Institute of Neurology, Catholic University of Sacred Heart, I-00168 Rome, Italy
| | - Domenico Plantone
- Unit of Neurology, Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, I-00144 Rome, Italy
| | - Andrea Pace
- Unit of Neurology, Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, I-00144 Rome, Italy
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, I-00144 Rome, Italy
| | - Bruno Jandolo
- Unit of Neurology, Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, I-00144 Rome, Italy
| | - Tatiana Koudriavtseva
- Unit of Neurology, Regina Elena National Cancer Institute, Istituti Fisioterapici Ospitalieri, I-00144 Rome, Italy
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