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Tung H, Chou CC, Chen HM, Chen YM, Wu YY, Chai JW, Chen JP, Chen SC, Chen HC, Lee WJ. White Matter Hyperintensities and Cognitive Functions in People With the R544C Variant of the NOTCH3 Gene Without Stroke or Dementia. Neurology 2024; 103:e209941. [PMID: 39374470 DOI: 10.1212/wnl.0000000000209941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND AND OBJECTIVES NOTCH3 pathologic variants cause cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), which presents with stroke and dementia and is characterized by white matter hyperintensities (WMHs) on brain MRI. The R544C variant is a common pathologic variant in Taiwan, but not all carriers exhibit significant symptoms. We investigated whether WMHs occur before clinical symptoms in carriers with pathogenic variants, examined factors associated with WMHs, and explored their relationship with cognitive functions. METHODS We enrolled 63 R544C carriers without overt clinical disease (WOCD) and 37 age-matched and sex-matched noncarriers as controls from the Taiwan Precision Medicine Initiative data set. All participants underwent clinical interviews, comprehensive neuropsychological assessments, and brain MRI. We calculated total and regional WMH volumes, determined the age at which WMHs began increasing in carriers, and examined the relationship between WMHs and neuropsychological performance. Factors associated with WMH volumes were analyzed using multivariable linear regression models. RESULTS Compared with controls, R544C carriers WOCD had increased WMH volume, except in the occipital and midbrain areas, and showed a rapid increase in WMHs starting at age 48. They scored lower on the Mini-Mental State Examination (median = 28.4 vs 29.0, p = 0.048), Montreal Cognitive Assessment (MoCA) (median = 28.3 vs 29.0, p = 0.013), and memory and executive function tests than controls. After adjusting for age, sex, and education, MoCA scores were associated with whole-brain (r = -0.387, padj = 0.008) and regional WMHs (all padj < 0.05) except in the midbrain area. Age (β = 0.034, 95% CI 0.021-0.046, p < 0.001), hypercholesterolemia (β = 0.375, 95% CI 0.097-0.653, p = 0.009), and the vascular risk factor (VRF) index (β = 0.132, 95% CI 0.032-0.242, p = 0.019) were associated with the WMH severity in carriers. DISCUSSION Our study revealed that WMHs are extensively distributed in R544C carriers WOCD. They exhibited a rapid increase in WMHs beginning at age 48, approximately 7 years earlier than the reported age at symptomatic onset. Age was the strongest predictive factor of WMHs, and VRF, particularly hypercholesterolemia, might be modifying factors of WMHs.
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Affiliation(s)
- Hsin Tung
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Chih Chou
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsian-Min Chen
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ming Chen
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ying Wu
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jyh-Wen Chai
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jun-Peng Chen
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-Chun Chen
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Chieh Chen
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Ju Lee
- From the Department of Post-Baccalaureate Medicine (H.T., C.-C.C., Y.-M.C., W.-J.L.), College of Medicine, National Chung Hsing University; Center of Faculty Development (H.T.), Department of Medical Education, and Department of Neurology (H.T., W.-J.L.), Neurological Institute, Taichung Veterans General Hospital; Graduate Institute of Clinical Medicine (C.-C.C.), College of Medicine, National Taiwan University, Taipei; Department of Ophthalmology (C.-C.C.), Taichung Veterans General Hospital; School of Medicine (C.-C.C., Y.-M.C., H.-C.C.), National Yang Ming Chiao Tung University, Taipei; Center for Quantitative Imaging in Medicine (H.-M.C.), Department of Medical Research, Division of Allergy, Immunology and Rheumatology (Y.-M.C.), Department of Internal Medicine, and Department of Medical Research (Y.-M.C.), Taichung Veterans General Hospital; Institute of Biomedical Science and Rong Hsing Research Center for Translational Medicine & Program in Translational Medicine (Y.-M.C.), and Precision Medicine Research Center (Y.-M.C.), College of Medicine, National Chung Hsing University, Taichung; Department of Radiology (Y.-Y.W., J.-W.C., H.-C.C.), Taichung Veterans General Hospital; Department of Electrical Engineering (Y.-Y.W.), National Chung Hsing University, Taichung; Biostatistics Task Force of Taichung Veterans General Hospital (J.-P.C.), Taichung; Institute of Statistical Science (S.-C.C.), Academia Sinica, Taipei; Dementia Center (W.-J.L.), Taichung Veterans General Hospital; and Brain Research Center (W.-J.L.), National Yang Ming Chiao Tung University, Taipei, Taiwan
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Mizuno T, Ohara T, Mizuta I, Naito A, Nakata M, Uno-Kadowaki A, Iwami Y, Watanabe-Hosomi A, Matsuura H, Fukunaga D, Ito-Ihara T, Teramukai S. Study Protocol for LOMCAD Trial: Effect of Lomerizine Hydrochloride to Prevent Recurrence of Cerebral Ischemic Events in CADASIL Patients. J Stroke Cerebrovasc Dis 2024:108042. [PMID: 39454930 DOI: 10.1016/j.jstrokecerebrovasdis.2024.108042] [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: 06/01/2024] [Revised: 07/28/2024] [Accepted: 09/25/2024] [Indexed: 10/28/2024] Open
Abstract
OBJECTIVES Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is one of the most common monogenic cerebral small vessel diseases. Our previous observational study suggested that lomerizine hydrochloride, a calcium channel blocker approved in Japan in 1999 for the prevention of migraine headaches, is also effective for preventing recurrent ischemic stroke in CADASIL patients. The aim of this study (LOMCAD trial) is to verify the efficacy of lomerizine hydrochloride. MATERIALS AND METHODS This is a multicenter, prospective, single-arm trial, using a historical control for comparison. CADASIL patients with a history of two or more cerebral ischemic events within the last two years will be administered lomerizine hydrochloride (5-mg tablet twice daily) for 24 months. The primary endpoint is symptomatic cerebral ischemic events during the 24-month period. Using our historical data and Bayesian sample size calculation based on a prior predictive distribution, the planned sample size was determined as 20 subjects. CONCLUSION We have planned a clinical trial to verify the effectiveness of lomerizine hydrochloride as prophylaxis to prevent recurrent cerebral ischemic events in CADASIL patients. REGISTRATION The LOMCAD trial has been registered in the Japan Registry of Clinical Trials (jRCTs051220072, https://jrct.niph.go.jp/latest-detail/jRCTs051220072).
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Affiliation(s)
- Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Tomoyuki Ohara
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akari Naito
- Division of Data Science, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Mitsuko Nakata
- Division of Data Science, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Aoi Uno-Kadowaki
- Division of Research Management, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yayoi Iwami
- Division of Research Management, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akiko Watanabe-Hosomi
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hiraku Matsuura
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Daiki Fukunaga
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiko Ito-Ihara
- Division of Research Management, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Division of Data Science, The Clinical and Translational Research Center, University Hospital, Kyoto Prefectural University of Medicine, Kyoto, Japan; Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Correale J, Solomon AJ, Cohen JA, Banwell BL, Gracia F, Gyang TV, de Bedoya FHD, Harnegie MP, Hemmer B, Jacob A, Kim HJ, Marrie RA, Mateen FJ, Newsome SD, Pandit L, Prayoonwiwat N, Sahraian MA, Sato DK, Saylor D, Shi FD, Siva A, Tan K, Viswanathan S, Wattjes MP, Weinshenker B, Yamout B, Fujihara K. Differential diagnosis of suspected multiple sclerosis: global health considerations. Lancet Neurol 2024; 23:1035-1049. [PMID: 39304243 DOI: 10.1016/s1474-4422(24)00256-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 05/14/2024] [Accepted: 06/04/2024] [Indexed: 09/22/2024]
Abstract
The differential diagnosis of multiple sclerosis can present specific challenges in patients from Latin America, Africa, the Middle East, eastern Europe, southeast Asia, and the Western Pacific. In these areas, environmental factors, genetic background, and access to medical care can differ substantially from those in North America and western Europe, where multiple sclerosis is most common. Furthermore, multiple sclerosis diagnostic criteria have been developed primarily using data from North America and western Europe. Although some diagnoses mistaken for multiple sclerosis are common regardless of location, a comprehensive approach to the differential diagnosis of multiple sclerosis in Latin America, Africa, the Middle East, eastern Europe, southeast Asia, and the Western Pacific regions requires special consideration of diseases that are prevalent in those locations. A collaborative effort has therefore assessed global differences in multiple sclerosis differential diagnoses and proposed recommendations for evaluating patients with suspected multiple sclerosis in regions beyond North America and western Europe.
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Affiliation(s)
- Jorge Correale
- Department of Neurology, Fleni, Buenos Aires, Argentina; Institute of Biological Chemistry and Biophysics, CONICET/University of Buenos Aires, Buenos Aires, Argentina.
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Jeffrey A Cohen
- Department of Neurology, Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brenda L Banwell
- Division of Child Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Fernando Gracia
- Hospital Santo Tomás, Panama City, Panama; Universidad Interamericana de Panamá, School of Medicine, Panama City, Panama
| | - Tirisham V Gyang
- Department of Neurology, The Ohio State University, Columbus, Ohio, USA
| | | | - Mary P Harnegie
- Cleveland Clinic Libraries, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, School of Medicine and Health, Technical University of Munich, Munich Cluster for Systems Neurology, Munich, Germany
| | - Anu Jacob
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, South Korea
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Harvard University, Boston, USA
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hedge Medical Academy, Nitte University, Mangalore, India
| | - Naraporn Prayoonwiwat
- Division of Neurology, Department of Medicine and Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Mohammad A Sahraian
- MS Research Center, Neuroscience Institute, Teheran University of Medical Sciences, Iran
| | - Douglas K Sato
- Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; University Teaching Hospital, Lusaka, Zambia
| | - Fu-Dong Shi
- Tianjin Medical University General Hospital, Tianjin, China; National Clinical Research Center for Neurological Disorders, Beijing Tiantan Hospital, Beijing, China
| | - Aksel Siva
- Istanbul University Cerrahpasa, School of Medicine, Department of Neurology, Clinical Neuroimmunology Unit and MS Clinic, Istanbul, Türkiye
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Duke-NUS Medical School, Singapore
| | | | - Mike P Wattjes
- Department of Neuroradiology, Charité Berlin, Corporate Member of Freie Universität zu Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Brian Weinshenker
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine and Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan.
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Meschia JF, Worrall BB, Elahi FM, Ross OA, Wang MM, Goldstein ED, Rost NS, Majersik JJ, Gutierrez J. Management of Inherited CNS Small Vessel Diseases: The CADASIL Example: A Scientific Statement From the American Heart Association. Stroke 2023; 54:e452-e464. [PMID: 37602377 DOI: 10.1161/str.0000000000000444] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023]
Abstract
Lacunar infarcts and vascular dementia are important phenotypic characteristics of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, the most common inherited cerebral small vessel disease. Individuals with the disease show variability in the nature and onset of symptoms and rates of progression, which are only partially explained by differences in pathogenic mutations in the NOTCH3 gene. Recognizing the disease early in its course and securing a molecular diagnosis are important clinical goals, despite the lack of proven disease-modifying treatments. The purposes of this scientific statement are to review the clinical, genetic, and imaging aspects of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, contrasting it with other inherited small vessel diseases, and to provide key prevention, management, and therapeutic considerations with the intent of reducing practice variability and encouraging production of high-quality evidence to support future treatment recommendations.
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Takei J, Higuchi Y, Ando M, Yoshimura A, Yuan JH, Fujisaki N, Tokashiki T, Kanzato N, Jonosono M, Sueyoshi T, Kanda N, Matsuoka H, Okubo R, Suehara M, Matsuura E, Takashima H. Microbleed clustering in thalamus sign in CADASIL patients with NOTCH3 R75P mutation. Front Neurol 2023; 14:1241678. [PMID: 37681004 PMCID: PMC10480842 DOI: 10.3389/fneur.2023.1241678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/31/2023] [Indexed: 09/09/2023] Open
Abstract
Background and objective Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral microvascular disease characterized by the development of vascular dementia and lacunar infarctions. This study aimed to identify the genetic and clinical features of CADASIL in Japan. Methods We conducted genetic analysis on a case series of patients clinically diagnosed with CADASIL. Clinical and imaging analyses were performed on 32 patients with pathogenic mutations in the NOTCH3 gene. To assess the presence of cerebral microbleeds (CMBs), we utilized several established rating scales including the Fazekas scale, Scheltens rating scale, and Microbleed Anatomical Rating Scale, based on brain MRI images. Results Among the 32 CADASIL patients, 24 cases were found carrying the R75P mutation in NOTCH3, whereas the remaining eight cases had other NOTCH3 mutations (R75Q, R110C, C134F, C144F, R169C, and R607C). The haplotype analysis of the R75P mutation uncovered the presence of a founder effect. A brain MRI analysis revealed that cases with the R75P mutation had a significantly higher total number of CMBs, particularly in the thalamus when compared to patients with other NOTCH3 mutations. Among 15 out of 24 cases with the R75P mutation, we observed a notable clustering of CMBs in the thalamus, termed microbleed clustering in thalamus sign (MCT sign). Conclusion We propose that the MCT sign observed in NOTCH3 R75P-related CADASIL patients may serve as a potentially characteristic imaging feature. This finding offers further insights into the interactions between genotypes and phenotypes between NOTCH3 and CADASIL.
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Affiliation(s)
- Jun Takei
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yujiro Higuchi
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Masahiro Ando
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Akiko Yoshimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Jun-Hui Yuan
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Natsumi Fujisaki
- Department of Neurology, National Hospital Organization Okinawa Hospital, Okinawa, Japan
| | - Takashi Tokashiki
- Department of Neurology, National Hospital Organization Okinawa Hospital, Okinawa, Japan
| | - Naomi Kanzato
- Department of Neurology, Okinawa Prefectural Southern Medical Center & Children's Medical Center, Okinawa, Japan
| | - Manabu Jonosono
- Department of Neurology, Okinawa Chubu Hospital, Okinawa, Japan
| | | | - Naoaki Kanda
- Department of Neurology, Imamura General Hospital, Kagoshima, Japan
| | - Hideki Matsuoka
- Department of Cerebrovascular Medicine, Stroke Center, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Ryuichi Okubo
- Department of Neurology, Fujimoto General Hospital, Miyazaki, Japan
| | - Masahito Suehara
- Department of Neurology, Fujimoto General Hospital, Miyazaki, Japan
| | - Eiji Matsuura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
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6
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Muppa J, Yaghi S, Goldstein ED. Antiplatelet use and CADASIL: a retrospective observational analysis. Neurol Sci 2023:10.1007/s10072-023-06773-1. [PMID: 36966219 DOI: 10.1007/s10072-023-06773-1] [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: 01/25/2023] [Accepted: 03/20/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVES Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is hallmarked by age-dependent accumulation of microangiopathy with antiplatelet medications commonly used for stroke prevention though without known therapeutic benefit. Our objective was to identify whether antiplatelet therapy impacted the incidence of acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) in those with reported CADASIL. MATERIALS AND METHODS Owing to the rarity of the disease, we performed a retrospective study of anonymized data from the international TriNetX Research Network (Oct 2015 through January 2021). Individuals had an ICD-10 code (I67.850) for CADASIL. The primary outcome was incidence of validated ICD-10 codes for AIS (I63) and ICH (I61) linked with unique hospital admission encounters. The primary exposure was use of an antiplatelet medication for at least 1 month prior to the primary outcome. Age-adjusted logistic regression was used for likelihood ratios. RESULTS We identified 455 individuals: 36% female, 40 (8.8%) antiplatelet exposed. Those with antiplatelet use were older (antiplatelet: 61±12 years vs. unexposed: 57±14 years, p = 0.034) with similar rates of AIS [antiplatelet: 23%(9/40) vs. unexposed: 14%(60/415); p=0.18] and ICH [antiplatelet: 3%(1/40) vs. unexposed: 5%(19/415); p = 0.54) and without significant impact on age-adjusted AIS likelihood (OR 1.62, 95%CI 0.73-3.60, p=0.23). Sample size precluded ICH regression analyses. CONCLUSIONS Our data suggests that antiplatelet use did not significantly impact incidence of AIS or ICH within a group of individuals with suspected CADASIL This study highlights the need for further understanding of the pathophysiology of CADASIL to lead to disease modifying treatments.
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Affiliation(s)
- Jayachandra Muppa
- Department of Neurology, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | - Shadi Yaghi
- Department of Neurology, Warren Alpert Medical School of Brown University, 593 Eddy St, APC 5th Floor, Providence, RI, 02903, USA
| | - Eric D Goldstein
- Department of Neurology, Warren Alpert Medical School of Brown University, 593 Eddy St, APC 5th Floor, Providence, RI, 02903, USA.
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7
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Xu WJ, Barisano G, Phung D, Chou B, Pinto SN, Lerner A, Sheikh-Bahaei N. Structural MRI in Migraine: A Review of Migraine Vascular and Structural Changes in Brain Parenchyma. J Cent Nerv Syst Dis 2023; 15:11795735231167868. [PMID: 37077432 PMCID: PMC10108417 DOI: 10.1177/11795735231167868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/15/2023] [Indexed: 04/21/2023] Open
Abstract
Migraine is a complex and common disorder that affects patients around the world. Despite recent advances in this field, the exact pathophysiology of migraine is still not completely understood. Structural MRI sequences have revealed a variety of changes to brain parenchyma associated with migraine, including white matter lesions, volume changes, and iron deposition. This Review highlights different structural imaging findings in various types of migraine and their relationship to migraine characteristics and subtypes in order to improve our understanding of migraine, its pathophysiologic mechanisms, and how to better diagnose and treat it.
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Affiliation(s)
- Wilson J Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel Phung
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Brendon Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Alexander Lerner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Nasim Sheikh-Bahaei
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Nasim Sheikh-Bahaei, Keck School of Medicine, University of Southern California, 1520 San Pablo St, Lower Level Imaging L1451, Los Angeles, CA 90033, USA.
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8
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Yamamoto Y, Liao YC, Lee YC, Ihara M, Choi JC. Update on the Epidemiology, Pathogenesis, and Biomarkers of Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. J Clin Neurol 2023; 19:12-27. [PMID: 36606642 PMCID: PMC9833879 DOI: 10.3988/jcn.2023.19.1.12] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/06/2022] [Accepted: 11/09/2022] [Indexed: 01/04/2023] Open
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common monogenic disorder of the cerebral small blood vessels. It is caused by mutations in the NOTCH3 gene on chromosome 19, and more than 280 distinct pathogenic mutations have been reported to date. CADASIL was once considered a very rare disease with an estimated prevalence of 1.3-4.1 per 100,000 adults. However, recent large-scale genomic studies have revealed a high prevalence of pathogenic NOTCH3 variants among the general population, with the highest risk being among Asians. The disease severity and age at onset vary significantly even among individuals who carry the same NOTCH3 mutations. It is still unclear whether a significant genotype-phenotype correlation is present in CADASIL. The accumulation of granular osmiophilic material in the vasculature is a characteristic feature of CADASIL. However, the exact pathogenesis of CADASIL remains largely unclear despite various laboratory and clinical observations being made. Major hypotheses proposed so far have included aberrant NOTCH3 signaling, toxic aggregation, and abnormal matrisomes. Several characteristic features have been observed in the brain magnetic resonance images of patients with CADASIL, including subcortical lacunar lesions and white matter hyperintensities in the anterior temporal lobe or external capsule, which were useful in differentiating CADASIL from sporadic stroke in patients. The number of lacunes and the degree of brain atrophy were useful in predicting the clinical outcomes of patients with CADASIL. Several promising blood biomarkers have also recently been discovered for CADASIL, which require further research for validation.
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Affiliation(s)
- Yumi Yamamoto
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yi-Chu Liao
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Chung Lee
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jay Chol Choi
- Department of Neurology, Jeju National University, Jeju, Korea.,Institute for Medical Science, Jeju National University, Jeju, Korea
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9
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Dupé C, Guey S, Biard L, Dieng S, Lebenberg J, Grosset L, Alili N, Hervé D, Tournier-Lasserve E, Jouvent E, Chevret S, Chabriat H. Phenotypic variability in 446 CADASIL patients: Impact of NOTCH3 gene mutation location in addition to the effects of age, sex and vascular risk factors. J Cereb Blood Flow Metab 2023; 43:153-166. [PMID: 36254369 PMCID: PMC9875352 DOI: 10.1177/0271678x221126280] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The recent discovery that the prevalence of cysteine mutations in the NOTCH3 gene responsible for CADASIL was more than 100 times higher in the general population than that estimated in patients highlighted that the mutation location in EGFr-like-domains of the NOTCH3 receptor could have a major effect on the phenotype of the disease. The exact impact of such mutations locations on the multiple facets of the disease has not been fully evaluated. We aimed to describe the phenotypic spectrum of a large population of CADASIL patients and to investigate how this mutation location influenced various clinical and imaging features of the disease. Both a supervised and a non-supervised approach were used for analysis. The results confirmed that the mutation location is strongly related to clinical severity and showed that this effect is mainly driven by a different development of the most damaging ischemic tissue lesions at cerebral level. These effects were detected in addition to those of aging, male sex, hypertension and hypercholesterolemia. The exact mechanisms relating the location of mutations along the NOTCH3 receptor, the amount or properties of the resulting NOTCH3 products accumulating in the vessel wall, and their final consequences at cerebral level remain to be determined.
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Affiliation(s)
- Charlotte Dupé
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Stéphanie Guey
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Lucie Biard
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Sokhna Dieng
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Jessica Lebenberg
- UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Lina Grosset
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | - Nassira Alili
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | - Dominique Hervé
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France
| | | | - Eric Jouvent
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
| | - Sylvie Chevret
- ECSTRRA Team, UMR-S 1153, Université Paris Cité, INSERM, Paris, France
| | - Hugues Chabriat
- Translational Neurovascular Centre (CERVCO) and Department of Neurology, FHU NeuroVasc, Hopital Lariboisière, Assistance Publique des Hôpitaux de Paris APHP, Université Paris Cité, Paris, France.,UMR 1141 NeuroDiderot, INSERM and Université Paris Cité, Paris, France
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10
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Taniguchi A, Shindo A, Tabei KI, Onodera O, Ando Y, Urabe T, Kimura K, Kitagawa K, Miyamoto Y, Takegami M, Ihara M, Mizuta I, Mizuno T, Tomimoto H. Imaging Characteristics for Predicting Cognitive Impairment in Patients With Cerebral Autosomal Dominant Arteriopathy With Subcortical Infarcts and Leukoencephalopathy. Front Aging Neurosci 2022; 14:876437. [PMID: 35754959 PMCID: PMC9226637 DOI: 10.3389/fnagi.2022.876437] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/06/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives Patients with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) show various clinical symptoms, including migraine, recurrent stroke, and cognitive impairment. We investigated the associations between magnetic resonance imaging (MRI) markers of small vessel disease and neuropsychological tests and identified the MRI characteristics for predicting cognitive impairment in patients with CADASIL. Methods Subjects included 60 CADASIL patients diagnosed with genetic tests and registered in the Japanese CADASIL REDCap database between June 2016 and December 2020. Patient information including clinical data, modified Rankin Scale (mRS); MRI findings of small vessel disease including periventricular and deep white matter lesions (WML), lacunar infarcts, and cerebral microbleeds (CMBs); and neuropsychological tests, including the Japanese version of the Mini-Mental State Examination (MMSE), the Japanese version of the Montreal Cognitive Assessment (MoCA-J), and the Frontal Assessment Battery (FAB), were evaluated. Results Data from 44 CADASIL patients were eligible for this study, compared between patients with and without dementia. Regarding the neuroimaging findings, the Fazekas score of periventricular and deep WML was higher in patients with dementia (periventricular, p = 0.003; deep, p = 0.009). The number of lacunar infarcts was higher in patients with dementia (p = 0.001). The standardized partial regression coefficient (SPRC) in MoCA-J was 0.826 (95% CI, 0.723-0.942; p = 0.005) for the number of CMBs. The SPRC in MMSE was 0.826 (95% CI, 0.719-0.949; p = 0.007) for the number of CMBs. The SPRC for FAB decreased significantly to 0.728 (95% CI, 0.551-0.960; p = 0.024) for the number of lacunar infarcts. Receiver operating characteristic (ROC) curves for dementia showed that in the number of lacunar infarcts, a cut-off score of 5.5 showed 90.9% sensitivity and 61.1% specificity. For the number of CMBs, a cut-off score of 18.5 showed 45.5% sensitivity and 100% specificity. Conclusion The characteristic MRI findings were that CADASIL patients with dementia had severe WML, both periventricular and deep, and a larger number of lacunar infarcts than those without dementia. The risk of dementia may be associated with ≥ 6 lacunar infarcts, ≥19 CMBs, or a Fazekas scale score of 3 in periventricular and deep WML.
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Affiliation(s)
- Akira Taniguchi
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Akihiro Shindo
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
| | - Ken-ichi Tabei
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
- School of Industrial Technology, Advanced Institute of Industrial Technology, Tokyo Metropolitan Public University Corporation, Tokyo, Japan
| | - Osamu Onodera
- Department of Neurology, Clinical Neuroscience Branch, Brain Research Institute, Niigata University, Niigata, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Amyloidosis Research, Nagasaki International University, Nagasaki, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ikuko Mizuta
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Mizuno
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hidekazu Tomimoto
- Department of Neurology, Mie University Graduate School of Medicine, Tsu, Japan
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11
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R558C NOTCH3 Mutation in a CADASIL Patient with Intracerebral Hemorrhage: A Case Report with Literature Review. J Stroke Cerebrovasc Dis 2022; 31:106541. [PMID: 35523050 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106541] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/20/2022] [Accepted: 04/24/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a monogenic cerebral small-vessel disease, which is characterized by migraine, recurrent ischemic strokes, psychiatric disorder, progressive cognitive decline, and occasionally intracerebral hemorrhage (ICH). ICH events have been reported in a high proportion of East Asian CADASIL patients with R544C mutation in exon 11 of NOTCH3; however, whether any other specific NOTCH3 mutation determines the ICH phenotype has yet to be explored. CASE PRESENTATION We report the case of a 60-year-old male CADASIL patient with a novel R558C mutation in exon 11 of the NOTCH3 gene, who presented with ICH in the basal ganglia and cerebellum. Brain imaging revealed multiple confluent white matter hyperintensities and abundant cerebral microbleeds (CMBs) in the bilateral basal ganglia, thalamus, and cerebellum. The patient had been having recurrent ischemic strokes prior to this ICH event, and had taken antiplatelet and antihypertensive agents for six months. We analyzed the possible reasons for ICH onset in the patient to recommend certain guidelines for the clinic. CONCLUSIONS Novel R558C mutation-related CADASIL vasculopathy and numerous CMBs, uncontrolled hypertension, and antiplatelet therapy could collectively contribute to ICH onset in the patient with CADASIL. These findings suggest that a diagnosis of CADASIL should also be considered when patients present with ICH, whenever MRI imaging reveals typical white matter abnormalities. Furthermore, this case report emphasizes the importance of CMB assessment, appropriate blood pressure control, and cautious assessment of the risk-benefits of antiplatelet medication in patients with CADASIL.
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12
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Gravesteijn G, Hack RJ, Mulder AA, Cerfontaine MN, van Doorn R, Hegeman IM, Jost CR, Rutten JW, Lesnik Oberstein SAJ. NOTCH3 variant position is associated with NOTCH3 aggregation load in CADASIL vasculature. Neuropathol Appl Neurobiol 2021; 48:e12751. [PMID: 34297860 PMCID: PMC9291091 DOI: 10.1111/nan.12751] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/15/2021] [Accepted: 07/17/2021] [Indexed: 12/02/2022]
Abstract
Aims CADASIL, the most prevalent hereditary cerebral small vessel disease, is caused by cysteine‐altering NOTCH3 variants (NOTCH3cys) leading to vascular NOTCH3 protein aggregation. It has recently been shown that variants located in one of NOTCH3 protein epidermal growth‐factor like repeat (EGFr) domains 1–6, are associated with a more severe phenotype than variants located in one of the EGFr domains 7–34. The underlying mechanism for this genotype–phenotype correlation is unknown. The aim of this study was to analyse whether NOTCH3cys variant position is associated with NOTCH3 protein aggregation load. Methods We quantified vascular NOTCH3 aggregation in skin biopsies (n = 25) and brain tissue (n = 7) of CADASIL patients with a NOTCH3cys EGFr 1–6 variant or a EGFr 7–34 variant, using NOTCH3 immunohistochemistry (NOTCH3 score) and ultrastructural analysis of granular osmiophilic material (GOM count). Disease severity was assessed by neuroimaging (lacune count and white matter hyperintensity volume) and disability (modified Rankin scale). Results Patients with NOTCH3cys EGFr 7–34 variants had lower NOTCH3 scores (P = 1.3·10−5) and lower GOM counts (P = 8.2·10−5) than patients with NOTCH3cys EGFr 1–6 variants in skin vessels. A similar trend was observed in brain vasculature. In the EGFr 7–34 group, NOTCH3 aggregation levels were associated with lacune count (P = 0.03) and white matter hyperintensity volume (P = 0.02), but not with disability. Conclusions CADASIL patients with an EGFr 7–34 variant have significantly less vascular NOTCH3 aggregation than patients with an EGFr 1–6 variant. This may be one of the factors underlying the difference in disease severity between NOTCH3cys EGFr 7–34 and EGFr 1–6 variants.
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Affiliation(s)
- Gido Gravesteijn
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco J Hack
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Aat A Mulder
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Minne N Cerfontaine
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - Remco van Doorn
- Department of Dermatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ingrid M Hegeman
- Department of Pathology, Leiden University Medical Center, Leiden, The Netherlands
| | - Carolina R Jost
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, The Netherlands
| | - Julie W Rutten
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
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13
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Guo X, Deng B, Zhong L, Xie F, Qiu Q, Wei X, Wang W, Xu J, Liu G, Hon WPT, Yenari MA, Zhu S, Wang Q. Fibrinogen is an Independent Risk Factor for White Matter Hyperintensities in CADASIL but not in Sporadic Cerebral Small Vessel Disease Patients. Aging Dis 2021; 12:801-811. [PMID: 34094643 PMCID: PMC8139197 DOI: 10.14336/ad.2020.1110] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
The relationship between fibrinogen and white matter hyperintensities (WMHs) are inconsistent. Whether there are different relationships between WMHs and fibrinogen in disparate subtypes of cerebral small vessel disease (CSVD) remains unknown. Here, we investigated the roles of plasma fibrinogen in sporadic CSVD (sCSVD) and Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) patients. We performed a cross-sectional study that included 74 CSVD patients (19 CADASIL and 55 sporadic) and 74 age- and gender-matched healthy controls (HCs). Plasma fibrinogen was determined, and the severity of WMHs in CSVD patients was rated according to Fazekas scales. Univariate analysis and ordinal logistic regression were performed to evaluate the relationship between fibrinogen and the severity of WMHs in CSVD. Both CADASIL and sCSVD patients showed significantly higher plasma fibrinogen levels than HCs. No significant difference in the plasma fibrinogen level was observed between CADASIL and sCSVD. Univariate analysis and ordinal logistic regression indicated that fibrinogen is an independent risk factor for the severity of WMHs in CADASIL patients (odds ratio [OR] =1.064; 95% Confidence interval (CI, 1.004-1.127); p =0.037). However, age (odds ratio [OR] =1.093; 95% CI (1.033-1.156); P = 0.002), but not fibrinogen (odds ratio [OR] =1.004; 95% CI (0.997-1.011); P=0.262), is an independent risk factor for the severity of WMHs in sCSVD patients. Our results suggest that high levels of plasma fibrinogen are associated with the severity of WMHs in CADASIL but not in sCSVD patients, indicating that the role of fibrinogen may be different in disparate subtypes of CSVD. A better understanding of fibrinogen may yield insights into the pathogenesis of CSVD.
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Affiliation(s)
- Xingfang Guo
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Bin Deng
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Lizi Zhong
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Fen Xie
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Qing Qiu
- 2Department of Radiology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Xiaobo Wei
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Wenya Wang
- 3School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Jiangping Xu
- 3School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
| | - Ganqiang Liu
- 4School of Medicine, Sun Yat-sen University, Guangzhou, Guangzhou 510515, China
| | - Wong Peter Tsun Hon
- 5Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Midori A Yenari
- 6Department of Neurology, University of California, San Francisco & the San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Shuzhen Zhu
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
| | - Qing Wang
- 1Department of Neurology, Zhujiang Hospital of Southern Medical University, Guangdong 510282, China
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