1
|
Teng O, Quek AML, Nguyen TM, Wang S, Ng IXQ, Fragata L, Mohd-Abu-Bucker FB, Tambyah PA, Seet RCS. Biomarkers of early SARS-CoV-2 infection before the onset of respiratory symptoms. Clin Microbiol Infect 2024; 30:540-547. [PMID: 38160754 DOI: 10.1016/j.cmi.2023.12.024] [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: 08/03/2023] [Revised: 12/11/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES Currently, limited data exist regarding the pathological changes occurring during the incubation phase of SARS-CoV-2 infection. We utilized proteomic analysis to explore changes in the circulatory host response in individuals with SARS-CoV-2 infection before the onset of symptoms. METHODS Participants were individuals from a randomized clinical trial of prophylaxis for COVID-19 in a workers' dormitory. Proteomic signatures of blood samples collected within 7 days before symptom onset (incubation group) were compared with those collected >21 days (non-incubation group) to derive candidate biomarkers of incubation. Candidate biomarkers were assessed by comparing levels in the incubation group with both infected individuals (positive controls) and non-infected individuals (negative controls). RESULTS The study included men (mean age 34.2 years and standard deviation 7.1) who were divided into three groups: an incubation group consisting of 44 men, and two control groups-positive (n = 56) and negative (n = 67) controls. Through proteomic analysis, we identified 49 proteins that, upon pathway analyses, indicated an upregulation of the renin-angiotensin and innate immune systems during the virus incubation period. Biomarker analyses revealed increased concentrations of plasma angiotensin II (mean 731 vs. 139 pg/mL), angiotensin (1-7) (302 vs. 9 pg/mL), CXCL10 (423 vs. 85 pg/mL), CXCL11 (82.7 vs. 32.1 pg/mL), interferon-gamma (0.49 vs. 0.20 pg/mL), legumain (914 vs. 743 pg/mL), galectin-9 (1443 vs. 836 pg/mL), and tumour necrosis factor (20.3 vs. 17.0 pg/mL) during virus incubation compared with non-infected controls (all p < 0.05). Plasma angiotensin (1-7) exhibited a significant increase before the onset of symptoms when compared with uninfected controls (area under the curve 0.99, sensitivity 0.97, and specificity 0.99). DISCUSSION Angiotensin (1-7) could play a crucial role in the progression of symptomatic COVID-19 infection, and its assessment could help identify individuals who would benefit from enhanced monitoring and early antiviral intervention.
Collapse
Affiliation(s)
- Ooiean Teng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Amy May Lin Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Tuong Minh Nguyen
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Suqing Wang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Isabel Xue Qi Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lorivie Fragata
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | | | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Infectious Diseases Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Raymond Chee Seong Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore; Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| |
Collapse
|
2
|
Goh Y, Lee XY, Chin AXY, Jing M, Makmur A, Quek AML. Shapiro syndrome: a cause of episodic hyperhidrosis, hypothermia and altered mental status. QJM 2023; 116:861-863. [PMID: 37338563 DOI: 10.1093/qjmed/hcad145] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Indexed: 06/21/2023] Open
Affiliation(s)
- Y Goh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - X Y Lee
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore
| | - A X Y Chin
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - M Jing
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - A Makmur
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - A M L Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
3
|
Koh JS, Hoe RHM, Chen GJ, Goh Y, Tan BYQ, Yong MH, Hui ACF, Tu TM, Yong KP, Angon J, Tan K, Quek AML, Umapathi T, Seet RCS. Low incidence of neurological recurrent side-effects following COVID-19 reimmunization. QJM 2023; 116:221-226. [PMID: 36355458 DOI: 10.1093/qjmed/hcac251] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/02/2022] [Accepted: 11/02/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Individuals who suffered a neurological adverse event after the Coronavirus disease (COVID-19) vaccine could hesitate and defer reimmunization. AIM We examine the risk of recurrence following reimmunization among patients who developed a neurological event after the first dose of the COVID-19 mRNA vaccine. DESIGN Observational study. METHODS Individuals who developed an adjudicated neurological adverse event (based on Brighton Collaboration criteria) within 6 weeks of the first dose of the COVID-19 vaccine requiring hospitalization were enrolled into a multicenter national registry in Singapore. Neurological recurrence, defined by the development of another neurological event within 6 weeks of the second vaccine dose, was reviewed. Clinical characteristics were compared between patients who chose to proceed or withhold further vaccination, and between those who received timely (3-6 weeks) or delayed (>6 weeks) reimmunization. RESULTS From 235 patients (median age, 67 years; 63% men) who developed an adjudicated neurological event after their first dose of mRNA vaccine between 30 December 2020 and 20 April 2021, 181 (77%) chose to undergo reimmunization. Those who decided against reimmunization were older (median age, 74 vs. 66 years) and had greater physical disability following their primary neurological event (46% vs. 20%, P < 0.001). Patients who suffered greater physical disability were three times more likely to delay their reimmunization (odds ratio 3.36, 95% confidence interval: 1.76-6.40). Neurological recurrence was observed in only four individuals (three with seizures and one with myasthenia gravis exacerbation). CONCLUSIONS A prior neurological event should not necessarily preclude reimmunization and the decision to proceed with reimmunization should consider the overwhelming benefits conferred by vaccination toward ending this pandemic.
Collapse
Affiliation(s)
- Jasmine Shimin Koh
- From the Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore, Singapore
| | - Rebecca Hui Min Hoe
- From the Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore, Singapore
| | - Geraldine Jiangyan Chen
- Clinical Trials and Research Unit, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
| | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Tian Ming Tu
- Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore, Singapore
| | - Kok Pin Yong
- Department of Neurology, Sengkang General Hospital, Singapore, Singapore
| | - Jasmyn Angon
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - Kevin Tan
- From the Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore, Singapore
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Thirugnanam Umapathi
- From the Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore, Singapore
| | - Raymond Chee Seong Seet
- Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
4
|
Quek AML, Ng MY, Teng O, Lim NA, Ng GJL, Yang SP, Hartman M, Tambyah PA, Cook AR, Seet RCS. Stable thyroid function despite regular use of povidone-iodine throat spray for SARS-CoV-2 prophylaxis. Ann Med 2022; 54:3299-3305. [PMID: 36399104 PMCID: PMC9677975 DOI: 10.1080/07853890.2022.2108132] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is unclear whether unintentional ingestion of povidone-iodine following its application to the oropharyngeal space could affect thyroid function. OBJECTIVE To examine thyroid function among individuals who regularly apply povidone-iodine throat spray for SARS-CoV-2 prophylaxis. METHODS We designed a case-control study to compare thyroid function among participants who received povidone-iodine throat spray three times a day for 42 days ('cases') and those who received vitamin C ('controls'). Thyroid function was assessed by profiling serum TSH, free T3, and free T4; iodine status was estimated using serum thyroglobulin level, while infection status was determined by measuring anti-SARS-CoV-2 antibody against the nucleocapsid antigen. All measurements were performed in pairs, at baseline and 42 days later. Pre-post changes in thyroid function were compared between groups, before and after stratification according to baseline TSH quartiles. RESULTS A total of 177 men (117 cases and 60 controls) (mean age, 32.2 years) were included. Despite comparable demographics and clinical profiles, no clinically or statistically significant differences were observed in thyroid indices between 'cases' and 'controls' before and after stratification according to TSH quartiles. None of the participants developed symptomatic hypo- or hyperthyroidism throughout the study. Post-hoc analysis did not reveal differences in thyroid function according to infection status. CONCLUSIONS Data from this study support the overall safety of povidone-iodine use in the oropharyngeal space for SARS-CoV-2 prophylaxis among individuals with normal thyroid function and subclinical thyroid disease.
Collapse
Affiliation(s)
- Amy May Lin Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Mei Yen Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ooiean Teng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Nicole-Ann Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Geelyn Jeng Lin Ng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Samantha Peiling Yang
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Endocrinology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore.,Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Raymond Chee Seong Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| |
Collapse
|
5
|
Yeo T, Quek AML, Yong KP, Tye JSN, Ratnagopal P, Soon DTL, Tan K. COVID-19 infection after two doses of SARS-CoV-2 mRNA vaccine in multiple sclerosis, AQP4-antibody NMOSD and MOGAD. Mult Scler Relat Disord 2022; 65:104003. [PMID: 35803084 PMCID: PMC9233746 DOI: 10.1016/j.msard.2022.104003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/01/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND In pre-vaccinated people with multiple sclerosis (MS), certain disease-modifying therapies (DMTs), particularly the anti-CD20 treatments, appear to be associated with an increased risk of COVID-19 infection and indeed with severe infection. It is still not known if such observations extend to vaccinated individuals and there have been considerably fewer studies in aquaporin-4-antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein-antibody associated disease (MOGAD) patients. In this study, we investigated the rates of symptomatic COVID-19 infection in adult patients with MS, AQP4-NMOSD and MOGAD who had received 2 doses of SARS-CoV-2 mRNA vaccine. METHODS This was a prospective observational study conducted at the 2 main neuroimmunology referral centres in Singapore. Only patients on active follow-up were recruited to ensure robust data collection. Data on demographics, disease history, DMTs and SARS-CoV-2 mRNA vaccinations were recorded, and for those infected with COVID-19, data on COVID-19 infection was collected. RESULTS Nineteen (13 MS, 5 AQP4-NMOSD, 1 MOGAD) out of 365 (231 MS, 106 AQP4-NMOSD, 28 MOGAD) patients had COVID-19 infection despite 2 doses of SARS-CoV-2 mRNA vaccine. Amongst the infected patients, 11 patients were on DMTs (3 rituximab, 2 interferons, 1 azathioprine, 1 mycophenolate, 1 prednisolone, 1 cladribine, 1 alemtuzumab, 1 fingolimod), while 8 patients were untreated. The crude infection rate was calculated using time-at-risk analysis, revealing that rituximab had the highest infection rate amongst all the DMTs. A lower crude infection rate was observed in patients who received a third vaccination. The majority of infections were mild and no patients required oxygen supplementation. CONCLUSION Our findings suggest that patients on rituximab are still at risk of COVID-19 infection after 2 vaccinations and the receipt of a third vaccination may help to prevent infection. Future large scale studies will be required to better delineate the infection risk of different DMTs after the second and subsequent vaccinations.
Collapse
Affiliation(s)
- Tianrong Yeo
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore.
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kok Pin Yong
- Duke-NUS Medical School, Singapore, Singapore; Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Janis Siew Noi Tye
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore
| | - Pavanni Ratnagopal
- Duke-NUS Medical School, Singapore, Singapore; Department of Neurology, National Neuroscience Institute (Singapore General Hospital Campus), Singapore, Singapore
| | - Derek Tuck Loong Soon
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Campus), Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| |
Collapse
|
6
|
Tu TM, Yi SJ, Koh JS, Saffari SE, Hoe RHM, Chen GJ, Chiew HJ, Tham CH, Seet CYH, Yong MH, Yong KP, Hui ACF, Fan BE, Tan BYQ, Quek AML, Seet RCS, Yeo LLL, Tan K, Thirugnanam UN. Incidence of Cerebral Venous Thrombosis Following SARS-CoV-2 Infection vs mRNA SARS-CoV-2 Vaccination in Singapore. JAMA Netw Open 2022; 5:e222940. [PMID: 35297971 PMCID: PMC8931554 DOI: 10.1001/jamanetworkopen.2022.2940] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Reports of cerebral venous thrombosis (CVT) after messenger RNA (mRNA)-based SARS-CoV-2 vaccination has caused safety concerns, but CVT is also known to occur after SARS-CoV-2 infection. Comparing the relative incidence of CVT after infection vs vaccination may provide a better perspective of this complication. OBJECTIVE To compare the incidence rates and clinical characteristics of CVT following either SARS-CoV-2 infection or mRNA-based SARS-CoV-2 vaccines. DESIGN, SETTING, AND PARTICIPANTS Between January 23, 2020, and August 3, 2021, this observational cohort study was conducted at all public acute hospitals in Singapore, where patients hospitalized with CVT within 6 weeks of SARS-CoV-2 infection or after mRNA-based SARS-CoV-2 vaccination (BNT162b2 [Pfizer-BioNTech] or mRNA-1273 [Moderna]) were identified. Diagnosis of SARS-CoV-2 infection was based on quantitative reverse transcription-polymerase chain reaction or positive serology. National SARS-CoV-2 infection data were obtained from the National Centre for Infectious Disease, Singapore, and vaccination data were obtained from the National Immunisation Registry, Singapore. EXPOSURES SARS-CoV-2 infection or mRNA-based SARS-CoV-2 vaccines. MAIN OUTCOMES AND MEASURES Clinical characteristics, crude incidence rate (IR), and incidence rate ratio (IRR) of CVT after SARS-CoV-2 infection and after mRNA SARS-CoV-2 vaccination. RESULTS Among 62 447 individuals diagnosed with SARS-CoV-2 infections included in this study, 58 989 (94.5%) were male; the median (range) age was 34 (0-102) years; 6 CVT cases were identified (all were male; median [range] age was 33.5 [27-40] years). Among 3 006 662 individuals who received at least 1 dose of mRNA-based SARS-CoV-2 vaccine, 1 626 623 (54.1%) were male; the median (range) age was 50 (12-121) years; 9 CVT cases were identified (7 male individuals [77.8%]; median [range] age: 60 [46-76] years). The crude IR of CVT after SARS-CoV-2 infections was 83.3 per 100 000 person-years (95% CI, 30.6-181.2 per 100 000 person-years) and 2.59 per 100 000 person-years (95% CI, 1.19-4.92 per 100 000 person-years) after mRNA-based SARS-CoV-2 vaccination. Six (66.7%) received BNT162b2 (Pfizer-BioNTech) vaccine and 3 (33.3%) received mRNA-1273 (Moderna) vaccine. The crude IRR of CVT hospitalizations with SARS-CoV-2 infection compared with those who received mRNA SARS-CoV-2 vaccination was 32.1 (95% CI, 9.40-101; P < .001). CONCLUSIONS AND RELEVANCE The incidence rate of CVT after SARS-CoV-2 infection was significantly higher compared with after mRNA-based SARS-CoV-2 vaccination. CVT remained rare after mRNA-based SARS-CoV-2 vaccines, reinforcing its safety.
Collapse
Affiliation(s)
- Tian Ming Tu
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Shen Jia Yi
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | - Seyed Ehsan Saffari
- Centre of Quantitative Medicine, Duke-NUS Medical School, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute, Singapore
| | - Kok Pin Yong
- Department of Neurology, National Neuroscience Institute, Singapore
| | | | | | | | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | | | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore
| | | |
Collapse
|
7
|
Quek AML, Ooi DSQ, Teng O, Chan CY, Ng GJL, Ng MY, Yee S, Cheong EW, Weng R, Cook AR, Hartman M, Angeli V, Tambyah PA, Seet RCS. Zinc and vitamin C intake increases spike and neutralising antibody production following SARS‐CoV‐2 infection. Clin Transl Med 2022; 12:e731. [PMID: 35184404 PMCID: PMC8858613 DOI: 10.1002/ctm2.731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 01/23/2022] [Accepted: 01/25/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Amy May Lin Quek
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore
- Division of Neurology Department of Medicine National University Hospital Singapore
| | - Delicia Shu Qin Ooi
- Department of Pediatrics Yong Loo Lin School of Medicine National University of Singapore Singapore
- Khoo Teck Puat‐National University Children's Medical Institute National University Hospital National University Health System Singapore
| | - Ooiean Teng
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Chang Yien Chan
- Department of Pediatrics Yong Loo Lin School of Medicine National University of Singapore Singapore
- Khoo Teck Puat‐National University Children's Medical Institute National University Hospital National University Health System Singapore
| | - Geelyn Jeng Lin Ng
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Mei Yen Ng
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Sidney Yee
- Diagnostic Development Hub, Agency for Science Technology and Research (A*STAR) Singapore
| | - Ee Wan Cheong
- Diagnostic Development Hub, Agency for Science Technology and Research (A*STAR) Singapore
| | - Ruifen Weng
- Diagnostic Development Hub, Agency for Science Technology and Research (A*STAR) Singapore
| | - Alex R. Cook
- Saw Swee Hock School of Public Health National University of Singapore and National University Health System Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health National University of Singapore and National University Health System Singapore
- Department of Surgery Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Veronique Angeli
- Immunology Translational Research Programme Department of Microbiology and Immunology Yong Loo Lin School of Medicine National University of Singapore Singapore
- Immunology Programme Life Sciences Institute National University of Singapore Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore
- Division of Infectious Diseases National University Hospital Singapore
- Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine National University of Singapore Singapore
| | - Raymond Chee Seong Seet
- Department of Medicine Yong Loo Lin School of Medicine National University of Singapore Singapore
- Division of Neurology Department of Medicine National University Hospital Singapore
- Healthy Longevity Translational Research Program Yong Loo Lin School of Medicine National University of Singapore Singapore
| |
Collapse
|
8
|
Koh JS, Goh Y, Tan BYQ, Hui ACF, Hoe RHM, Makmur A, Kei PL, Vijayan J, Ng KWP, Quek AML, Thirugnanm U. Neuralgic amyotrophy following COVID-19 mRNA vaccination. QJM 2021; 114:503-505. [PMID: 34347105 DOI: 10.1093/qjmed/hcab216] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- J S Koh
- From the Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), 11 Jalan Tan Tock Seng, Singapore 308433 Singapore
| | - Y Goh
- Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - B Y-Q Tan
- Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - A C-F Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital: 1 Jurong East Street 21, Singapore 609606
| | - R H M Hoe
- From the Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), 11 Jalan Tan Tock Seng, Singapore 308433 Singapore
| | - A Makmur
- Department of Diagnostic Imaging, National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - P L Kei
- Department of Radiology, Ng Teng Fong General Hospital: 1 Jurong East Street 21, Singapore 609606
| | - J Vijayan
- Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - K W P Ng
- Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - A M L Quek
- Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Road, Singapore 119228
| | - U Thirugnanm
- Division of Neurology, Department of Medicine, National University Health System, 1E Kent Ridge Road, Singapore 119228
| |
Collapse
|
9
|
Seet RCS, Quek AML, Ooi DSQ, Sengupta S, Lakshminarasappa SR, Koo CY, So JBY, Goh BC, Loh KS, Fisher D, Teoh HL, Sun J, Cook AR, Tambyah PA, Hartman M. Positive impact of oral hydroxychloroquine and povidone-iodine throat spray for COVID-19 prophylaxis: An open-label randomized trial. Int J Infect Dis 2021; 106:314-322. [PMID: 33864917 PMCID: PMC8056783 DOI: 10.1016/j.ijid.2021.04.035] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022] Open
Abstract
Background We examined whether existing licensed pharmacotherapies could reduce the spread of coronavirus disease 2019 (COVID-19). Methods An open-label parallel randomized controlled trial was performed among healthy migrant workers quarantined in a large multi-storey dormitory in Singapore. Forty clusters (each defined as individual floors of the dormitory) were randomly assigned to receive a 42-day prophylaxis regimen of either oral hydroxychloroquine (400 mg once, followed by 200 mg/day), oral ivermectin (12 mg once), povidone-iodine throat spray (3 times/day, 270 μg/day), oral zinc (80 mg/day)/vitamin C (500 mg/day) combination, or oral vitamin C, 500 mg/day. The primary outcome was laboratory evidence of SARS-CoV-2 infection as shown by either: (1) a positive serologic test for SARS-CoV-2 antibody on day 42, or (2) a positive PCR test for SARS-CoV-2 at any time between baseline and day 42. Results A total of 3037 asymptomatic participants (mean age, 33.0 years; all men) who were seronegative to SARS-CoV-2 at baseline were included in the primary analysis. Follow-up was nearly complete (99.6%). Compared with vitamin C, significant absolute risk reductions (%, 98.75% confidence interval) were observed for oral hydroxychloroquine (21%, 2–42%) and povidone-iodine throat spray (24%, 7–39%). No statistically significant differences were observed with oral zinc/vitamin C combination (23%, –5 to +41%) and ivermectin (5%, –10 to +22%). Interruptions due to side effects were highest among participants who received zinc/vitamin C combination (6.9%), followed by vitamin C (4.7%), povidone-iodine (2.0%), and hydroxychloroquine (0.7%). Conclusions Chemoprophylaxis with either oral hydroxychloroquine or povidone-iodine throat spray was superior to oral vitamin C in reducing SARS-CoV-2 infection in young and healthy men.
Collapse
Affiliation(s)
- Raymond Chee Seong Seet
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore.
| | - Amy May Lin Quek
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Delicia Shu Qin Ooi
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Pediatric Endocrinology, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore
| | - Sharmila Sengupta
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | | | - Chieh Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore
| | - Jimmy Bok Yan So
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Boon Cher Goh
- Department of Hematology-Oncology, National University Cancer Institute, Singapore
| | - Kwok Seng Loh
- Department of Otolaryngology-Head and Neck Surgery, National University Hospital, Singapore
| | - Dale Fisher
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Hock Luen Teoh
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Jie Sun
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Paul Anantharajah Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| |
Collapse
|
10
|
Koh JS, De Silva DA, Quek AML, Chiew HJ, Tu TM, Seet CYH, Hoe RHM, Saini M, Hui ACF, Angon J, Ker JR, Yong MH, Goh Y, Yu WY, Lim TCC, Tan BYQ, Ng KWP, Yeo LLL, Pang YZ, Prakash KM, Ahmad A, Thomas T, Lye DCB, Tan K, Umapathi T. Corrigendum to 'Neurology of COVID-19 in Singapore' [Journal of the Neurological Sciences Volume 418, 15 November 2020, 117118]. J Neurol Sci 2021; 424:117406. [PMID: 33773769 PMCID: PMC7979574 DOI: 10.1016/j.jns.2021.117406] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jasmine Shimin Koh
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | | | - Rebecca Hui Min Hoe
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Monica Saini
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Jasmyn Angon
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Justin Ruixin Ker
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | | | | | - Kay Wei Ping Ng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Yu Zhi Pang
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | - Kumar M Prakash
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Department of Neurology, Sengkang General Hospital, Singapore
| | - Aftab Ahmad
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Terrence Thomas
- Department of Paediatrics, Neurology Service, KK Women's and Children's Hospital, Singapore
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Thirugnanam Umapathi
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore.
| |
Collapse
|
11
|
Koh JS, De Silva DA, Quek AML, Chiew HJ, Tu TM, Seet CYH, Hoe RHM, Saini M, Hui ACF, Angon J, Ker JR, Yong MH, Goh Y, Yu WY, Lim TCC, Tan BYQ, Ng KWP, Yeo LLL, Pang YZ, Prakash KM, Ahmad A, Thomas T, Lye DCB, Tan K, Umapathi T. Neurology of COVID-19 in Singapore. J Neurol Sci 2020; 418:117118. [PMID: 32977228 PMCID: PMC7470792 DOI: 10.1016/j.jns.2020.117118] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/23/2020] [Accepted: 09/01/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To describe the spectrum of COVID-19 neurology in Singapore. METHOD We prospectively studied all microbiologically-confirmed COVID-19 patients in Singapore, who were referred for any neurological complaint within three months of COVID-19 onset. Neurological diagnoses and relationship to COVID-19 was made by consensus guided by contemporaneous literature, refined using recent case definitions. RESULTS 47,572 patients (median age 34 years, 98% males) were diagnosed with COVID-19 in Singapore between 19 March to 19 July 2020. We identified 90 patients (median age 38, 98.9% males) with neurological disorders; 39 with varying certainty of relationship to COVID-19 categorised as: i) Central nervous system syndromes-4 acute disseminated encephalomyelitis (ADEM) and encephalitis, ii) Cerebrovascular disorders-19 acute ischaemic stroke and transient ischaemic attack (AIS/TIA), 4 cerebral venous thrombosis (CVT), 2 intracerebral haemorrhage, iii) Peripheral nervous system-7 mono/polyneuropathies, and a novel group, iv) Autonomic nervous system-4 limited dysautonomic syndromes. Fifty-one other patients had pre/co-existent neurological conditions unrelated to COVID-19. Encephalitis/ADEM is delayed, occurring in critical COVID-19, while CVT and dysautonomia occurred relatively early, and largely in mild infections. AIS/TIA was variable in onset, occurring in patients with differing COVID-19 severity; remarkably 63.2% were asymptomatic. CVT was more frequent than expected and occurred in mild/asymptomatic patients. There were no neurological complications in all 81 paediatric COVID-19 cases. CONCLUSION COVID-19 neurology has a wide spectrum of dysimmune-thrombotic disorders. We encountered relatively few neurological complications, probably because our outbreak involved largely young men with mild/asymptomatic COVID-19. It is also widely perceived that the pandemic did not unduly affect the Singapore healthcare system.
Collapse
Affiliation(s)
- Jasmine Shimin Koh
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Amy May Lin Quek
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Hui Jin Chiew
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Tian Ming Tu
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | | | - Rebecca Hui Min Hoe
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Monica Saini
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Andrew Che-Fai Hui
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Jasmyn Angon
- Department of General Medicine, Khoo Teck Puat Hospital, Singapore
| | - Justin Ruixin Ker
- Department of Neurosurgery, National Neuroscience Institute, Singapore
| | - Ming Hui Yong
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Wai-Yung Yu
- Department of Neuroradiology, National Neuroscience Institute, Singapore
| | | | | | - Kay Wei Ping Ng
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Leonard Leong Litt Yeo
- Division of Neurology, Department of Medicine, National University Health System, Singapore
| | - Yu Zhi Pang
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Division of Neurology, Department of General Medicine, Changi General Hospital, Singapore
| | - Kumar M Prakash
- Department of Neurology, National Neuroscience Institute (Singapore General Hospital campus), Singapore; Department of Neurology, Sengkang General Hospital, Singapore
| | - Aftab Ahmad
- Division of Neurology, Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Terrence Thomas
- Department of Paediatrics, Neurology Service, KK Women's and Children's Hospital, Singapore
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore
| | - Thirugnanam Umapathi
- Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital campus), Singapore.
| |
Collapse
|
12
|
Toledano M, Britton JW, McKeon A, Shin C, Lennon VA, Quek AML, So E, Worrell GA, Cascino GD, Klein CJ, Lagerlund TD, Wirrell EC, Nickels KC, Pittock SJ. Utility of an immunotherapy trial in evaluating patients with presumed autoimmune epilepsy. Neurology 2014; 82:1578-86. [PMID: 24706013 DOI: 10.1212/wnl.0000000000000383] [Citation(s) in RCA: 162] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To evaluate a trial of immunotherapy as an aid to diagnosis in suspected autoimmune epilepsy. METHOD We reviewed the charts of 110 patients seen at our autoimmune neurology clinic with seizures as a chief complaint. Twenty-nine patients met the following inclusion criteria: (1) autoimmune epilepsy suspected based on the presence of ≥ 1 neural autoantibody (n = 23), personal or family history or physical stigmata of autoimmunity, and frequent or medically intractable seizures; and (2) initiated a 6- to 12-week trial of IV methylprednisolone (IVMP), IV immune globulin (IVIg), or both. Patients were defined as responders if there was a 50% or greater reduction in seizure frequency. RESULTS Eighteen patients (62%) responded, of whom 10 (34%) became seizure-free; 52% improved with the first agent. Of those receiving a second agent after not responding to the first, 43% improved. A favorable response correlated with shorter interval between symptom onset and treatment initiation (median 9.5 vs 22 months; p = 0.048). Responders included 14/16 (87.5%) patients with antibodies to plasma membrane antigens, 2/6 (33%) patients seropositive for glutamic acid decarboxylase 65 antibodies, and 2/6 (33%) patients without detectable antibodies. Of 13 responders followed for more than 6 months after initiating long-term oral immunosuppression, response was sustained in 11 (85%). CONCLUSIONS These retrospective findings justify consideration of a trial of immunotherapy in patients with suspected autoimmune epilepsy. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that in patients with suspected autoimmune epilepsy, IVMP, IVIg, or both improve seizure control.
Collapse
Affiliation(s)
- M Toledano
- From the Departments of Neurology (M.T., J.W.B., A.M., C.S., V.A.L., E.S., G.A.W., G.D.C., C.J.K., T.D.L., E.C.W., K.C.N., S.J.P.), Laboratory Medicine and Pathology (A.M., V.A.L., A.M.L.Q., C.J.K., S.J.P.), and Immunology (V.A.L.), Mayo Clinic, College of Medicine, Rochester, MN
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Quek AML, Soon D, Chan YC, Thamboo TP, Yuki N. Acute-onset chronic inflammatory demyelinating polyneuropathy with focal segmental glomerulosclerosis. J Neurol Sci 2014; 341:139-43. [PMID: 24726719 DOI: 10.1016/j.jns.2014.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [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: 11/24/2013] [Revised: 03/17/2014] [Accepted: 03/20/2014] [Indexed: 12/19/2022]
Abstract
Inflammatory neuropathies have been reported to occur in association with nephrotic syndrome. Their underlying immuno-pathogenic mechanisms remain unknown. A 50-year-old woman concurrently presented with acute-onset chronic inflammatory demyelinating polyneuropathy and nephrotic syndrome secondary to focal segmental glomerulosclerosis. Both neuropathy and proteinuria improved after plasma exchange and steroids. Literature review of cases of concurrent inflammatory neuropathies and nephrotic syndrome revealed similar neuro-renal presentations. This neuro-renal condition may be mediated by autoantibodies targeting myelin and podocytes.
Collapse
Affiliation(s)
- Amy May Lin Quek
- Department of Medicine, National University Health System, Singapore
| | - Derek Soon
- Department of Medicine, National University Health System, Singapore
| | - Yee Cheun Chan
- Department of Medicine, National University Health System, Singapore
| | | | - Nobuhiro Yuki
- Department of Medicine, National University Health System, Singapore.
| |
Collapse
|
14
|
Quek AML, McKeon A. Rapidly Progressive Dementia and its Mimics. Dementia 2013. [DOI: 10.1002/9781118656082.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
15
|
Kotsenas AL, Watson RE, Pittock SJ, Britton JW, Hoye SL, Quek AML, Shin C, Klein CJ. MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis. AJNR Am J Neuroradiol 2013; 35:84-9. [PMID: 23868165 DOI: 10.3174/ajnr.a3633] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune voltage-gated potassium channel complex encephalitis is a common form of autoimmune encephalitis. Patients with seizures due to this form of encephalitis commonly have medically intractable epilepsy and may require immunotherapy to control seizures. It is important that radiologists recognize imaging characteristics of this type of autoimmune encephalitis and suggest it in the differential diagnosis because this seizure etiology is likely under-recognized. Our purpose was to characterize MR imaging findings in this patient population. MATERIALS AND METHODS MR imaging in 42 retrospectively identified patients (22 males; median age, 56 years; age range, 8-79 years) with seizures and voltage-gated potassium channel complex autoantibody seropositivity was evaluated for mesial and extratemporal swelling and/or atrophy, T2 hyperintensity, restricted diffusion, and enhancement. Statistical analysis was performed. RESULTS Thirty-three of 42 patients (78.6%) demonstrated enlargement and T2 hyperintensity of mesial temporal lobe structures at some time point. Mesial temporal sclerosis was commonly identified (16/33, 48.5%) at follow-up imaging. Six of 9 patients (66.7%, P = .11) initially demonstrating hippocampal enhancement and 8/13 (61.5%, P = .013) showing hippocampal restricted diffusion progressed to mesial temporal sclerosis. Conversely, in 6 of 33 patients, abnormal imaging findings resolved. CONCLUSIONS Autoimmune voltage-gated potassium channel complex encephalitis is frequently manifested as enlargement, T2 hyperintensity, enhancement, and restricted diffusion of the mesial temporal lobe structures in the acute phase. Recognition of these typical imaging findings may help prompt serologic diagnosis, preventing unnecessary invasive procedures and facilitating early institution of immunotherapy. Serial MR imaging may demonstrate resolution or progression of radiologic changes, including development of changes involving the contralateral side and frequent development of mesial temporal sclerosis.
Collapse
|
16
|
Lim ECH, Quek AML, Seet RCS. Botulinum toxin-A injections via electrical motor point stimulation to treat writer's cramp: pilot study. Neurol Neurophysiol Neurosci 2006:4. [PMID: 17260081] [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] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Accepted: 07/19/2006] [Indexed: 05/13/2023]
Abstract
PURPOSE Writer's cramp describes a task-specific dystonia, in which the act of writing initiates dystonic posturing of the hands. Previous studies have described the efficacy of injections of botulinum toxin type-A (BTX-A) under electromyographic guidance, in which the injected muscle is either voluntarily, or less often, electrically (electrical motor point stimulation, EMPS) activated to ensure that the needle is in the target muscle. We performed an open label, prospective study to assess the efficacy of BTX-A injections, performed with EMPS under electromyographic guidance. METHODS Eight patients (seven male and one female) of mean age 44 (range 25-66) were recruited. All had idiopathic writer's cramp. Outcome measures, which included timed writing, objective assessment of dystonia (modified Ashworth scale and a visual analog scale rating) and patient assessment of functional disability, were assessed before injections and at six weeks follow-up. RESULTS The total dose of BTX-A injected for writer's cramp ranged from 50 to 130 units, which was less than that reported in previous studies using muscle activation techniques (up to 300 units). Improvements were observed in all outcome measures. Patients reported mild (non-disabling) weakness of injected, but not of uninjected muscles. CONCLUSION Lower dosages of BTX-A, administered using EMPS, offers the advantages of decreased cost and increased accuracy of targeting, while achieving good outcomes.
Collapse
Affiliation(s)
- E C H Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | | |
Collapse
|
17
|
Low JGH, Quek AML, Sin YK, Ang BSP. Mycotic aneurysm due to Burkholderia pseudomallei infection: case reports and literature review. Clin Infect Dis 2004; 40:193-8. [PMID: 15614712 DOI: 10.1086/426590] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2004] [Accepted: 08/25/2004] [Indexed: 11/03/2022] Open
Abstract
Melioidosis caused by Burkholderia pseudomallei infection is endemic in Southeast Asia and Northern Australia. Cardiovascular complications resulting in mycotic aneurysms are very rare. To our knowledge, there have only been 6 isolated case reports published in the literature to date. We report 6 cases of melioidosis in Singapore that presented as aortic aneurysms.
Collapse
Affiliation(s)
- Jenny Guek Hong Low
- Infectious Disease Unit, Department of Internal Medicine, Singapore General Hospital, Singapore.
| | | | | | | |
Collapse
|