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Vicino A, Hottinger AF, Latifyan S, Boughdad S, Becce F, Prior JO, Kuntzer T, Brouland JP, Dunet V, Obeid M, Théaudin M. Immune checkpoint inhibitor-related myositis and myocarditis: diagnostic pitfalls and imaging contribution in a real-world, institutional case series. J Neurol 2024; 271:1947-1958. [PMID: 38141128 DOI: 10.1007/s00415-023-12134-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/20/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Immune checkpoint inhibitors (ICIs) are reshaping the prognosis of many cancers, but often cause immune-related adverse events (irAEs). Among neurological irAEs, myositis is the most frequently reported. Our aim is to describe clinical and non-clinical characteristics, treatment and outcome of all irMyositis (skeletal limb-girdle and/or ocular myositis) and irMyocarditis cases in our reference center. METHODS We retrospectively enrolled all irMyositis/irMyocarditis patients seen between 2018 and 2022. We reviewed demographics, clinical characteristics, biological, neurophysiological, imaging workup, treatment and outcome. RESULTS We included 14 consecutive patients. The most frequent treatments were pembrolizumab (35%) or ipilimumab-nivolumab combination (35%). Limb-girdle, ocular (non-fluctuating palpebral ptosis and/or diplopia with or without ophthalmoparesis) and cardiac phenotypes were equally distributed, overlapping in 40% of cases. Ocular involvement was frequently misdiagnosed; review of brain MRIs disclosed initially missed signs of skeletal myositis in one patient and ocular myositis in 3. Seven patients had other co-existing irAEs. When performed, myography showed a myogenic pattern. CK was elevated in 8/15 patients, troponin-T in 12/12 and troponin-I in 7/9 tested patients. ICI were discontinued in all cases, with further immunosuppressive treatment in nine patients. In most cases, neurological and cardiological outcome was good at last follow-up. CONCLUSION Myositis is a potentially severe irAE. Despite its heterogeneous presentation, some highly suggestive clinical symptoms, such as ocular involvement, or radiological signs should raise physicians' attention to avoid misdiagnosis. We thus recommend a multidisciplinary assessment (including complete neuromuscular evaluation) even in case of isolated myocarditis. Our series underlines the importance of an early diagnosis, since suspension of ICI and adequate treatment are usually associated with good functional outcome.
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Affiliation(s)
- Alex Vicino
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - Andreas F Hottinger
- Lundin Family Brain Tumor Center, Departments of Oncology and Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sofiya Latifyan
- Department of Oncology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Sarah Boughdad
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - John O Prior
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Philippe Brouland
- Pathology Institute, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Vincent Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Michel Obeid
- Immunology and Allergy Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Marie Théaudin
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Ripellino P, Lascano AM, Scheidegger O, Schilg-Hafer L, Schreiner B, Tsouni P, Vicino A, Peyer AK, Humm AM, Décard BF, Pianezzi E, Zezza G, Sparasci D, Hundsberger T, Dietmann A, Jung H, Kuntzer T, Wilder-Smith E, Martinetti-Lucchini G, Petrini O, Fontana S, Gowland P, Niederhauser C, Gobbi C. Neuropathies related to hepatitis E virus infection: A prospective, matched case-control study. Eur J Neurol 2024; 31:e16030. [PMID: 37548584 DOI: 10.1111/ene.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Acute hepatitis E virus (HEV) infection has recently emerged as a potential trigger for acute dysimmune neuropathies, but prospective controlled studies are lacking. AIMS To compare the frequency of concomitant acute HEV infection in patients with neuralgic amyotrophy (NA), Guillain-Barré syndrome (GBS), and Bell's palsy with a matched control population. METHODS Swiss multicenter, prospective, observational, matched case-control study over 3 years (September 2019-October 2022). Neurological cases with NA, GBS, or Bell's palsy were recruited within 1 month of disease onset. Healthy controls were matched for age, sex, geographical location, and timing of blood collection. Diagnostic criteria for acute hepatitis E were reactive serum anti-HEV IgM and IgG assays (ELISA test) and/or HEV RNA detection in serum by real-time polymerase chain reaction (RT-PCR). RT-PCR was performed on sera to confirm IgM positivity. RESULTS We included 180 patients (59 GBS, 51 NA, 70 Bell's palsy cases) and corresponding matched controls (blood donors) with median age 51 years for both groups and equal gender distribution. Six IgM+ cases were detected in the NA, two in the GBS, and none in the Bell's palsy group. Two controls were anti-HEV IgM-positive. At disease onset, most cases with acute HEV infection had increased liver enzymes. A moderate association (p = 0.027, Fisher's exact test; Cramér's V = -0.25) was observed only between acute HEV infection and NA. CONCLUSION This prospective observational study suggests an association between concomitant acute HEV infection and NA, but not with GBS or Bell's palsy.
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Affiliation(s)
- Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Agustina Maria Lascano
- Neurology Division, Department of Clinical Neuroscience, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Bettina Schreiner
- Department of Neurology, University and Hospital Zurich, Zurich, Switzerland
| | | | - Alex Vicino
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Kathrin Peyer
- Cantonal Hospital, Lucerne, Switzerland
- Neuroliestal, Liestal, Switzerland
| | - Andrea Monika Humm
- Department of Medicine, Neurology Unit, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | | | - Enea Pianezzi
- Laboratory of Microbiology EOC, Bellinzona, Switzerland
| | - Giulia Zezza
- Laboratory of Microbiology EOC, Bellinzona, Switzerland
| | - Davide Sparasci
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | | | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hans Jung
- Department of Neurology, University and Hospital Zurich, Zurich, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Einar Wilder-Smith
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Cantonal Hospital, Lucerne, Switzerland
| | | | - Orlando Petrini
- University of Applied Sciences and Arts of Southern Switzerland, Bellinzona, Switzerland
| | - Stefano Fontana
- Blood Transfusion Service SRC Southern Switzerland, Lugano, Switzerland
- Interregional Blood Transfusion SRC, Bern, Switzerland
| | - Peter Gowland
- Interregional Blood Transfusion SRC, Bern, Switzerland
| | - Christoph Niederhauser
- Interregional Blood Transfusion SRC, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Vicino A, Bello L, Bonanno S, Govoni A, Cerri F, Ferraro M, Capece G, Gadaleta G, Meneri M, Vacchiano V, Ricci G, D'Errico E, Tramacere I, Banfi P, Bortolani S, Zanin R, Maioli MA, Silvestrini M, Previtali SC, Berardinelli A, Turri M, Coccia M, Mantegazza R, Liguori R, Filosto M, Siciliano G, Simone IL, Mongini T, Comi G, Pegoraro E, Maggi L. Respiratory function in a large cohort of treatment-naïve adult spinal muscular atrophy patients: a cross-sectional study. Neuromuscul Disord 2023; 33:911-916. [PMID: 37945485 DOI: 10.1016/j.nmd.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/03/2023] [Accepted: 10/09/2023] [Indexed: 11/12/2023]
Abstract
Due to poor data in literature, we aimed to investigate the respiratory function in a large cohort of naïve Italian adult (≥18 years) SMA patients in a multi-centric cross-sectional study. The following respiratory parameters were considered: forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and need for non-invasive ventilation (NIV). We included 145 treatment-naïve adult patients (SMA2=18, SMA3=125; SMA4=2), 58 females (40 %), with median age at evaluation of 37 years (range 18-72). Fifty-six (37 %) and 41 (31 %) patients had abnormal (<80 %) values of FVC and FEV1, respectively. Fourteen (14 %) patients needed NIV, started at median age of 21 (range 4-68). Motor function, measured by Hammersmith Functional Motor Scale Expanded and Revised Upper Limb Module as well as SMA2, loss of walking ability, surgery for scoliosis, use of NIV, and cough assisting device (CAD) were all significantly associated to lower FVC and FEV1 values, while no association with age at baseline, disease duration, gender or 6 min walking test was observed, except for a correlation between FVC and age in SMA3 walkers (p < 0.05). In conclusion, respiratory function in adult SMA patients is relatively frequently impaired, substantially stable, and significantly correlated with motor function and disease severity.
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Affiliation(s)
- Alex Vicino
- Neuroimmunology and Neuromuscular Disease Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, Milano 20133, Italy; Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Luca Bello
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Silvia Bonanno
- Neuroimmunology and Neuromuscular Disease Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, Milano 20133, Italy
| | - Alessandra Govoni
- Neuromuscular and Rare Disease Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Federica Cerri
- Division of Neuroscience, Department of Neurology & INSPE, San Raffaele Hospital, Milano, Italy
| | - Manfredi Ferraro
- Department of Neuroscience Rita Levi Montalcini, Università degli Studi di Torino, Torino, Italy
| | - Giuliana Capece
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Giulio Gadaleta
- Department of Neuroscience Rita Levi Montalcini, Università degli Studi di Torino, Torino, Italy
| | - Megi Meneri
- Neuromuscular and Rare Disease Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy
| | - Veria Vacchiano
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giulia Ricci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Eustachio D'Errico
- Neurology Unit, Azienda Ospedaliero-Universitaria, Policlinico of Bari, Bari, Italy
| | - Irene Tramacere
- Department of Research and Clinical Development, Scientific Directorate, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paolo Banfi
- Heart-Respiratory Rehabilitation Unit, IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - Sara Bortolani
- Department of Neuroscience Rita Levi Montalcini, Università degli Studi di Torino, Torino, Italy
| | - Riccardo Zanin
- Developmental Neurology, Foundation IRCCS Carlo Besta Neurological Institute, Milano, Italy
| | | | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Universita Politecnica delle Marche Facolta di Medicina e Chirurgia, Ancona, Italy; Department of Neurological Sciences, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Stefano Carlo Previtali
- Division of Neuroscience, Department of Neurology & INSPE, San Raffaele Hospital, Milano, Italy
| | - Angela Berardinelli
- Department of Child Neuropsychiatry, Fondazione Istituto Neurologico Nazionale C Mondino Istituto di Ricovero e Cura a Carattere Scientifico, Pavia, Italy
| | - Mara Turri
- Department of Neurology/Stroke Unit, Bolzano Hospital, Bolzano, Italy
| | - Michela Coccia
- Department of Neurological Sciences, AOU Ospedali Riuniti di Ancona, Ancona, Italy
| | - Renato Mantegazza
- Neuroimmunology and Neuromuscular Disease Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, Milano 20133, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie, Universita degli Studi di Bologna, Bologna, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, Italy; NeMO-Brescia Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Gabriele Siciliano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Isabella Laura Simone
- Neurology Unit, Azienda Ospedaliero-Universitaria, Policlinico of Bari, Bari, Italy; School of Medicine, University of Bari "Aldo Moro" Bari, Bari, Italy
| | - Tiziana Mongini
- Department of Neuroscience Rita Levi Montalcini, Università degli Studi di Torino, Torino, Italy
| | - Giacomo Comi
- Neuromuscular and Rare Disease Unit, La Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Milano, Italy; Department of Pathophysiology and Transplantation (DEPT), Dino Ferrari Centre, University of Milan, Milano, Italy
| | - Elena Pegoraro
- Department of Neurosciences, University of Padua, Padova, Italy
| | - Lorenzo Maggi
- Neuroimmunology and Neuromuscular Disease Unit, Foundation IRCCS Carlo Besta Neurological Institute, Via Celoria 11, Milano 20133, Italy.
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Vicino A, Brugnoni R, Maggi L. Diagnostics in skeletal muscle channelopathies. Expert Rev Mol Diagn 2023; 23:1175-1193. [PMID: 38009256 DOI: 10.1080/14737159.2023.2288258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/22/2023] [Indexed: 11/28/2023]
Abstract
INTRODUCTION Skeletal muscle channelopathies (SMCs) are a heterogenous group of disorders, caused by mutations in skeletal ion channels leading to abnormal muscle excitability, resulting in either delayed muscle relaxation (myotonia) which characterizes non-dystrophic myotonias (NDMs), or membrane transient inactivation, causing episodic weakness, typical of periodic paralyses (PPs). AREAS COVERED SMCs include myotonia congenita, paramyotonia congenita, and sodium-channel myotonia among NDMs, and hyper-normokalemic, hypokalemic, or late-onset periodic paralyses among PPs. When suspecting an SMC, a structured diagnostic approach is required. Detailed personal and family history and clinical examination are essential, while neurophysiological tests should confirm myotonia and rule out alternative diagnosis. Moreover, specific electrodiagnostic studies are important to further define the phenotype of de novo cases and drive molecular analyses together with clinical data. Definite diagnosis is achieved through genetic testing, either with Sanger sequencing or multigene next-generation sequencing panel. In still unsolved patients, more advanced techniques, as exome-variant sequencing or whole-genome sequencing, may be considered in expert centers. EXPERT OPINION The diagnostic approach to SMC is still mainly based on clinical data; moreover, definite diagnosis is sometimes complicated by the difficulty to establish a proper genotype-phenotype correlation. Lastly, further studies are needed to allow the genetic characterization of unsolved patients.
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Affiliation(s)
- Alex Vicino
- Neurology IV Unit, Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Raffaella Brugnoni
- Neurology IV Unit, Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Lorenzo Maggi
- Neurology IV Unit, Neuroimmunology and Neuromuscular Diseases, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Vicino A, Cochet S, Pistocchi S, Conrad C, Ribi C, Pasquier RD, Brouland JP, Théaudin M. A severe case of neuroleukemiosis caused by B cell chronic lymphocytic leukemia, presenting as mononeuritis multiplex. J Peripher Nerv Syst 2023. [PMID: 37119473 DOI: 10.1111/jns.12552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/01/2023]
Abstract
AIMS To report an exceptional case of nerve infiltration by an otherwise benign chronic B cell leukemia, inducing severe mononeuritis multiplex. METHODS The patient underwent extensive evaluation, including nerve conduction study and myography, brain and plexus MRI and nerve biopsy. RESULTS The clinical and electrophysiological diagnosis was a mononeuritis multiplex with severe motor and sensory involvement; only the nerve biopsy allowed definite diagnosis and introduction of chemotherapy, leading to resolution of sensory deficit and progressive motor improvement. DISCUSSION Neuroleukemiosis caused by chronic lymphoid leukemia is an exceptional diagnosis. The presence of other possible causes like cryoglobulinemia could induce avoidance of nerve biopsy thus undertreating patient, since steroid treatment is not expected to be efficient on lymphocytic proliferation. Our case stretches the importance of nerve biopsy and raises neuromuscular specialist's awareness of this rare entity.
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Affiliation(s)
- Alex Vicino
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Stéphane Cochet
- Hematology Service, Clinique La Source, Lausanne, Switzerland
| | - Silvia Pistocchi
- Diagnostic and interventional Radiology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Curdin Conrad
- Dermatology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Camillo Ribi
- Immunology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Renaud Du Pasquier
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Jean-Philippe Brouland
- Pathology Department, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marie Théaudin
- Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Switzerland
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Loser V, Benkert P, Vicino A, Lim Dubois Ferriere P, Kuntzer T, Pasquier J, Maceski A, Kuhle J, Theaudin M. Serum neurofilament light chain as a reliable biomarker of hereditary transthyretin-related amyloidosis-A Swiss reference center experience. J Peripher Nerv Syst 2023; 28:86-97. [PMID: 36471582 DOI: 10.1111/jns.12524] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/12/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Hereditary transthyretin-related (hATTR) amyloidosis is a rare disease, causing a disabling and life-threatening axonal length-dependent polyneuropathy. Monitoring of disease progression and treatment response is difficult. We aimed to determine if serum neurofilament light chain (sNfL) is a reliable and early biomarker of peripheral neuropathy in hATTR amyloidosis. We prospectively included 20 hATTR patients, 14 symptomatic and 6 asymptomatic. Patients were assessed at baseline and 1 year, including a full clinical examination with disease severity and functional scores, electrochemical skin conductance measurement with Sudoscan and nerve conduction studies, and sNfL level. hATTR patient sNfL were also compared with sNfL of 4532 healthy controls of a reference database by calculating age and BMI-adjusted Z scores. At baseline, median sNfL concentration was 3.6-fold higher in symptomatic than asymptomatic hATTR patients (P = .003), and this difference was also found in our under 60-years-old patients (P = .003). There was no significant difference of sNfL concentration between asymptomatic patients and healthy controls (Z-score of -0.29), but a significant difference between symptomatic patients and healthy controls (Z-score of 2.52). We found a significant correlation between sNfL levels and most clinical and electrophysiological disease severity scores, the strongest correlation being with the NIS score. sNfL seems to be a reliable biomarker of peripheral neuropathy severity in hATTR amyloidosis and can distinguish between asymptomatic and symptomatic patients. sNfL could also become a reliable biomarker to establish disease onset and treatment response.
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Affiliation(s)
- Valentin Loser
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pascal Benkert
- Multiple Sclerosis Centre and Research Centre for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Alex Vicino
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pansy Lim Dubois Ferriere
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jérôme Pasquier
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Aleksandra Maceski
- Multiple Sclerosis Centre and Research Centre for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Jens Kuhle
- Multiple Sclerosis Centre and Research Centre for Clinical Neuroimmunology and Neuroscience (RC2NB), Departments of Biomedicine and Clinical Research, University Hospital and University of Basel, Basel, Switzerland
| | - Marie Theaudin
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Loser V, Blanchard G, Guenova E, Théaudin M, Vicino A. Clinical Reasoning: A 39-Year-Old Man With Asymmetric Distal Weakness and Loss of Sensitivity. Neurology 2023; 100:88-93. [PMID: 36257711 DOI: 10.1212/wnl.0000000000201410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
A 39-year-old man presented with an asymmetric distal weakness and loss of sensitivity sequentially affecting both lower extremities and the left upper limb. Nerve conduction studies showed a multifocal sensory and motor axonal neuropathy, and a pseudo-conduction block of the right fibular nerve, the whole being consistent with a mononeuropathy multiplex. An uncommon etiology was found after an extensive workup. Axonal loss was severe, with only partial response to treatment with corticosteroids and IV immunoglobulins.
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Affiliation(s)
- Valentin Loser
- From the Nerve-Muscle Unit (V.L., M.T., A.V.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; and Dermatology Service (G.B., E.G.), Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Gabriela Blanchard
- From the Nerve-Muscle Unit (V.L., M.T., A.V.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; and Dermatology Service (G.B., E.G.), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Emmanuella Guenova
- From the Nerve-Muscle Unit (V.L., M.T., A.V.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; and Dermatology Service (G.B., E.G.), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Marie Théaudin
- From the Nerve-Muscle Unit (V.L., M.T., A.V.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; and Dermatology Service (G.B., E.G.), Lausanne University Hospital and University of Lausanne, Switzerland
| | - Alex Vicino
- From the Nerve-Muscle Unit (V.L., M.T., A.V.), Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne; and Dermatology Service (G.B., E.G.), Lausanne University Hospital and University of Lausanne, Switzerland
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Théaudin M, Ochsner F, Adam C, Echaniz-Laguna A, Magy L, Fayolle D, Vicino A, Hübers A, Pereon Y. [Small fiber neuropathy diagnosis]. Rev Med Suisse 2022; 18:803-807. [PMID: 35481505 DOI: 10.53738/revmed.2022.18.779.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Small fiber neuropathies affect small, poorly myelinated sensory Aδ and amyelinated C autonomic fibers. Neuropathic pain is often the main symptom. Positive diagnosis is based on the presence of deficient thermo-algesic sensory signs and/or dysautonomic signs with normal neurography. Several tests help to confirm the involvement of small fibers, ranging from simple tests such as the sympathetic skin response to skin biopsy, which measures the density of intraepidermal nerve fibers. The availability of these different tests varies greatly from one center to another. There are multiple etiologies, from rare genetic causes to the more frequent acquired dysimmune or metabolic causes. However, in more than half of the cases, no etiology is identified.
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Affiliation(s)
- Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Clovis Adam
- Service d'anatomopathologie, CHU de Bicêtre, 78 rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- Service de neurologie et Centre de référence national pour les neuropathies rares, CHU Bicêtre, 78 rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France
- Université Paris-Saclay, 3 rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Laurent Magy
- Service et Laboratoire de neurologie, Centre de référence neuropathies périphériques rares, CHU de Limoges, 2 avenue Martin-Luther-King, 87042 Limoges, France
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Yann Pereon
- Centre de référence pour les maladies neuromusculaires AOC, CHU Hôtel-Dieu, 1 Pl. Alexis-Ricordeau, 44000 Nantes, France
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9
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Vicino A, Fayolle D, Ochsner F, Echaniz-Laguna A, Magy L, Hübers A, Théaudin M. [Muscle disease in the adults: when to suspect it?]. Rev Med Suisse 2022; 18:799-802. [PMID: 35481504 DOI: 10.53738/revmed.2022.18.779.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Muscle diseases or myopathies have heterogeneous clinical presentations and etiologies. The principal sign is muscular weakness, whose distribution can help diagnostic orientation. Exercise intolerance, even without weakness at rest, can indicate an underlying myopathy. An isolated CK elevation can have multiple causes, but its persistence after a period of rest can point towards a subclinical myopathy. Isolated myalgia, especially at rest, are usually not associated with muscle disease. If the suspicion of myopathy is high, the patient will be assessed by a neurologist trained in muscle disorders, with correlation of clinical and neurophysiological findings, muscle imaging and, if indicated, muscle biopsy and genetic analysis. Cardiac and respiratory assessments are mandatory if a myopathy is suspected.
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Affiliation(s)
- Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andoni Echaniz-Laguna
- Service de neurologie, Centre de référence national pour les neuropathies rares, CHU de Bicêtre, 78 rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre Cedex, France
- Université Paris-Saclay, 3 rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Laurent Magy
- Service et laboratoire de neurologie, Centre de référence neuropathies périphériques rares, CHU de Limoges, 2 avenue Martin-Luther-King, 87042 Limoges, France
| | - Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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10
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Echaniz-Laguna A, Magy L, Vicino A, Fayolle D, Hübers A, Ochsner F, Théaudin M. [Treating hereditary neuropathies : a dream come true?]. Rev Med Suisse 2022; 18:813-816. [PMID: 35481507 DOI: 10.53738/revmed.2022.18.779.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Hereditary neuropathies have been the subject of recent major therapeutic advances. Treatments based on antisense oligonucleotides (ASO) and small interfering RNA (siRNA) have been developed and are now commercially available to treat hereditary transthyretin amyloidosis (hTTR) and porphyria. More recently, a CRISPR-Cas9 genomic editing treatment targeting the TTR gene has been developed and is being tested in patients with hTTR. Based on their success in hTTR and porphyria, innovative treatments targeting mRNA and DNA are being evaluated in other hereditary neuropathies, including Charcot-Marie-Tooth disease (CMT).
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Affiliation(s)
- Andoni Echaniz-Laguna
- Service de neurologie, Centre de référence national pour les neuropathies rares, CHU de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
- Université Paris-Saclay, 3, rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Laurent Magy
- Service et laboratoire de neurologie, Centre de référence national neuropathies périphériques rares, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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11
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Ochsner F, Kuntzer T, Vicino A, Hübers A, Fayolle D, Echaniz-Laguna A, Magy L, Théaudin M, Tatu L. [Neurological shoulder pain and weakness : practical attitudes]. Rev Med Suisse 2022; 18:794-798. [PMID: 35481503 DOI: 10.53738/revmed.2022.18.779.794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Shoulder pain or paresis should be assessed carefully, as there are many possible causes, which can be osteoarticular, degenerative, inflammatory, or neurological. Weakness or pain can be related to cervicobrachialgia, plexitis, or focal mononeuropathy. The clinical picture should identify any muscular or mechanical origin of paresis responsible for pseudo-paretic functional limitation. Neurogenic scapulalgia with functional deficit implies the compression or entrapment of a nerve trunk including the axillary, long thoracic, accessory, suprascapular, or dorsal scapular nerves. Nerve conduction study and myography together with medical imaging help to identify the relevant etiology. Treatment mostly includes pain relief and physiotherapy, but surgery is rarely necessary.
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Affiliation(s)
- François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Thierry Kuntzer
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Andoni Echaniz-Laguna
- Service de neurologie, Centre de référence national pour les neuropathies rares (NNERF), CHU de Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
- Université Paris-Saclay, 3, rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Laurent Magy
- Service et laboratoire de neurologie, Centre de référence national neuropathies périphériques rares, CHU de Limoges, 2, avenue Martin-Luther-King, 87042 Limoges, France
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Laurent Tatu
- Département de neurologie et laboratoire d'anatomie, CHU de Besançon, Université de Franche-Comté, 3, boulevard Alexandre-Fleming, 25000 Besançon, France
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12
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Magy L, Echaniz-Laguna A, Fayolle D, Hübers A, Ochsner F, Vicino A, Théaudin M. [What have we learned about chronic inflammatory demyelinating polyradiculoneuropathyin the last twenty years ?]. Rev Med Suisse 2022; 18:808-812. [PMID: 35481506 DOI: 10.53738/revmed.2022.18.779.808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) has been widely described during the last quarter of the twentieth century. The last 20 years have seen decisive progress in its understanding. The diagnostic criteria have been simplified and the steps of the diagnostic process have been clarified. The phenotypic contours of the disease are now well known, as are the diagnostic pitfalls. From a pathophysiological point of view, the discovery of autoantibodies directed against nodal and paranodal proteins has been a major advance, although it concerns only a minority of patients. These discoveries have a major impact on the therapeutic management of these patients, often suffering from a very active form of the disease. The next 20 years will surely see a further deepening of knowledge about this fascinating disease.
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Affiliation(s)
- Laurent Magy
- Service et laboratoire de neurologie, Centre de référence neuropathies périphériques rares, CHU de Limoges, 2 avenue Martin-Luther-King, 87042 Limoges, France
| | - Andoni Echaniz-Laguna
- Service de neurologie et Centre de référence national pour les neuropathies rares, CHU de Bicêtre, 78 rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
- Université Paris-Saclay, 3 rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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13
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Hübers A, Fayolle D, Ochsner F, Echaniz-Laguna A, Magy L, Vicino A, Théaudin M. [Cramps and fasciculations: is it amyotrophic lateral sclerosis?]. Rev Med Suisse 2022; 18:790-793. [PMID: 35481502 DOI: 10.53738/revmed.2022.18.779.790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease of the adult age. It is an aggressive condition with a mean disease duration of only 3 to 5 years, characterized by progressive weakness and atrophy of limb, bulbar, and respiratory muscles. In general, death is caused by chronic hypoventilation due to respiratory insufficiency. No causal treatment is known today, but the two therapeutic agents authorized in Switzerland for the treatment of ALS can slow disease progression significantly. Other important therapeutic strategies include invasive/non-invasive ventilation, pain therapy, as well as physio-, ergo- and speech therapy on a regular basis.
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Affiliation(s)
- Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andoni Echaniz-Laguna
- Service de neurologie, Centre de référence national pour les neuropathies rares, CHU de Bicêtre, 78 rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
- Université Paris-Saclay, 3 rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Laurent Magy
- Service et laboratoire de neurologie, Centre de référence neuropathies périphériques rares, CHU de Limoges, 2 avenue Martin-Luther-King, 87042 Limoge, France
| | - Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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14
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Fayolle D, Théaudin M, Ochsner F, Echaniz-Laguna A, Magy L, Vicino A, Hübers A. [Muscle cramps]. Rev Med Suisse 2022; 18:785-788. [PMID: 35481501 DOI: 10.53738/revmed.2022.18.779.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Muscle cramps are very common and can reduce quality of life. There are multiple causes, including some physiological conditions, metabolic, endocrine, vascular disorders or neuromuscular diseases. Adequate management first requires differentiating cramps from other muscular phenomena. In most cases, the investigations are limited to a comprehensive history and clinical examination, but a biological, radiological and/or electrophysiological work-up may be useful. Treatment, when needed, is most often symptomatic and is unfortunately based on little evidence.
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Affiliation(s)
- Damien Fayolle
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - François Ochsner
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andoni Echaniz-Laguna
- Service de neurologie, Centre de référence national pour les neuropathies rares, CHU de Bicêtre, 78 rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
- Université Paris-Saclay, 3 rue Joliot-Curie, 91190 Gif-sur-Yvette, France
| | - Laurent Magy
- Service et laboratoire de neurologie, Centre de référence neuropathies périphériques rares, CHU de Limoges, 2 avenue Martin-Luther-King, 87042 Limoges, France
| | - Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Annemarie Hübers
- Service de neurologie, Département des neurosciences cliniques, Hôpitaux universitaires de Genève, 1211 Genève 14
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15
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Vicino A, Allali G, Bally J, Castro Jimenez M, Chiabotti Salvioni P, Hirt L, Hottinger A, Michel P, Novy J, Pot Kreis C, Rossetti A, Rouaud O, Ryvlin P, Théaudin M, Du Pasquier R. [Neurology : what's new in 2021]. Rev Med Suisse 2022; 18:51-55. [PMID: 35048580 DOI: 10.53738/revmed.2022.18.764-65.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In 2021, we assisted to the publication of new diagnostic criteria, classifications, and guidelines (CIDP, brain tumors, auto-immune encephalitis). Several studies helped to define the pharmacological management of focal and generalized epileptic seizures and epilepsy in pregnant women. The availability of biomarkers and the approval of immunotherapies are modifying the landscape of dementia management. Endovascular interventions without previous thrombolysis seems to be effective in anterior circulation acute ischemic stroke (AIS) and severe posterior circulation AIS. Neurologic complications of Sars-CoV-2 infection were further studied, as well as the efficacy of vaccines in immunosuppressed patients. New molecules and techniques show promising results for the treatment of migraine and cluster headache.
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Affiliation(s)
- Alex Vicino
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Gilles Allali
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Julien Bally
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Mayte Castro Jimenez
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Paolo Chiabotti Salvioni
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Lorenz Hirt
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andreas Hottinger
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Patrik Michel
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Jan Novy
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Caroline Pot Kreis
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Andrea Rossetti
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Olivier Rouaud
- Centre Leenaards de la Mémoire, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Philippe Ryvlin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Marie Théaudin
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
| | - Renaud Du Pasquier
- Service de neurologie, Département des neurosciences cliniques, Centre hospitalier universitaire vaudois et Université de Lausanne, 1011 Lausanne
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16
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Luijten LWG, Leonhard SE, van der Eijk AA, Doets AY, Appeltshauser L, Arends S, Attarian S, Benedetti L, Briani C, Casasnovas C, Castellani F, Dardiotis E, Echaniz-Laguna A, Garssen MPJ, Harbo T, Huizinga R, Humm AM, Jellema K, van der Kooi AJ, Kuitwaard K, Kuntzer T, Kusunoki S, Lascano AM, Martinez-Hernandez E, Rinaldi S, Samijn JPA, Scheidegger O, Tsouni P, Vicino A, Visser LH, Walgaard C, Wang Y, Wirtz PW, Ripellino P, Jacobs BC. Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study. Brain 2021; 144:3392-3404. [PMID: 34553216 PMCID: PMC8677532 DOI: 10.1093/brain/awab279] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022] Open
Abstract
In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12-22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.
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Affiliation(s)
- Linda W G Luijten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Sonja E Leonhard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Annemiek A van der Eijk
- Department of Viroscience, Unit Clinical Virology, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | | | - Samuel Arends
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, Hôpital de La Timone, 13005 Marseille, France
| | - Luana Benedetti
- Department of Neurology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Carlos Casasnovas
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Neurometabolic Diseases Group, IDIBELL and CIBERER, Barcelona, Spain
| | - Francesca Castellani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, 41110 Larissa, Greece
| | | | - Marcel P J Garssen
- Department of Neurology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Andrea M Humm
- Unit of Neurology, Department of Internal Medicine, HFR Fribourg—Hôpital Cantonal, CH-1708 Fribourg, Switzerland
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, 2512 VA, Den Haag, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Neuroscience institute, 1105 AZ Amsterdam, The Netherlands
| | - Krista Kuitwaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Thierry Kuntzer
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Agustina M Lascano
- Department of Neurology, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | | | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, OX3 9DU Oxford, UK
| | - Johnny P A Samijn
- Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Pinelopi Tsouni
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland,Department of Neurology, Hôpital du Valais, 1950 Sion, Switzerland
| | - Alex Vicino
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Leo H Visser
- Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Christa Walgaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, 272029 Jining, China
| | - Paul W Wirtz
- Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland, 6903 Lugano, Switzerland
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands,Correspondence to: Bart C. Jacobs, MD, PhD Departments of Neurology and Immunology, Erasmus MC University Medical Center Rotterdam, Room number: EE-2289 Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands E-mail:
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Vicino A, Perrenoud MP, Yersin E, Dunet V, Théaudin M. Unusual brainstem and spine involvement in post-transplant lymphoproliferative disease. Rev Neurol (Paris) 2021; 177:1303-1305. [PMID: 34266656 DOI: 10.1016/j.neurol.2021.02.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/21/2021] [Accepted: 02/17/2021] [Indexed: 10/20/2022]
Affiliation(s)
- A Vicino
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - M P Perrenoud
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - E Yersin
- Department of Pneumology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - V Dunet
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
| | - M Théaudin
- Department of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Vicino A, Loser V, Salvioni Chiabotti P, Brouland JP, Du Pasquier R. Anti-Adenylate Kinase 5 Encephalitis With Histologic Evidence of CNS Vasculitis. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/4/e1010. [PMID: 33975915 PMCID: PMC8114832 DOI: 10.1212/nxi.0000000000001010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/10/2021] [Indexed: 11/15/2022]
Affiliation(s)
- Alex Vicino
- From the Department of Clinical Neurosciences (A.V., V.L., P.S.C., R.D.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne; and Department of Pathology (J.P.B.), Lausanne University Hospital and University of Lausanne.
| | - Valentin Loser
- From the Department of Clinical Neurosciences (A.V., V.L., P.S.C., R.D.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne; and Department of Pathology (J.P.B.), Lausanne University Hospital and University of Lausanne
| | - Paolo Salvioni Chiabotti
- From the Department of Clinical Neurosciences (A.V., V.L., P.S.C., R.D.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne; and Department of Pathology (J.P.B.), Lausanne University Hospital and University of Lausanne
| | - Jean Philippe Brouland
- From the Department of Clinical Neurosciences (A.V., V.L., P.S.C., R.D.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne; and Department of Pathology (J.P.B.), Lausanne University Hospital and University of Lausanne
| | - Renaud Du Pasquier
- From the Department of Clinical Neurosciences (A.V., V.L., P.S.C., R.D.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne; and Department of Pathology (J.P.B.), Lausanne University Hospital and University of Lausanne
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Salvioni Chiabotti P, Vicino A, Rossetti AO. Lateralized rhythmic delta activity: A peri-ictal feature beyond epilepsy. Clin Neurophysiol 2021; 132:1302-1303. [PMID: 33867255 DOI: 10.1016/j.clinph.2021.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/03/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Salvioni Chiabotti
- Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Alex Vicino
- Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Andrea O Rossetti
- Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland.
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Perraudin C, Bourdin A, Vicino A, Kuntzer T, Bugnon O, Berger J. Home-based subcutaneous immunoglobulin for chronic inflammatory demyelinating polyneuropathy patients: A Swiss cost-minimization analysis. PLoS One 2020; 15:e0242630. [PMID: 33237959 PMCID: PMC7688145 DOI: 10.1371/journal.pone.0242630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/05/2020] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To compare the cost of two patient management strategies with similar efficacies for chronic inflammatory demyelinating polyneuropathy (CIDP) patients in the chronic phase: hospital-based IV immunoglobulin G (IVIg) and home-based subcutaneous immunoglobulin G (SCIg) associated with an interprofessional drug therapy management programme (initial training and follow-up). METHODS A 48-week model-based cost-minimization analysis from a societal perspective was performed. Resources included immunoglobulin (IVIg: 1 g/kg/3 weeks; SCIg: 0.4 g/kg/week initially and 0.2 g/kg/week in the maintenance phase), hospital charges, time of professionals, infusion material, transport and losses of productivity for patients. Costs were expressed in Swiss francs (CHF) (1 CHF = 0.93€ = US$1.10, www.xe.com, 2020/10/28). RESULTS The total costs of IVIg were higher than those of SCIg for health insurance and other payers: 114,747 CHF versus 86,558 CHF and 8,762 CHF versus 2,401 CHF, respectively. The results were sensitive to the immunoglobulin doses, as this was the main cost driver. The SCIg daily cost in the initial phase was higher for health insurance than hospital-based IVIg was, but the additional costs were compensated during the maintenance phase (from week 28). The professional costs associated with the switch were not fully covered by the insurance and were borne by the pharmacist and the nurse. CONCLUSIONS SCIg for CIDP patients reinforced by an interprofessional drug therapy management programme may be a cost-effective and sustainable alternative to IVIg in the Swiss system context. From an economic perspective, this therapy alternative should be more widely supported by healthcare systems and proposed to eligible patients by professionals.
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Affiliation(s)
- Clémence Perraudin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- * E-mail:
| | - Aline Bourdin
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Alex Vicino
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Bugnon
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
| | - Jérôme Berger
- Community Pharmacy, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland
- Institute of Pharmaceutical Sciences of Western Switzerland, University of Geneva, University of Lausanne, Lausanne, Switzerland
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Vicino A, Rouaud O, Du Pasquier R, Strambo D. Clinical Reasoning: A 69-year-old man with rare complex visual symptoms. Neurology 2020; 95:316-320. [PMID: 32732297 DOI: 10.1212/wnl.0000000000010218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alex Vicino
- From the Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland.
| | - Olivier Rouaud
- From the Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Renaud Du Pasquier
- From the Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Davide Strambo
- From the Department of Clinical Neurosciences, Neurology Service, Lausanne University Hospital and University of Lausanne, Switzerland
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Delmont E, Wang F, Lefaucheur JP, Puma A, Breniere C, Beaudonnet G, Cintas P, Collin R, Fortanier E, Grapperon AM, Jomir L, Kribich H, Kouton L, Kuntzer T, Lenglet T, Magot A, Nordine T, Ochsner F, Bolloy G, Pereon Y, Salort-Campana E, Tard C, Vicino A, Verschueren A, Attarian S. Motor unit number index as an individual biomarker: Reference limits of intra-individual variability over time in healthy subjects. Clin Neurophysiol 2020; 131:2209-2215. [PMID: 32707479 DOI: 10.1016/j.clinph.2020.06.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/13/2020] [Accepted: 06/05/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Motor unit number index (MUNIX) is proposed to monitor neuromuscular disorders. Our objective is to determine the intra-individual variability over time of the MUNIX. METHODS In 11 different hospital centres, MUNIX was assessed twice, at least 3 months apart (range 90-360 days), in tibialis anterior (TA), abductor pollicis brevis (APB), abductor digiti minimi (ADM) and deltoid muscles in 118 healthy subjects. MUNIX sum score 2, 3 and 4 were respectively the sum of the MUNIX of the TA and ADM, of the TA, APB and ADM and of the TA, APB, ADM and deltoid muscles. RESULTS The repeatability of the MUNIX was better for sum scores than for single muscle recordings. The variability of the MUNIX was independent of sex, age, interval between measurements and was lower for experienced than non-experienced operators. The 95th percentile of the coefficient of variability of the MUNIX sum score 2, 3 and 4 were respectively 22%, 18% and 15% for experienced operators. CONCLUSIONS The MUNIX technique must be performed by experienced operators on several muscles to reduce its variability and improve its reliability. SIGNIFICANCE A variation of the MUNIX sum score ≥20% can be interpreted as a significant change of muscle innervation.
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Affiliation(s)
- Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France; Aix-Marseille University, Timone Neuroscience Institute, UMR CNRS 7289, 13005 Marseille, France.
| | - François Wang
- Department of Neurophysiology, CHU Sart Tilman B35, 4000 Liège, Belgium
| | - Jean-Pascal Lefaucheur
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Angela Puma
- Université Côte d'Azur, Peripheral Nervous System and Muscle Department, CHU Nice, France
| | | | - Guillemette Beaudonnet
- Unité de Neurophysiologie Clinique et Epileptologie, CHU Bicêtre, Le Kremlin Bicêtre, France
| | | | - Romain Collin
- Department of Neurophysiology, CHU Sart Tilman B35, 4000 Liège, Belgium
| | - Etienne Fortanier
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Aude-Marie Grapperon
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Laurent Jomir
- Department of Neurology, Hospices Civiles de Lyon, France
| | - Hafida Kribich
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Ludivine Kouton
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Thierry Kuntzer
- Nerve Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Timothee Lenglet
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Armelle Magot
- Laboratoire d'explorations fonctionnelles, Referral Centre for Neuromuscular Disease Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, 44093 Nantes, France
| | - Tarik Nordine
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, Créteil, France; Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - François Ochsner
- Nerve Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Gaëlle Bolloy
- Laboratoire d'explorations fonctionnelles, Referral Centre for Neuromuscular Disease Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, 44093 Nantes, France
| | - Yann Pereon
- Laboratoire d'explorations fonctionnelles, Referral Centre for Neuromuscular Disease Atlantique-Occitanie-Caraïbes, Hôtel-Dieu, 44093 Nantes, France
| | | | - Céline Tard
- U1172 Lille Neuroscience et Cognition, CHU de Lille, Centre de référence des maladies neuromusculaires Nord Est Ile de France, Department of Neurology, Lille, France
| | - Alex Vicino
- Nerve Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital, Lausanne, Switzerland
| | - Annie Verschueren
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Shahram Attarian
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
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Ghosn J, Vicino A, Michielin O, Coukos G, Kuntzer T, Obeid M. A severe case of neuro-Sjögren's syndrome induced by pembrolizumab. J Immunother Cancer 2018; 6:110. [PMID: 30348223 PMCID: PMC6196470 DOI: 10.1186/s40425-018-0429-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/11/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The prevalence of connective tissue disease (CTD) induced by immune checkpoint inhibitors (CPIs) in the absence of pre-existing autoimmunity is unknown. CASE PRESENTATION We report the case of a melanoma patient treated for 8 months with pembrolizumab who developed a subacute ataxic sensory neuronopathy (SNN), including a right trigeminal neuropathy. Salivary gland biopsy showed inflammatory changes suggestive of Sjögren's syndrome, while brain MRI revealed enhancement of the right trigeminal ganglia. A high level of protein and pleocytosis was found in the cerebrospinal fluid, with negative cultures. Nerve conduction studies revealed the absence of sensory nerve action potentials in the upper and lower limbs and reduced motor responses in the upper limbs, fulfilling criteria for SNN. Blood tests revealed an important inflammatory syndrome, hemolytic anemia, elevation of total IgG levels and the presence of ANA autoantibodies specific to anti-SSA (52 and 60 kd). All these elements were absent before the initiation of the treatment with pembrolizumab. Initially, there was a clinical response following intravenous frontline methylprednisone, but the subacute relapse required the introduction of second-line treatment with intravenous immunoglobulins and then rituximab, which led to a quick clinical improvement. CONCLUSIONS Herein, we describe the first case of a patient who developed a typical SNN as a complication of severe neuro-Sjögren's syndrome induced by pembrolizumab treatment.
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Affiliation(s)
- Jaqueline Ghosn
- Department of Medicine, Division of Immunology and Allergy, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Alex Vicino
- Department of Neurology, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Olivier Michielin
- Department of Medical Oncology, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - George Coukos
- Department of Medical Oncology, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Ludwig Institute for Cancer Research, Chemin des Boveresses 155, CH-1066, Epalinges, Switzerland
| | - Thierry Kuntzer
- Department of Neurology, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Michel Obeid
- Department of Medicine, Division of Immunology and Allergy, Lausanne University Hospital CHUV, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland. .,Vaccination and Immunotherapy Center, Lausanne University Hospital CHUV, Rue du Bugnon 17, CH-1011, Lausanne, Switzerland. .,Medical School Pitié-Salpêtrière, Sorbonne University, 91 Boulevard de l'Hôpital, F-75013, Paris, France.
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Facchini A, Mocenni C, Vicino A. Identification of bifurcations of distributed systems using Generalized Recurrence Quantification Analysis. ACTA ACUST UNITED AC 2009. [DOI: 10.3182/20090706-3-fr-2004.00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Prattichizzo D, la Torre B, Barbagli F, Vicino A, Severi FM, Petraglia F. The FeTouch project: an application of haptic technologies to obstetrics and gynaecology. Int J Med Robot 2007; 1:83-7. [PMID: 17520599 DOI: 10.1002/rcs.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Ultrasound technologies have been widely used in gynecology and obstetrics. Modern ultrasound systems allow the reconstruction of a 3D model of the subject being scanned, but even though visual interfaces have reached very high standards, the problem of representing a 3D image on a 2D computer screen still exists. Moreover no physical interaction is possible with such a model. The FeTouch system, developed at Siena University in the last two years, partially solves such issues by using stereo visual feedback and haptic devices. While the system can be used with any 3D model obtained from ultrasound scans, its current prime use is to allow mothers to interact with a model of the fetus they are carrying. The system is freely available on the project web page.
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Affiliation(s)
- D Prattichizzo
- Dipartimento di Ingegneria dell'Informazione, Università di Siena, Italy.
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Severi FM, Prattichizzo D, Casarosa E, Barbagli F, Ferretti C, Altomare A, Vicino A, Petraglia F. Virtual fetal touch through a haptic interface decreases maternal anxiety and salivary cortisol. ACTA ACUST UNITED AC 2005; 12:37-40. [PMID: 15629669 DOI: 10.1016/j.jsgi.2004.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate whether a virtual reality workstation (Fetouch system) offering three-dimensional (3D) fetal visual and kinesthetic interaction may affect maternal stress. METHODS Maternal-fetal visual and kinesthetic interaction was obtained through a haptic interface based on 3D reconstruction of sequencial bi-dimensional ultrasound images of the fetus. Maternal stress was assessed before and after visual/kinesthetic interaction with the fetus: 1) by using the State Trait Anxiety Inventory-Form Y (STAI) test, and 2) by measuring salivary cortisol levels. Statistical analysis was performed by paired t test and analysis of variance for repeated measures. RESULTS After the fetal visual and kinesthetic experiences, a significant reduction was observed in anxiety (low state anxiety group, P < .0034; high state anxiety group, P < .0108), as well as in salivary cortisol concentration (P < .0004). CONCLUSION Physical interaction with the fetus through a 3D model may reduce maternal stress.
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Affiliation(s)
- F M Severi
- Department of Pediatrics, Obstetrics and Reproductive Medicine, University of Siena, Siena, Italy
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Rufa A, Mariottini GL, Prattichizzo D, Alessandrini D, Vicino A, Federico A. Video-based eye tracking: our experience with Advanced Stimuli Design for Eye Tracking software. Ann N Y Acad Sci 2005; 1039:575-9. [PMID: 15827026 DOI: 10.1196/annals.1325.071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
We present an independent, flexible, and easily programmable software program for generating a wide set of visual stimuli paradigms in eye-movement studies. The software, called ASTIDET (Advanced Stimuli Design for Eye Tracking), has been interfaced in real time with a high speed video-based eye tracking system in order to obtain a reliable measurement of saccades. Two saccadic paradigms have been tested (gap and memory guided tasks) in 10 normal subjects. The preliminary results confirm that ASTIDET is a user-friendly software and can be interfaced with a video-based eye-tracking device in order to obtain reliable measurement of saccades.
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Affiliation(s)
- A Rufa
- Department of Neurological and Behavioral Sciences, Medical School, University of Siena, Viale Bracci 2, 53100 Siena, Italy
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Chesi G, Hashimoto K, Prattichizzo D, Vicino A. Keeping Features in the Field of View in Eye-In-Hand Visual Servoing: A Switching Approach. IEEE T ROBOT 2004. [DOI: 10.1109/tro.2004.829456] [Citation(s) in RCA: 114] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Di Marco M, Garulli A, Giannitrapani A, Vicino A. Simultaneous localization and map building for a team of cooperating robots: a set membership approach. ACTA ACUST UNITED AC 2003. [DOI: 10.1109/tra.2003.808849] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bianchini G, Tesi A, Vicino A. Synthesis of robust strictly positive real systems with l/sub 2/ parametric uncertainty. ACTA ACUST UNITED AC 2001. [DOI: 10.1109/81.917981] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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