1
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Salvalaggio A, Cacciavillani M, Tiengo C, Cipriani A, Frizziero L, Fedrigo M, Rizzo S, Angelini A, Gasparotti R, Briani C. Multimodal evaluation of carpal tunnel syndrome in a pre-symptomatic TTR mutation carrier. J Neurol Sci 2023; 448:120596. [PMID: 36870789 DOI: 10.1016/j.jns.2023.120596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Affiliation(s)
- A Salvalaggio
- Neurology Unit, Department of Neuroscience, University of Padova, Italy; Padova Neuroscience Center (PNC), University of Padova, Italy
| | | | - C Tiengo
- Plastic Surgery Unit, Department of Neuroscience, University of Padova, Italy
| | - A Cipriani
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padova, Italy
| | - L Frizziero
- Ophthalmology Unit, Department of Neuroscience, University of Padova, Italy
| | - M Fedrigo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, Pathology Unit, University of Padova, Italy
| | - S Rizzo
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, Pathology Unit, University of Padova, Italy
| | - A Angelini
- Department of Cardiac Thoracic and Vascular Sciences and Public Health, Pathology Unit, University of Padova, Italy
| | - R Gasparotti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - C Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Italy.
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2
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Salvalaggio A, Cipriani A, Righetto S, Artioli P, Sinigiani G, De Michieli L, Cason M, Pilichou K, Cecchin D, Briani C. Incidental cardiac uptake of 99mTc-diphosphonates is predictive of poor outcome: data from 9616 bone scintigraphies. J Nucl Cardiol 2022; 29:3419-3425. [PMID: 35437680 DOI: 10.1007/s12350-022-02961-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 09/07/2021] [Accepted: 02/27/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Bone scintigraphy (BS) is highly diagnostic for amyloid transthyretin (ATTR) cardiomyopathy. Prevalence and prognostic value of BS cardiac uptake is not well established. Our aim was to assess the prevalence of subclinical cardiac ATTR amyloidosis in patients undergoing [99mTc]MDP/DPD scintigraphy and to define their phenotype and prognosis. METHODS AND RESULTS BS scans performed for any clinical indications from 2009 to 2020 were reviewed. Patients were stratified according to Perugini visual score of cardiac uptake. Follow-up data were collected. Among 9616 BS scans, 0.7% (n = 67) showed cardiac uptake. In 47 (70%) patients, Perugini score was 1 and in 20 (30%) patients uptake was ≥ 2, suggesting cardiac ATTR amyloidosis. Forty subjects (61%) died during the follow-up (mean 47 ± 30 months). Compared with patients with Perugini score 1, those Perugini score ≥ 2 showed increased death rate (P = .018). Two (2/67) subjects were investigated for TTR gene mutations resulting negative. CONCLUSIONS In patients undergoing BS for different clinical indications, cardiac uptake suggesting cardiac ATTR amyloidosis is a rare, but still neglected finding, thus preventing possible diagnosis of ATTR cardiomyopathy. Importantly, cardiac uptake negatively affects the survival. Physicians should be aware of this rare, but crucial finding for timely diagnosis and treatment.
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Affiliation(s)
- A Salvalaggio
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padua, Italy
| | - A Cipriani
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - S Righetto
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
| | - P Artioli
- Department of Medicine (DIMED), Nuclear Medicine Unit, University-Hospital of Padova, Padua, Italy
| | - G Sinigiani
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - L De Michieli
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - M Cason
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - K Pilichou
- Department of Cardio- Thoraco-Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - D Cecchin
- Department of Medicine (DIMED), Nuclear Medicine Unit, University-Hospital of Padova, Padua, Italy
| | - C Briani
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
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3
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Castellani F, Cacciavillani M, Salvalaggio A, Campagnolo M, Briani C. Indirect effects of the lockdown for the COVID-19 pandemic: Comparative study of fibular palsies from prolonged sitting posture. eNeurologicalSci 2021; 25:100385. [PMID: 34901477 PMCID: PMC8648599 DOI: 10.1016/j.ensci.2021.100385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/21/2021] [Accepted: 12/01/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- F Castellani
- Department of Neurosciences, Neurology, Padova, Italy
| | | | - A Salvalaggio
- Department of Neurosciences, Neurology, Padova, Italy
| | - M Campagnolo
- Department of Neurosciences, Neurology, Padova, Italy
| | - C Briani
- Department of Neurosciences, Neurology, Padova, Italy
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4
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Grandis M, Obici L, Luigetti M, Briani C, Benedicenti F, Bisogni G, Canepa M, Cappelli F, Danesino C, Fabrizi GM, Fenu S, Ferrandes G, Gemelli C, Manganelli F, Mazzeo A, Melchiorri L, Perfetto F, Pradotto LG, Rimessi P, Tini G, Tozza S, Trevisan L, Pareyson D, Mandich P. Recommendations for pre-symptomatic genetic testing for hereditary transthyretin amyloidosis in the era of effective therapy: a multicenter Italian consensus. Orphanet J Rare Dis 2020; 15:348. [PMID: 33317601 PMCID: PMC7734774 DOI: 10.1186/s13023-020-01633-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a late-onset, autosomal dominant disease caused by progressive extracellular deposition of transthyretin amyloid fibrils, leading to organ damage and death. For other late-onset fatal diseases, as Huntington’s disease, protocols for pre-symptomatic genetic testing (PST) are available since decades. For ATTRv, limited experience has been reported to date, mostly gathered before the availability of approved therapies. We aimed at developing recommendations for a safe and feasible PST protocol in ATTRv in the era of emerging treatments, taking also into account Italian patients’ characteristics and healthcare system rules. After an initial survey on ongoing approaches to PST for ATTRv in Italy, two roundtable meetings were attended by 24 experts from 16 Italian centers involved in the diagnosis and care of this disease. Minimal requirements for PST offer and potential critical issues were highlighted. By November 2019, 457 families affected by ATTRv with 209 molecularly confirmed pre-symptomatic carriers were counted. The median age at PST was 41.3 years of age, regardless of the specific mutation. Half of the Italian centers had a multidisciplinary team, including a neurologist, an internist, a cardiologist, a medical geneticist and a psychologist, although in most cases not all the specialists were available in the same center. A variable number of visits was performed at each site. Experts agreed that PST should be offered only in the context of genetic counselling to at risk individuals aged 18 or older. Advertised commercial options for DNA testing should be avoided. The protocol should consist of several steps, including a preliminary clinical examination, a pre-test information session, an interval time, the genetic test and a post-test session with the disclosure of the test results, in the context of an experienced multidisciplinary team. Recommendations for best timing were also defined. Protocols for PST in the context of ATTRv can be refined to offer at risk individuals the best chance for early diagnosis and timely treatment start, while respecting autonomous decisions and promoting safe psychological adjustment to the genetic result.
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Affiliation(s)
- M Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - M Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - F Benedicenti
- Medical Genetics, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
| | - G Bisogni
- Centro Clinico Nemo Adulti-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - F Cappelli
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - C Danesino
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - G M Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona and University Hospital GB Rossi, Verona, Italy
| | - S Fenu
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - G Ferrandes
- IRCCS Policlinico San Martino, Genova, Italy
| | - C Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Arenzano, GE, Italy
| | - F Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - A Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - L Melchiorri
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - F Perfetto
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - L G Pradotto
- Department of Neurosciences, University of Turin, Torino, Italy.,Division of Neurology and Neurorehabilitazion, IRCCS Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - P Rimessi
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - G Tini
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - L Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - D Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - P Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy. .,IRCCS Policlinico San Martino, Genova, Italy.
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5
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Liberatore G, Manganelli F, Doneddu PE, Cocito D, Fazio R, Briani C, Filosto M, Benedetti L, Mazzeo A, Antonini G, Cosentino G, Jann S, Cortese A, Marfia GA, Clerici AM, Siciliano G, Carpo M, Luigetti M, Lauria G, Rosso T, Cavaletti G, Santoro L, Peci E, Tronci S, Ruiz M, Cotti Piccinelli S, Schenone A, Leonardi L, Toscano A, Mataluni G, Spina E, Gentile L, Nobile-Orazio E. Chronic inflammatory demyelinating polyradiculoneuropathy: can a diagnosis be made in patients not fulfilling electrodiagnostic criteria? Eur J Neurol 2020; 28:620-629. [PMID: 32959475 DOI: 10.1111/ene.14545] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 06/10/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to identify the clinical and diagnostic investigations that may help to support a diagnosis of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) in patients not fulfilling the European Federation of Neurological Societies and Peripheral Nerve Society (EFNS/PNS) electrodiagnostic criteria. METHODS The data from patients with a clinical diagnosis of CIDP included in a national database were retrospectively reviewed. RESULTS In all, 535 patients with a diagnosis of CIDP were included. This diagnosis fulfilled the EFNS/PNS criteria in 468 patients (87.2%) (definite in 430, probable in 33, possible in three, while two had chronic immune sensory polyradiculopathy). Sixty-seven patients had a medical history and clinical signs compatible with CIDP but electrodiagnostic studies did not fulfill the EFNS/PNS criteria for CIDP. These patients had similar clinical features and frequency of abnormal supportive criteria for the diagnosis of CIDP compared to patients fulfilling EFNS/PNS criteria. Two or more abnormal supportive criteria were present in 40 (61.2%) patients rising to 54 (80.6%) if a history of a relapsing course as a possible supportive criterion was also included. Increased cerebrospinal fluid proteins and response to immune therapy most frequently helped in supporting the diagnosis of CIDP. Response to therapy was similarly frequent in patients fulfilling or not EFNS/PNS criteria (87.3% vs. 85.9%). CONCLUSIONS Patients with a clinical diagnosis of CIDP had similar clinical findings, frequency of abnormal supportive criteria and response to therapy compared to patients fulfilling EFNS/PNS criteria. The presence of abnormal supportive criteria may help in supporting the diagnosis of CIDP in patients with a medical history and clinical signs compatible with this diagnosis but non-diagnostic nerve conduction studies.
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Affiliation(s)
- G Liberatore
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute, Milan, Italy
| | - F Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - P E Doneddu
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute, Milan, Italy
| | - D Cocito
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - R Fazio
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - C Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - M Filosto
- Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology, ASST 'Spedali Civili', University of Brescia, Brescia, Italy
| | - L Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy.,Neurology Unit, Sant'Andrea Hospital, La Spezia, Italy
| | - A Mazzeo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - G Antonini
- Unit of Neuromuscular Diseases, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - G Cosentino
- Department of Experimental BioMedicine and Clinical Neurosciences (BioNeC), University of Palermo, Palermo, Italy.,IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - S Jann
- Department of Neuroscience, Niguarda Ca' Granda Hospital, Milan, Italy
| | - A Cortese
- IRCCS Foundation C. Mondino National Neurological Institute, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Molecular Neurosciences, University College London, London, UK
| | - G A Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - A M Clerici
- Neurology Unit, Circolo and Macchi Foundation Hospital, Insubria University, DBSV, Varese, Italy
| | - G Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Carpo
- Neurology Unit, ASST Bergamo Ovest-Ospedale Treviglio, Treviglio, Italy
| | - M Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Lauria
- Unit of Neuroalgology, IRCCS Foundation 'Carlo Besta' Neurological Institute, Milan, Italy.,Department of Biomedical and Clinical Sciences 'Luigi Sacco', University of Milan, Milan, Italy
| | - T Rosso
- ULSS2 Marca Trevigiana, UOC Neurologia-Castelfranco Veneto, Treviso, Italy
| | - G Cavaletti
- School of Medicine and Surgery and Experimental Neurology Unit, University of Milano-Bicocca, Monza, Italy
| | - L Santoro
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - E Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Turin, Italy
| | - S Tronci
- Department of Neurology, Division of Neuroscience, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milan, Italy
| | - M Ruiz
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - S Cotti Piccinelli
- Center for Neuromuscular Diseases and Neuropathies, Unit of Neurology, ASST 'Spedali Civili', University of Brescia, Brescia, Italy
| | - A Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa and IRCCS AOU San Martino-IST, Genoa, Italy
| | - L Leonardi
- Unit of Neuromuscular Diseases, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, 'Sapienza' University of Rome, Rome, Italy
| | - A Toscano
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - G Mataluni
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - E Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - L Gentile
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - E Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Clinical and Research Institute, Milan, Italy.,Department of Medical Biotechnology and Translational Medicine, Milan University, Milan, Italy
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Doneddu PE, Bianchi E, Cocito D, Manganelli F, Fazio R, Filosto M, Mazzeo A, Cosentino G, Cortese A, Jann S, Clerici AM, Antonini G, Siciliano G, Luigetti M, Marfia GA, Briani C, Lauria G, Rosso T, Cavaletti G, Carpo M, Benedetti L, Beghi E, Liberatore G, Santoro L, Peci E, Tronci S, Cotti Piccinelli S, Toscano A, Piccolo L, Verrengia EP, Leonardi L, Schirinzi E, Mataluni G, Ruiz M, Dacci P, Nobile‐Orazio E. Risk factors for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): antecedent events, lifestyle and dietary habits. Data from the Italian CIDP Database. Eur J Neurol 2019; 27:136-143. [DOI: 10.1111/ene.14044] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 07/10/2019] [Indexed: 02/06/2023]
Affiliation(s)
- P. E. Doneddu
- Humanitas Clinical and Research Institute MilanItaly
| | | | | | | | - R. Fazio
- San Raffaele Scientific Institute MilanItaly
| | - M. Filosto
- ASST ‘Spedali Civili’ University of Brescia BresciaItaly
| | | | | | - A. Cortese
- IRCCS Foundation C. Mondino National Neurological Institute PaviaItaly
| | - S. Jann
- Niguarda Ca’ Granda Hospital MilanItaly
| | - A. M. Clerici
- Circolo and Macchi Foundation Hospital Insubria UniversityDBSV VareseItaly
| | - G. Antonini
- ‘Sapienza’ University of RomeSant'Andrea Hospital RomeItaly
| | | | - M. Luigetti
- Catholic University of Sacred Heart RomeItaly
| | | | | | - G. Lauria
- IRCCS Foundation ‘Carlo Besta’ Neurological Institute University of Milan MilanItaly
| | - T. Rosso
- UOC Neurologia‐Castelfranco Veneto TrevisoItaly
| | | | - M. Carpo
- ASST Bergamo Ovest‐Ospedale Treviglio TreviglioItaly
| | | | - E. Beghi
- Istituto Mario Negri IRCCS MilanItaly
| | - G. Liberatore
- Humanitas Clinical and Research Institute MilanItaly
| | - L. Santoro
- University of Naples ‘Federico II’ NaplesItaly
| | - E. Peci
- University of Turin TurinItaly
| | - S. Tronci
- San Raffaele Scientific Institute MilanItaly
| | | | | | - L. Piccolo
- IRCCS Foundation C. Mondino National Neurological Institute PaviaItaly
| | | | - L. Leonardi
- ‘Sapienza’ University of RomeSant'Andrea Hospital RomeItaly
| | | | | | - M. Ruiz
- University of Padua PaduaItaly
| | - P. Dacci
- IRCCS Foundation ‘Carlo Besta’ Neurological Institute University of Milan MilanItaly
| | - E. Nobile‐Orazio
- Humanitas Clinical and Research Institute MilanItaly
- Milan University Milan Italy
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7
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Briani C, Visentin A, Salvalaggio A, Cacciavillani M, Trentin L. Obinutuzumab, a new anti-CD20 antibody, and chlorambucil are active and effective in anti-myelin-associated glycoprotein antibody polyneuropathy. Eur J Neurol 2018; 26:371-375. [PMID: 30315672 DOI: 10.1111/ene.13838] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 06/15/2018] [Accepted: 10/08/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Rituximab, a chimeric anti-CD20 monoclonal antibody, has been used in polyneuropathy associated with anti-myelin-associated glycoprotein (anti-MAG) antibody polyneuropathy with controversial results. Herein, two patients with anti-MAG antibody neuropathy and concurrent chronic lymphocytic leukemia (CLL) are reported, who dramatically responded to obinutuzumab, a novel glycoengineered humanized anti-CD20 monoclonal antibody. METHODS Patient 1 was an 82-year-old man with severe demyelinating sensory-motor neuropathy. He was wheelchair-bound, with loss of sensation up to the knees. He had a CLL, immunoglobulin M (IgM) lambda monoclonal gammopathy, with anti-MAG antibodies >70 000 Bühlmann titer units (BTU). Patient 2 was an 84-year-old woman with demyelinating neuropathy, paresthesias and gait instability. She had CLL and IgM kappa paraprotein with anti-MAG antibodies >70 000 BTU. Both patients were treated with obinutuzumab intravenously at 100 mg on day +1, 900 mg +2, then at 1000 mg on days 8 and 15 of cycle 1 and day 1 of cycles 2-6; chlorambucil was given orally at 0.5 mg/kg on days 1 and 15 of cycles 1-6. RESULTS Patient 1 at cycle 6 was able to stand, gait was possible with monolateral support, hypoesthesia and strength improved. M-protein and IgM level decreased. In patient 2, already after three cycles, the monoclonal component disappeared and there was dramatic improvement of symptoms and gait normalization. At the end of therapy anti-MAG antibody titer decreased to 5462 BTU. Neurophysiology also improved. CONCLUSIONS In our patients, obinutuzumab was effective as a first-line treatment of anti-MAG antibody polyneuropathy. CLL might have had a role in the response to therapy, but the associations might be considered in future trials.
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Affiliation(s)
- C Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - A Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - A Salvalaggio
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | | | - L Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padova, Italy
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8
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Salvalaggio A, Cagnin A, Nardetto L, Manara R, Briani C. Acute amnestic syndrome in isolated bilateral fornix stroke. Eur J Neurol 2018; 25:787-789. [PMID: 29427459 DOI: 10.1111/ene.13592] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 10/16/2017] [Accepted: 01/08/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Acute onset of amnestic syndrome may represent a challenging diagnostic issue. In addition to non-vascular etiology, thalamic strokes or infarction involving several temporal lobe structures have been reported. METHODS We describe three patients in whom an isolated bilateral anterior fornix infarction presented with an acute amnestic syndrome. Clinical presentation, differential diagnosis and magnetic resonance images are discussed for each patient and vascular anatomy of the involved brain regions is also considered. RESULTS Bilateral anterior columns of the fornix showed cytotoxic edema and bilateral narrowing of anterior cerebral artery was demonstrated. CONCLUSIONS We suggest that bilateral fornix infarction should always be considered in the diagnostic work-up of an amnestic syndrome with acute onset.
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Affiliation(s)
- A Salvalaggio
- Department of Neurosciences (DNS), University of Padova, Padova
| | - A Cagnin
- Department of Neurosciences (DNS), University of Padova, Padova.,IRCCS San Camillo Hospital, Venice
| | | | - R Manara
- Neuroradiology. Sezione di Neuroscienze, University of Salerno, Salerno, Italy
| | - C Briani
- Department of Neurosciences (DNS), University of Padova, Padova
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Boso F, Ruggero S, Giannotta C, Benedetti L, Marfia GA, Ermani M, Campagnolo M, Salvalaggio A, Gallia F, De Michelis C, Visentin A, Bianco M, Ruiz M, Mataluni G, Nobile-Orazio E, Briani C. Anti-sulfatide/galactocerebroside antibodies in immunoglobulin M paraproteinemic neuropathies. Eur J Neurol 2017; 24:1334-1340. [PMID: 28782863 DOI: 10.1111/ene.13387] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/27/2017] [Indexed: 12/13/2022]
Affiliation(s)
- F. Boso
- Department of Neurosciences; University of Padova; Padova Italy
| | - S. Ruggero
- Department of Neurosciences; University of Padova; Padova Italy
| | - C. Giannotta
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - L. Benedetti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova and IRCCS AOU San Martino-IST; Genoa Italy
| | - G. A. Marfia
- Neurology COU; Department of Systems Medicine; University of Tor Vergata; Rome Italy
| | - M. Ermani
- Department of Neurosciences; University of Padova; Padova Italy
| | - M. Campagnolo
- Department of Neurosciences; University of Padova; Padova Italy
| | - A. Salvalaggio
- Department of Neurosciences; University of Padova; Padova Italy
| | - F. Gallia
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - C. De Michelis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova and IRCCS AOU San Martino-IST; Genoa Italy
| | - A. Visentin
- Hematology and Clinical Immunology Unit; Department of Medicine; University of Padova; Italy
| | - M. Bianco
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - M. Ruiz
- Department of Neurosciences; University of Padova; Padova Italy
| | - G. Mataluni
- Neurology COU; Department of Systems Medicine; University of Tor Vergata; Rome Italy
| | - E. Nobile-Orazio
- Second Neurology; Humanitas Clinical and Research Centre; Department of Medical Biotechnology and Translational Medicine; Milan University; Rozzano Milan Italy
| | - C. Briani
- Department of Neurosciences; University of Padova; Padova Italy
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Nardetto L, Briani C, Fedrigo M, Castellani C, Valente M, Polverino De Laureto P, Santelli L, Angelini A, Giometto B. Isaacs’ syndrome with overlapping myopathy as the first manifestation of AL amyloidosis. J Neurol 2016; 263:2332-2335. [DOI: 10.1007/s00415-016-8264-3] [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] [Received: 06/06/2016] [Revised: 08/07/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023]
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Padua L, Pazzaglia C, Coraci D, Lucchetta M, Paolasso I, Granata G, Cacciavillani M, Luigetti M, Manganelli F, Pareyson D, Briani C. ID 270 – Nerve ultrasound findings in cmt neuropathy. Clin Neurophysiol 2016. [DOI: 10.1016/j.clinph.2015.11.443] [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: 10/22/2022]
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Aprile I, Briani C, Pazzaglia C, Cecchi F, Negrini S, Padua L. Pain in stroke patients: characteristics and impact on the rehabilitation treatment. A multicenter cross-sectional study. Eur J Phys Rehabil Med 2015; 51:725-736. [PMID: 25739508] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Post-stroke pain (PSP) is a common and disabling complication, difficult to treat, that often decreases patients' quality of life (QoL). The hypothesis is that PSP may negatively affect rehabilitation treatment. AIM The aim of this paper was to quantify and characterize pain in a sample of post-stroke patients undergoing rehabilitation and to investigate the impact of pain in slowing down or discontinuing the rehabilitation program. DESIGN Multicenter cross-sectional study. SETTING Inpatients and outpatients of rehabilitation department. POPULATION One hundred and six subacute and chronic stroke patients. METHODS Pain intensity was measured with the NRS or the PAINAD (if cognitive/language impairment was present); pain characteristics were assessed with the DN4, and NPSI questionnaire. Qol was measured with the SF-36. A clinical assessment and a semi-structured questionnaire on pain occurrence, impact, and management was administered by the physiotherapist in charge of the patients and by the physician. RESULTS Nearly 1/3 of the patients (32.9%) with normal cognitive functions and language reported pain occurrence after stroke; 81.8% of them had NRS≥3 and 31.8% DN4≥4 (meaning neuropathic origin of pain). In about 20% of the patients the PAINAD was used to measure pain; 17.4% of them presented a score ≥3. In 24.5% of our sample, pain influenced rehabilitation treatment. In 16% of the whole sample, pain influenced patients' attention during rehabilitation session. Patients with hypoesthesia presented significantly higher neuropathic pain scores than patients with normal sensory function. Regarding QoL, we found that patients with higher neuropathic pain showed more severe deterioration of mental aspects of QoL, where patients with higher nociceptive pain presented more severe deterioration of physical aspects of QoL. CONCLUSION The results from this multicenter study showed that in about ¼ of the patients, pain negatively influenced the rehabilitation program delaying the recovery and likely increasing the cost of rehabilitation. CLINICAL REHABILITATION IMPACT Clinicians should pay more attention to pain, especially neuropathic pain, in post-stroke patients. Tailored pharmacological therapy, to treat and prevent pain, might improve patients' compliance during the rehabilitation process.
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Affiliation(s)
- I Aprile
- Rehabilitation Department, Don Carlo Gnocchi Onlus Foundation, Milan, Italy -
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Paolasso I, Hobson-Webb L, Briani C, Tsukamoto H, Coraci D, Erra C, Granata G, Padua L. 63. Multicenter protocol on the role of ultrasound in immune-mediated neuropathies. Clin Neurophysiol 2015. [DOI: 10.1016/j.clinph.2014.10.082] [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: 11/29/2022]
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14
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Manara R, Citton V, Maffei P, Marshall JD, Naggert JK, Milan G, Vettor R, Baglione A, Vitale A, Briani C, Di Salle F, Favaro A. Degeneration and plasticity of the optic pathway in Alström syndrome. AJNR Am J Neuroradiol 2015; 36:160-5. [PMID: 25355816 PMCID: PMC7965932 DOI: 10.3174/ajnr.a4115] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/04/2014] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Alström syndrome is a rare inherited ciliopathy in which early progressive cone-rod dystrophy leads to childhood blindness. We investigated functional and structural changes of the optic pathway in Alström syndrome by using MR imaging to provide insight into the underlying pathogenic mechanisms. MATERIALS AND METHODS Eleven patients with genetically proved Alström syndrome (mean age, 23 years; range, 6-45 years; 5 females) and 19 age- and sex-matched controls underwent brain MR imaging. The study protocol included conventional sequences, resting-state functional MR imaging, and diffusion tensor imaging. RESULTS In patients with Alström syndrome, the evaluation of the occipital regions showed the following: 1) diffuse white matter volume decrease while gray matter volume decrease spared the occipital poles (voxel-based morphometry), 2) diffuse fractional anisotropy decrease and radial diffusivity increase while mean and axial diffusivities were normal (tract-based spatial statistics), and 3) reduced connectivity in the medial visual network strikingly sparing the occipital poles (independent component analysis). After we placed seeds in both occipital poles, the seed-based analysis revealed significantly increased connectivity in patients with Alström syndrome toward the left frontal operculum, inferior and middle frontal gyri, and the medial portion of both thalami (left seed) and toward the anterior portion of the left insula (right and left seeds). CONCLUSIONS The protean occipital brain changes in patients with Alström syndrome likely reflect the coexistence of diffuse primary myelin derangement, anterograde trans-synaptic degeneration, and complex cortical reorganization affecting the anterior and posterior visual cortex to different degrees.
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Affiliation(s)
- R Manara
- From the Department of Medicine and Surgery (R.M., A.V., F.D.S.), Neuroradiology, University of Salerno, Salerno, Italy
| | - V Citton
- Department of Radiology (V.C.), Neuroradiology Unit, IRCCS San Camillo Hospital, Venezia, Italy
| | - P Maffei
- Department of Internal Medicine (P.M., G.M., R.V.), University Hospital of Padova, Padova, Italy
| | - J D Marshall
- Jackson Laboratory (J.D.M., J.K.N.), Bar Harbor, Maine
| | - J K Naggert
- Jackson Laboratory (J.D.M., J.K.N.), Bar Harbor, Maine
| | - G Milan
- Department of Internal Medicine (P.M., G.M., R.V.), University Hospital of Padova, Padova, Italy
| | - R Vettor
- Department of Internal Medicine (P.M., G.M., R.V.), University Hospital of Padova, Padova, Italy
| | - A Baglione
- Department of Neurosciences (A.B., C.B., A.F.), University of Padua, Padova, Italy
| | - A Vitale
- From the Department of Medicine and Surgery (R.M., A.V., F.D.S.), Neuroradiology, University of Salerno, Salerno, Italy
| | - C Briani
- Department of Neurosciences (A.B., C.B., A.F.), University of Padua, Padova, Italy
| | - F Di Salle
- From the Department of Medicine and Surgery (R.M., A.V., F.D.S.), Neuroradiology, University of Salerno, Salerno, Italy
| | - A Favaro
- Department of Neurosciences (A.B., C.B., A.F.), University of Padua, Padova, Italy
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Da Silva Domingues V, Iaccarino L, Briani C, Caso F, Vasconcelos C, Doria A. Scleromyxedema complicated by dermato-neuro syndrome during pregnancy. Clin Exp Rheumatol 2014; 32:S-234-5. [PMID: 25372807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 10/09/2014] [Indexed: 06/04/2023]
Affiliation(s)
- V Da Silva Domingues
- Division of Rheumatology, Department of Medicine-DIMED, University of Padova, Italy.
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Iannicelli E, Sessa B, Sapori A, Cappucci M, Briani C, Federici GF, Di Pietropaolo M, Merola S. [Scrotal ultrasound: anatomy and pathological findings]. Clin Ter 2014; 164:e63-75. [PMID: 23455755 DOI: 10.7417/ct.2013.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ultrasonography (US) is the imaging modality of choice for the evaluation of scrotal disease. It provides high anatomical detail and in most cases, it is essential to enable a correct diagnosis and to obtain the right management of the patient. Color Doppler ultrasonography is a non invasive technique that aids important information about testicular perfusion, necessary in reaching a specific diagnosis in many pathologic conditions; moreover contrast-enhanced ultrasonography (CEUS), recently introduced in the clinical practice, may be considered an additional tool in the classification and differentiation of testicular pathology. The purpose of this review, is to provide the state of the art on the role of ultrasonography in the evaluation of different scrotal pathologies including vaginal process' disorders, acute scrotum, varicocele, hydrocele, chronic inflammatory diseases and testicular tumours.
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Affiliation(s)
- E Iannicelli
- Dipartimento di Scienze Medico-Chirurgiche e di Medicina Traslazionale, Facoltà di Medicina e Psicologia. Università Sapienza di Roma, Italia.
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Manara R, Salvalaggio A, Citton V, Palumbo V, D'Errico A, Elefante A, Briani C, Cantone E, Ottaviano G, Pellecchia MT, Greggio NA, Weis L, D'Agosto G, Rossato M, De Carlo E, Napoli E, Coppola G, Di Salle F, Brunetti A, Bonanni G, Sinisi AA, Favaro A. Brain anatomical substrates of mirror movements in Kallmann syndrome. Neuroimage 2014; 104:52-8. [PMID: 25300200 DOI: 10.1016/j.neuroimage.2014.09.067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [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: 04/13/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 10/24/2022] Open
Abstract
Among male patients affected by Kallmann syndrome, a genetically determined disease due to defective neural migration leading to hypogonadropic hypogonadism and hypo/anosmia, about 40% present the peculiar phenomenon of mirror movements, i.e. involuntary movements mirroring contralateral voluntary hand movements. Several pathogenic hypotheses have been proposed, but the ultimate neurological mechanisms are still elusive. The aim of the present study was to investigate brain anatomical substrates of mirror movements in Kallmann syndrome by means of a panel of quantitative MRI analyses. Forty-nine male Kallmann syndrome patients underwent brain MRI. The study protocol included 3D-T1-weighted gradient echo, fluid attenuated inversion recovery and diffusion tensor imaging. Voxel-based morphometry, sulcation, curvature and cortical thickness analyses and tract based spatial statistics were performed using SPM8, Freesurfer and FSL. All patients underwent a complete physical and neurological examination including the evaluation of mirror movements (according to the Woods and Teuber criteria). Kallmann syndrome patients presenting with mirror movements (16/49, 32%) displayed the following brain changes: 1) increased gray matter density in the depth of the left precentral sulcus behind the middle frontal gyrus; 2) decreased cortical thickness in the precentral gyrus bilaterally, in the depth of right precentral sulcus and in the posterior portion of the right superior frontal gyrus; and 3) decreased fractional anisotropy in the left hemisphere involving the temporal lobe and peritrigonal white matter. No differences were shown by cortical curvature and sulcation analyses. The composite array of brain changes observed in Kallmann syndrome patients with mirror movements likely represents the anatomical-structural underpinnings leading to the peculiar derangement of the complex circuitry committed to unilateral hand voluntary movements.
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Affiliation(s)
- R Manara
- Neuroradiology, Dept. of Medicine and Surgery, University of Salerno, Italy.
| | - A Salvalaggio
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - V Citton
- IRCCS S. Camillo, Venezia, Italy.
| | - V Palumbo
- Dept. of Clinical and Experimental Medicine and Surgery, Endocrinology and Medical Andrology Section, Second University of Napoli, Italy.
| | - A D'Errico
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - A Elefante
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - C Briani
- Neurology, Dept. of Neurosciences, University of Padova, Italy.
| | - E Cantone
- Ent. Section, Dept. of Neurosciences, "Federico II" University, Napoli, Italy; Dept. of Molecular and Cellular Biology and Pathology, "Federico II" University, Napoli, Italy.
| | - G Ottaviano
- Otolaryngology Section, Dept. of Neurosciences, University of Padova, Italy.
| | - M T Pellecchia
- Neurology, Dept. of Medicine and Surgery, University of Salerno, Italy.
| | - N A Greggio
- UOS di Endocrinolgia Pediatrica e Adolescentologia, D.A.I.S. per la Salute della Donna e del Bambino, Azienda Ospedaliera - University of Padova, Italy.
| | - L Weis
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - G D'Agosto
- Medicanova, Diagnostic Center, Battipaglia (SA), Italy.
| | - M Rossato
- Clinica Medica III, Dept. of Medicine (DIMED), University of Padova, Italy.
| | - E De Carlo
- Clinica Medica III, Dept. of Medicine (DIMED), University of Padova, Italy.
| | - E Napoli
- Medicanova, Diagnostic Center, Battipaglia (SA), Italy.
| | - G Coppola
- Child and Adolescent Neuropsychiatry, University of Salerno, Italy.
| | - F Di Salle
- Neuroradiology, Dept. of Medicine and Surgery, University of Salerno, Italy.
| | - A Brunetti
- Neuroradiology, Dept. of Scienze Biomediche Avanzate, Federico II University, Napoli, Italy.
| | - G Bonanni
- Unità di Endocrinologia, Dept. of Medicine (DIMED), University of Padova, Italy.
| | - A A Sinisi
- Dept. of Clinical and Experimental Medicine and Surgery, Endocrinology and Medical Andrology Section, Second University of Napoli, Italy.
| | - A Favaro
- Psychiatry, Dept. of Neurosciences, University of Padova, Italy.
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Lucchetta M, Padua L, Granata G, Luigetti M, Campagnolo M, Dalla Torre C, Coraci D, Sabatelli M, Briani C. Nerve ultrasound findings in neuropathy associated with anti-myelin-associated glycoprotein antibodies. Eur J Neurol 2014; 22:193-202. [PMID: 25174585 DOI: 10.1111/ene.12554] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 03/28/2014] [Accepted: 07/16/2014] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE No systematic nerve ultrasound (US) studies on patients with neuropathy and anti-myelin-associated glycoprotein (anti-MAG) antibodies are available. PATIENTS AND METHODS Twenty-eight patients (18 men, 10 women, mean age 69.2 ± 10.9 years; mean disease duration 6.9 years) with anti-MAG neuropathy underwent nerve US. Echotexture, nerve cross-sectional area (CSA) and intra-nerve and inter-nerve CSA variability were assessed. The frequency (number of nerves with enlarged CSA, 'enlarged nerves sum score') and distribution (proximal versus distal, arms versus legs, symmetry) of US abnormalities were considered. Controls included two groups: four patients with immunoglobulin M (IgM) paraproteinaemic neuropathy without anti-MAG antibodies and five with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) associated with IgM paraprotein. RESULTS In all, 26/28 patients had increased CSA (23 with at least one nerve outside entrapment sites). Intra-nerve CSA variability was abnormal in 21/28 patients (in 14 for increased nerve CSA outside entrapment sites). Inter-nerve CSA variability was abnormal in 16 patients (of whom half for CSA increase out of entrapment sites). The enlarged nerves sum score in anti-MAG neuropathy patients was greater than in MAG-negative paraproteinaemic neuropathies and lower than in CIDP. Intra-nerve variability appeared instead similar in anti-MAG and controls. No correlation was found between US findings and Inflammatory Neuropathy Cause and Treatment Group (INCAT) disability score or disease duration. DISCUSSION Amongst the different measures to assess the US pattern (symmetry/asymmetry, proximal/distal distribution and sum score), the enlarged nerves sum score was the most useful for differentiating the three groups of patients with demyelinating neuropathies and may contribute to diagnosis in a typical cases.
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Affiliation(s)
- M Lucchetta
- Department of Neurosciences, SNPSRR, University of Padova, Padova, Italy
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Padua L, Paolasso I, Pazzaglia C, Granata G, Lucchetta M, Erra C, Coraci D, De Franco P, Briani C. High ultrasound variability in chronic immune-mediated neuropathies. Review of the literature and personal observations. Rev Neurol (Paris) 2013; 169:984-90. [DOI: 10.1016/j.neurol.2013.07.028] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 12/12/2022]
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Alberti P, Rossi E, Cornblath DR, Merkies ISJ, Postma TJ, Frigeni B, Bruna J, Velasco R, Argyriou AA, Kalofonos HP, Psimaras D, Ricard D, Pace A, Galiè E, Briani C, Dalla Torre C, Faber CG, Lalisang RI, Boogerd W, Brandsma D, Koeppen S, Hense J, Storey D, Kerrigan S, Schenone A, Fabbri S, Valsecchi MG, Cavaletti G. Physician-assessed and patient-reported outcome measures in chemotherapy-induced sensory peripheral neurotoxicity: two sides of the same coin. Ann Oncol 2013; 25:257-64. [PMID: 24256846 DOI: 10.1093/annonc/mdt409] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The different perception and assessment of chemotherapy-induced peripheral neurotoxicity (CIPN) between healthcare providers and patients has not yet been fully addressed, although these two approaches might eventually lead to inconsistent, possibly conflicting interpretation, especially regarding sensory impairment. PATIENTS AND METHODS A cohort of 281 subjects with stable CIPN was evaluated with the National Cancer Institute-Common Toxicity Criteria (NCI-CTC v. 2.0) sensory scale, the clinical Total Neuropathy Score (TNSc©), the modified Inflammatory Neuropathy Cause and Treatment (INCAT) sensory sumscore (mISS) and the European Organization for Research and Treatment of Cancer CIPN specific self-report questionnaire (EORTC QOL-CIPN20). RESULTS Patients' probability estimates showed that the EORTC QLQ-CIPN20 sensory score was overall more highly related to the NCI-CTC sensory score. However, the vibration perception item of the TNSc had a higher probability to be scored 0 for EORTC QLQ-CIPN20 scores lower than 35, as vibration score 2 for EORTC QLQ-CIPN20 scores between 35 and 50 and as grade 3 or 4 for EORTC QLQ-CIPN20 scores higher than 50. The linear models showed a significant trend between each mISS item and increasing EORTC QLQ-CIPN20 sensory scores. CONCLUSION None of the clinical items had a perfect relationship with patients' perception, and most of the discrepancies stood in the intermediate levels of CIPN severity. Our data indicate that to achieve a comprehensive knowledge of CIPN including a reliable assessment of both the severity and the quality of CIPN-related sensory impairment, clinical and PRO measures should be always combined.
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Affiliation(s)
- P Alberti
- Department of Surgery and Translational Medicine
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Paolasso I, Briani C, Tsukamoto H, Coraci D, Erra C, Franco PD, Granata G, Padua L. 150. Proposal for a multicenter protocol on the role of ultrasound in immune-mediated neuropathies. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.177] [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: 11/16/2022]
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Erra C, Lauria A, Granata G, Coraci D, Briani C, Padua L. 154. Evolution of ultrasound abnormalities in multifocal motor neuropathy: Series of five cases. Clin Neurophysiol 2013. [DOI: 10.1016/j.clinph.2013.06.181] [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: 11/28/2022]
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Padua L, Granata G, Sabatelli M, Inghilleri M, Lucchetta M, Luigetti M, Coraci D, Martinoli C, Briani C. Heterogeneity of root and nerve ultrasound pattern in CIDP patients. Clin Neurophysiol 2013; 125:160-5. [PMID: 24099922 DOI: 10.1016/j.clinph.2013.07.023] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [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: 04/02/2013] [Revised: 06/25/2013] [Accepted: 07/20/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The few published ultrasound (US) studies on chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) report diffusely increased cross-sectional area (CSA) of nerves. The data are, however, heterogeneous and correlations with clinical history or disease severity are lacking. METHODS Thirty-four patients with CIDP underwent US nerve evaluation by two neurologists blinded to clinical data. US nerve pattern for each patient was defined by a third neurologist blinded to clinical data. Three US classes were identified based on CSA and echogenicity: large nerves with hypoechoic nerves/fascicles (class 1); large nerves with heterogeneous hypo- and hyperechoic fascicles (class 2); normal size nerve but abnormal hyperechoic array (class 3). RESULTS In all patients, US nerve changes were observed: in most of the cases, enlarged nerves or nerve segments were observed. The three 'classes' of US nerve changes significantly correlated (R: 0.68, p<0.001) with disease duration, but not with age or Inflammatory Neuropathy Cause and Treatment (INCAT) disability score. CONCLUSIONS US may be of adjunctive diagnostic value in CIDP assessment. Nerve morphological changes may mirror the underlying pathophysiological mechanisms and seem to correlate with disease duration. SIGNIFICANCE These results offer the possibility of exploring the use of US to assess CIDP disease activity and treatment.
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Affiliation(s)
- L Padua
- Institute of Neurology, Catholic University, Rome, Italy; Don Carlo Gnocchi Onlus Foundation, Rome, Italy.
| | - G Granata
- Institute of Neurology, Catholic University, Rome, Italy
| | - M Sabatelli
- Institute of Neurology, Catholic University, Rome, Italy
| | - M Inghilleri
- Institute of Neurology, "Sapienza" University of Rome, Rome, Italy
| | - M Lucchetta
- Department of Neurosciences, University of Padua, Padua, Italy
| | - M Luigetti
- Institute of Neurology, Catholic University, Rome, Italy
| | - D Coraci
- Don Carlo Gnocchi Onlus Foundation, Rome, Italy
| | - C Martinoli
- Radiology Institute, "R" - DICMI, University of Genoa, Genoa, Italy
| | - C Briani
- Department of Neurosciences, University of Padua, Padua, Italy
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Binda D, Vanhoutte E, Cavaletti G, Cornblath D, Postma T, Frigeni B, Alberti P, Bruna J, Velasco R, Argyriou A, Kalofonos H, Psimaras D, Ricard D, Pace A, Galiè E, Briani C, Dalla Torre C, Lalisang R, Boogerd W, Brandsma D, Koeppen S, Hense J, Storey D, Kerrigan S, Schenone A, Fabbri S, Rossi E, Valsecchi M, Faber C, Merkies I, Galimberti S, Lanzani F, Mattavelli L, Piatti M, Bidoli P, Cazzaniga M, Cortinovis D, Lucchetta M, Campagnolo M, Bakkers M, Brouwer B, Boogerd W, Grant R, Reni L, Piras B, Pessino A, Padua L, Granata G, Leandri M, Ghignotti I, Plasmati R, Pastorelli F, Heimans J, Eurelings M, Meijer R, Grisold W, Lindeck Pozza E, Mazzeo A, Toscano A, Russo M, Tomasello C, Altavilla G, Penas Prado M, Dominguez Gonzalez C, Dorsey S. Rasch-built Overall Disability Scale for patients with chemotherapy-induced peripheral neuropathy (CIPN-R-ODS). Eur J Cancer 2013; 49:2910-8. [DOI: 10.1016/j.ejca.2013.04.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 10/26/2022]
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Padua L, Di Pasquale A, Liotta G, Granata G, Pazzaglia C, Erra C, Briani C, Coraci D, De Franco P, Antonini G, Martinoli C. Ultrasound as a useful tool in the diagnosis and management of traumatic nerve lesions. Clin Neurophysiol 2013; 124:1237-43. [DOI: 10.1016/j.clinph.2012.10.024] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 10/02/2012] [Accepted: 10/29/2012] [Indexed: 11/25/2022]
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Pazzaglia C, Briani C, Padua L. Comment on Lekpa et al., 'socio-demographic and clinical profile of chronic pain with neuropathic characteristics in sub-Saharan African elderly'. Eur J Pain 2013; 17:944-5. [PMID: 23658073 DOI: 10.1002/j.1532-2149.2013.00295.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Cavaletti G, Cornblath DR, Merkies ISJ, Postma TJ, Rossi E, Frigeni B, Alberti P, Bruna J, Velasco R, Argyriou AA, Kalofonos HP, Psimaras D, Ricard D, Pace A, Galiè E, Briani C, Dalla Torre C, Faber CG, Lalisang RI, Boogerd W, Brandsma D, Koeppen S, Hense J, Storey D, Kerrigan S, Schenone A, Fabbri S, Valsecchi MG, Mazzeo A, Pace A, Pessino A, Schenone A, Toscano A, Argyriou AA, Brouwer B, Frigeni B, Piras B, Briani C, Dalla Torre C, Dominguez Gonzalez C, Faber CG, Tomasello C, Binda D, Brandsma D, Cortinovis D, Psimaras D, Ricard D, Storey D, Cornblath DR, Galiè E, Lindeck Pozza E, Rossi E, Vanhoutte EK, Lanzani F, Pastorelli F, Altavilla G, Cavaletti G, Granata G, Kalofonos HP, Ghignotti I, Merkies ISJ, Bruna J, Hense J, Heimans JJ, Mattavelli L, Padua L, Reni L, Bakkers M, Boogerd M, Campagnolo M, Cazzaniga M, Eurelings M, Leandri M, Lucchetta M, Penas Prado M, Russo M, Valsecchi MG, Piatti ML, Alberti P, Bidoli P, Grant R, Plasmati R, Velasco R, Lalisang RI, Meijer RJ, Fabbri S, Dorsey SG, Galimberti S, Kerrigan S, Koeppen S, Postma TJ, Boogerd W, Grisold W. The chemotherapy-induced peripheral neuropathy outcome measures standardization study: from consensus to the first validity and reliability findings. Ann Oncol 2013; 24:454-462. [PMID: 22910842 PMCID: PMC3551481 DOI: 10.1093/annonc/mds329] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [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: 03/15/2012] [Revised: 06/05/2012] [Accepted: 07/09/2012] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a debilitating and dose-limiting complication of cancer treatment. Thus far, the impact of CIPN has not been studied in a systematic clinimetric manner. The objective of the study was to select outcome measures for CIPN evaluation and to establish their validity and reproducibility in a cross-sectional multicenter study. PATIENTS AND METHODS After literature review and a consensus meeting among experts, face/content validity were obtained for the following selected scales: the National Cancer Institute-Common Toxicity Criteria (NCI-CTC), the Total Neuropathy Score clinical version (TNSc), the modified Inflammatory Neuropathy Cause and Treatment (INCAT) group sensory sumscore (mISS), the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30, and CIPN20 quality-of-life measures. A total of 281 patients with stable CIPN were examined. Validity (correlation) and reliability studies were carried out. RESULTS Good inter-/intra-observer scores were obtained for the TNSc, mISS, and NCI-CTC sensory/motor subscales. Test-retest values were also good for the EORTC QLQ-C30 and CIPN20. Acceptable validity scores were obtained through the correlation among the measures. CONCLUSION Good validity and reliability scores were demonstrated for the set of selected impairment and quality-of-life outcome measures in CIPN. Future studies are planned to investigate the responsiveness aspects of these measures.
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Affiliation(s)
- G Cavaletti
- Department of Neuroscience and Biomedical Technologies, University of Milano-Bicocca, Monza, Italy.
| | - D R Cornblath
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - I S J Merkies
- Department of Neurology, Spaarne Hospital, Hoofddorp/Maastricht, University Medical Center, Maastricht
| | - T J Postma
- Department of Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - E Rossi
- Center of Biostatistics for Clinical Epidemiology, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy
| | - B Frigeni
- Department of Neuroscience and Biomedical Technologies, University of Milano-Bicocca, Monza, Italy
| | - P Alberti
- Department of Neuroscience and Biomedical Technologies, University of Milano-Bicocca, Monza, Italy
| | - J Bruna
- Unit of Neuro-Oncology, Department of Neurology, University Hospital of Bellvitge, L'Hospitalet, Spain
| | - R Velasco
- Unit of Neuro-Oncology, Department of Neurology, University Hospital of Bellvitge, L'Hospitalet, Spain
| | - A A Argyriou
- Division of Clinical Oncology, Department of Medicine, University Hospital of Patras, Patras, Greece
| | - H P Kalofonos
- Division of Clinical Oncology, Department of Medicine, University Hospital of Patras, Patras, Greece
| | - D Psimaras
- Service de Neurologie Mazarin, Hôpital de la Pitié-Salpêtrière, AP-HP, Paris
| | - D Ricard
- Service de Neurologie, Hôpital du Val-de-Grâce, Service de Santé des Armées, Paris, France
| | - A Pace
- Neurology Unit, National Cancer Institute Regina Elena, Rome
| | - E Galiè
- Neurology Unit, National Cancer Institute Regina Elena, Rome
| | - C Briani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - C Dalla Torre
- Department of Neurosciences, University of Padova, Padova, Italy
| | - C G Faber
- Department of Neurology, Spaarne Hospital, Hoofddorp/Maastricht, University Medical Center, Maastricht
| | - R I Lalisang
- Division of Medical Oncology, Department of Internal Medicine, GROW-School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht
| | - W Boogerd
- Department of Neuro-oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - D Brandsma
- Department of Neuro-oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - S Koeppen
- Department of Neurology and West German Cancer Center, University of Essen, Essen, Germany
| | - J Hense
- Department of Neurology and West German Cancer Center, University of Essen, Essen, Germany
| | - D Storey
- Edinburgh Centre for Neuro-Oncology and Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - S Kerrigan
- Edinburgh Centre for Neuro-Oncology and Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - A Schenone
- Department of Neurosciences, Ophthalmology and Genetic, Center of Excellence for Biomedical Research, University of Genova, Genova, Italy
| | - S Fabbri
- Department of Neurosciences, Ophthalmology and Genetic, Center of Excellence for Biomedical Research, University of Genova, Genova, Italy
| | - M G Valsecchi
- Center of Biostatistics for Clinical Epidemiology, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Monza, Italy
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Imbergamo S, Campagnolo M, Manara R, Marino F, Adami F, Briani C. Teaching NeuroImages: Multifocal neurologic involvement as the only manifestation of IgG4-related disease. Neurology 2013; 80:e40-1. [DOI: 10.1212/wnl.0b013e31827f08ae] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Argyriou AA, Briani C, Cavaletti G, Bruna J, Alberti P, Velasco R, Lonardi S, Cortinovis D, Cazzaniga M, Campagnolo M, Santos C, Kalofonos HP. Advanced age and liability to oxaliplatin-induced peripheral neuropathy:post hocanalysis of a prospective study. Eur J Neurol 2012; 20:788-94. [DOI: 10.1111/ene.12061] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/01/2012] [Indexed: 11/27/2022]
Affiliation(s)
| | - C. Briani
- Department of Neurosciences; University of Padova; Padova; Italy
| | - G. Cavaletti
- Department of Neuroscience and Biomedical Technology; University of Milan-Bicocca; Monza; Italy
| | - J. Bruna
- Unit of Neuro-Oncology; University Hospital of Bellvitge-ICO Duran i Reynals; Barcelona; Spain
| | - P. Alberti
- Department of Neuroscience and Biomedical Technology; University of Milan-Bicocca; Monza; Italy
| | - R. Velasco
- Unit of Neuro-Oncology; University Hospital of Bellvitge-ICO Duran i Reynals; Barcelona; Spain
| | - S. Lonardi
- Oncology Unit 1; Veneto Oncology Institute - IRCCS; Padova; Italy
| | | | | | - M. Campagnolo
- Department of Neurosciences; University of Padova; Padova; Italy
| | - C. Santos
- Unit of Colorectal Cancer; University Hospital of Bellvitge-ICO Duran i Reynals; Barcelona; Spain
| | - H. P. Kalofonos
- Department of Medicine-Division of Clinical Oncology; University Hospital of Patras; Rion-Patras; Greece
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Argyriou AA, Velasco R, Briani C, Cavaletti G, Bruna J, Alberti P, Cacciavillani M, Lonardi S, Santos C, Cortinovis D, Cazzaniga M, Kalofonos HP. Peripheral neurotoxicity of oxaliplatin in combination with 5-fluorouracil (FOLFOX) or capecitabine (XELOX): a prospective evaluation of 150 colorectal cancer patients. Ann Oncol 2012; 23:3116-3122. [PMID: 22865779 DOI: 10.1093/annonc/mds208] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [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: 01/03/2023] Open
Abstract
BACKGROUND To report our prospective experience on the incidence and pattern of oxaliplatin (OXA)-induced peripheral neuropathy (OXA-IPN) in patients with colorectal cancer (CRC) treated with either FOLFOX-4 or XELoda + OXaliplatin (XELOX). PATIENTS AND METHODS One hundred and fifty patients scheduled to be treated with either FOLFOX or XELOX for CRC were prospectively monitored at baseline and followed-up during chemotherapy. The incidence and severity of symptoms secondary to OXA-IPN were recorded using three different types of assessment, i.e. the motor and neurosensory National Cancer Institute common toxicity criteria, version 3.0 (NCI-CTCv3), the clinical version of the total neuropathy score (TNSc) and electrophysiological scores. RESULTS Patients treated with either FOLFOX-4 or XELOX manifested similar incidence rates and severities of acute OXA-IPN. However, FOLFOX-4 was associated with increased incidence of chronic neurotoxicity, compared with XELOX-treated patients (n = 64/77 versus 44/73; P = 0.002), at a very similar OXA median cumulative dose during both regimens. Both the NCI-CTCv3 and TNSc demonstrated that the severity of cumulative OXA-IPN in FOLFOX-4-treated patients is higher than in those treated with XELOX. CONCLUSION The incidence of acute neurotoxicity during FOLFOX-4 therapy is similar to XELOX. However, it seems that FOLFOX-4 is more neurotoxic than XELOX in terms of cumulative OXA-IPN, despite comparable OXA cumulative dose.
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Affiliation(s)
- A A Argyriou
- Department of Neurology, 'Saint Andrew's" State General Hospital of Patras, Patras; Department of Medicine-Division of Clinical Oncology, University Hospital of Patras, Rion-Patras, Greece
| | - R Velasco
- Department of Neurology-Unit of Neuro-Oncology, University Hospital of Bellvitge-ICO Duran i Reynals, Barcelona, Spain
| | - C Briani
- Department of Neurosciences, University of Padova, Padova
| | - G Cavaletti
- Department of Neuroscience and Biomedical Technology, University of Milan-Bicocca, Monza
| | - J Bruna
- Department of Neurology-Unit of Neuro-Oncology, University Hospital of Bellvitge-ICO Duran i Reynals, Barcelona, Spain
| | - P Alberti
- Department of Neuroscience and Biomedical Technology, University of Milan-Bicocca, Monza
| | | | - S Lonardi
- Oncology Unit 1, Veneto Oncology Institute - IRCCS, Padova, Italy
| | - C Santos
- Department of Oncology-Unit of Colorectal Cancer, University Hospital of Bellvitge-ICO Duran i Reynals, Barcelona, Spain
| | - D Cortinovis
- Department of Oncology, S. Gerardo Hospital, Monza, Italy
| | - M Cazzaniga
- Department of Oncology, S. Gerardo Hospital, Monza, Italy
| | - H P Kalofonos
- Department of Neurology-Unit of Neuro-Oncology, University Hospital of Bellvitge-ICO Duran i Reynals, Barcelona, Spain.
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Briani C, Campagnolo M, Lucchetta M, Cacciavillani M, Dalla Torre C, Granata G, Bergamo F, Lonardi S, Zagonel V, Cavaletti G, Ermani M, Padua L. Ultrasound assessment of oxaliplatin-induced neuropathy and correlations with neurophysiologic findings. Eur J Neurol 2012; 20:188-92. [PMID: 22943629 DOI: 10.1111/j.1468-1331.2012.03852.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 06/25/2012] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Chemotherapy-induced peripheral neuropathy is a major adverse effect of oxaliplatin (OXL) treatment. Whereas neurophysiologic study is commonly used to assess the occurrence and severity of polyneuropathies, ultrasound (US) analysis of the peripheral nerves, an emerging technique in the study of peripheral nerve diseases, has never been used in chemotherapy-induced peripheral neuropathy. PATIENTS AND METHODS Fifteen patients (four women; 11 men; mean age, 60.1 ± 10.6 years; median, 62; range, 37-75) with colorectal cancer treated with OXL-based treatment have been clinically and neurophysiologically evaluated before and after OXL therapy. At the end of chemotherapy, all patients underwent also nerve US study at four limbs, and the findings correlated with clinical and neurophysiologic measures. RESULTS Clinical and neurophysiological evaluation showed that 13 of 15 (86.7%) patients developed sensory axonal neuropathy, 10 of whom severe (two or more sensory nerve action potential amplitude absent and the other amplitudes decreased of ≥50%). Nerve US did not reveal decreased cross-sectional area (CSA), a reported finding in axonal neuropathies. Instead increased CSA at entrapment sites (median nerve at wrist and ulnar nerve at elbow) was found in 09/15 (60%) of patients. DISCUSSION Sensory axonal neuropathy is a very common complication of OXL therapy, affecting almost 90% of patients. US findings of enlargement of median and ulnar nerves, mostly at entrapment sites, in patients with no history or symptoms of neuropathies at recruitment, and no neurophysiologic evidence of entrapment, may be expression of increased, OXL-induced, nerve susceptibility to mechanical damage. An ongoing prospective study will help clarify these findings.
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Affiliation(s)
- C Briani
- Department of Neurosciences, University of Padova, Padova, Italy
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Briani C, Manara R, Lessi F, Zambello R, Adami F. Pachymeningeal Involvement in POEMS Syndrome: Dramatic Cerebral MRI Improvement after Lenalidomide Therapy (P04.163). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p04.163] [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: 11/15/2022] Open
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Cocito D, Grimaldi S, Paolasso I, Falcone Y, Antonini G, Benedetti L, Briani C, Fazio R, Jann S, Matà S, Sabatelli M, Nobile-Orazio E. Immunosuppressive treatment in refractory chronic inflammatory demyelinating polyradiculoneuropathy. A nationwide retrospective analysis. Eur J Neurol 2011; 18:1417-21. [PMID: 21819489 DOI: 10.1111/j.1468-1331.2011.03495.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE There are other options open to patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) who are non-responders to conventional treatment, including immunosuppressive and immunomodulatory agents (IA). The aim of this study was to assess whether the use of IA is able to increase the number of responders. METHODS Clinical and electrophysiological data of patients with refractory CIDP, followed at 10 Italian centres, were collected, and the clinical outcome (Rankin Scale) and drug side effects (SE) for the different therapies were analysed. RESULTS A total of 110 patients were included. These patients underwent 158 different therapeutic procedures with IA. Seventy-seven patients were treated with azathioprine, 18 rituximab, 13 cyclophosphamide, 12 mycophenolate mofetil, 12 cyclosporine, 12 methotrexate, 11 interferon-alpha and three interferon beta-1a. The percentage of patients who responded to azathioprine (27%) was comparable to the percentage of responders to other therapies, after the exclusion of interferon beta-1a that was not effective in any of the three patients treated. The percentage of SE ranges from 8% (methotrexate) to 50% (cyclosporine). CONCLUSIONS One-fourth of patients, refractory to conventional treatment, showed an improvement in their disability with IA. Methotrexate had the lowest SE; cyclosporine was associated with severe SE and often led to drug discontinuation.
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Affiliation(s)
- D Cocito
- Dipartimento di Neuroscienze, AOU San Giovanni Battista, Torino, Italy.
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Lucchetta M, Briani C, Pazzaglia C, Granata G, Padua L. W12.4 POEMS syndrome: inside neuropathy. The ultrasound picture. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60127-2] [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: 10/17/2022]
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Padua L, Martinoli C, Pazzaglia C, Lucchetta M, Granata G, Briani C. P18.7 Nerve ultrasound indexes in non homogeneous nerve involvement: modelling on immune related neuropathies. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60497-5] [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: 10/17/2022]
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Pazzaglia C, Padua L, Briani C, Jann S, Nobile-Orazio E, Morini A, Mondelli M, Ciaramitaro P, Cavaletti G, Cocito D, Fazio R, Santoro L, Galeotti F, Carpo M, Plasmati R, Benedetti L, Schenone A, Marchettini P, Cruccu G. P23.12 Characterization of neuropathic pain in elderly patients. Clin Neurophysiol 2011. [DOI: 10.1016/s1388-2457(11)60598-1] [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: 10/17/2022]
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Pazzaglia C, Briani C, Nobile-Orazio E, Orazio EN, Caliandro P, Granata G, Tonali PA, Padua L. Occurrence and characterization of Pain in immune-mediated neuropathies: a multicentre prospective study. Eur J Neurol 2011; 18:177-83. [PMID: 20561036 DOI: 10.1111/j.1468-1331.2010.03108.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND pain is a common symptom of peripheral neuropathies that may severely affect patients' Quality of Life. Pain questionnaires, based on verbal descriptors, are a useful way to investigate it. METHODS we performed a multicentre study through validated measures to characterize pain in a sample of consecutive patients affected by immune-mediated neuropathies. RESULTS ninety-three patients were enrolled in 16 Italian centres. Based on the numeric rating scale, almost half of the patients complained of moderate pain and one-third of the patients severe pain. Overall, up to 50% of our patients with immune-mediated neuropathies complained of neuropathic pain. The most common neuropathic symptoms were paraesthesia/dysesthesia and superficial spontaneous pain. Surprisingly, also patients with neuropathies commonly thought to be painless (such as multifocal motor neuropathy) reported discomfort and painful symptoms. CONCLUSIONS pain questionnaires should be considered in the clinical evaluation of immune-mediated neuropathies, also when evaluating therapy efficacy, because they may provide clinicians with useful information on painful symptoms and patients' quality of life.
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Affiliation(s)
- C Pazzaglia
- Department of Neurosciences, Institute of Neurology, Catholic University, Rome, Italy.
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Briani C, Vitaliani R, Grisold W, Honnorat J, Graus F, Antoine JC, Bertolini G, Giometto B. Spectrum of paraneoplastic disease associated with lymphoma. Neurology 2011; 76:705-10. [PMID: 21339498 DOI: 10.1212/wnl.0b013e31820d62eb] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To define the frequency and clinical and immunologic characteristics of patients affected by paraneoplastic neurologic syndromes (PNS) and lymphoma. METHODS Patients fulfilling the criteria for PNS associated with lymphoma collected from the European Commission-funded PNS Euronetwork group database were analyzed. RESULTS Fifty-three patients with Hodgkin lymphoma (HL) (24 patients, mean age 51, range 16-84) or non-Hodgkin lymphoma (NHL) (29 patients, mean age 64, range 31-82) and PNS were analyzed. The most commonly associated PNS was paraneoplastic cerebellar degeneration, present in 21 cases, with a higher prevalence in HL (16/24 cases). Peripheral nervous system (mainly demyelinating polyradiculopathies) and motor neuron involvement were more common in NHL. Onconeural antibodies were more frequent in patients with paraneoplastic cerebellar degeneration, most commonly against the Tr antigen. Fifty percent of the patients with PNS and HL responded to chemotherapy, whereas neurologic improvement was less frequent (24%) in patients with PNS and NHL. In both groups, the survival rate was good. Overall, 10 out of 53 patients eventually died, with only 2 patients (1 with HL, 1 with NHL) dying from PNS. CONCLUSIONS PNS in patients with lymphoma are relatively rare. Paraneoplastic cerebellar degeneration, mainly associated with anti-Tr antibodies, is more prevalent in HL and NHL, followed in our study by motor neuron disease in patients with NHL. Involvement of the peripheral nervous system is heterogeneous, with a prevalence of polyradiculoneuritis in patients with NHL.
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Affiliation(s)
- C Briani
- Department of Neurosciences, University of Padova, Padova, Italy.
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Benedetti L, Briani C, Franciotta D, Fazio R, Paolasso I, Comi C, Luigetti M, Sabatelli M, Giannini F, Mancardi GL, Schenone A, Nobile-Orazio E, Cocito D. Rituximab in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a report of 13 cases and review of the literature. J Neurol Neurosurg Psychiatry 2011; 82:306-8. [PMID: 20639381 DOI: 10.1136/jnnp.2009.188912] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND A few case reports have shown controversial results of rituximab efficacy in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). OBJECTIVE To analyse the efficacy of rituximab in a large CIDP cohort. METHODS A retrospective, observational and multicentre study on the use of rituximab in CIDP. 13 Italian CIDP patients were treated with rituximab after the partial or complete lack of efficacy of conventional therapies. Eight patients had co-occurring haematological diseases. Patients who improved by at least two points in standard clinical scales, or who reduced or discontinued the pre-rituximab therapies, were considered as responders. RESULTS Nine patients (seven with haematological diseases) responded to rituximab: six of them, who were non-responders to conventional therapies, improved clinically, and the other three maintained the improvement that they usually achieved with intravenous immunoglobulin or plasma exchange. Significantly associated with shorter disease duration, rituximab responses started after a median period of 2.0 months (range, 1-6) and lasted for a median period of 1 year (range, 1-5). CONCLUSIONS Rituximab seems to be a promising therapeutic choice when it targets both CIDP and co-occurring haematological diseases. Timely post-onset administration of rituximab seems to be associated with better responses.
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Affiliation(s)
- L Benedetti
- Department of Neurology, Osp. S. Andrea, Via Vittorio Veneto 197, 19100 La Spezia, Italy.
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Barbato M, Curione M, Amato S, Carbone J, Briani C, Pannone V, Maiella G, Di Camillo C, Panetti D, Cucchiara S. Autonomic imbalance in celiac children. Minerva Pediatr 2010; 62:333-338. [PMID: 20940666] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Involvement of many organs and apparatus such as heart, central and peripheral nervous systems have been reported in celiac disease. Autonomic neuropathy has frequently been reported both in untreated and in gluten free diet (GFD) adult patients and, to our knowledge, has never been investigated in celiac children. The aim of the study was to evaluate autonomic function in children with celiac disease. METHODS Fifteen children with untreated celiac disease were enrolled. Fifteen healthy children served as controls. None of the patients was diabetic. Central or peripheral neurological diseases, were absent. In all participants, at recruitment and after 24 months of GFD, serum anti-tTG and AEA levels, inflammatory markers, IgG, IgM and IgA anti-ganglioside antibodies, were performed. Heart rate variability indexes were employed to evaluate autonomic system balance. RESULTS Our results indicate that also children with celiac disease may exhibit an imbalance of the neurovegetative system with a prevailing sympathetic tone, persisting on a GFD. All presented symptoms such as abdominal pain, diarrhea or constipation, vomiting, meteorism, regurgitation in whom autonomic dysfunction could be involved, but these symptoms disappeared on gluten free diet. This tend to exclude the prevailing sympathetic tone as a main factor underlying symptoms of celiac disease. CONCLUSION Children affected by celiac disease exhibit an enhanced sympathetic tone, persisting after 24 months of GFD whereas gastrointestinal and systemic symptoms disappear. The pathogenesis of this phenomenon still remains unclear.
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Affiliation(s)
- M Barbato
- Department of Pediatrics, La Sapienza University, Rome, Italy
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Ghirardello A, Briani C, Lucchetta M, Doria A. Anti-ribosomal P protein antibodies and neuropsychiatric systemic lupus erythematosus: cross-sectional vs. prospective studies. Lupus 2009; 19:771-3. [DOI: 10.1177/0961203309353914] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- A. Ghirardello
- Division of Rheumatology, Clinical and Experimental Medicine, University of Padova Via Giustiniani 2, 35128 Padova, Italy
| | - C. Briani
- Department of Neurosciences, University of Padova, Italy
| | - M. Lucchetta
- Department of Neurosciences, University of Padova, Italy
| | - A. Doria
- Division of Rheumatology, Clinical and Experimental Medicine, University of Padova Via Giustiniani 2, 35128 Padova, Italy,
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Cocito D, Paolasso I, Antonini G, Benedetti L, Briani C, Comi C, Fazio R, Jann S, Matà S, Mazzeo A, Sabatelli M, Nobile-Orazio E. A nationwide retrospective analysis on the effect of immune therapies in patients with chronic inflammatory demyelinating polyradiculoneuropathy. Eur J Neurol 2009; 17:289-94. [PMID: 19863650 DOI: 10.1111/j.1468-1331.2009.02802.x] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- D Cocito
- Dipartimento di Neuroscienze, AOU San Giovanni Battista, Torino, Italy.
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Abstract
The inflammatory myopathies are a group of acquired diseases, characterized by an inflammatory infiltrate of the skeletal muscle. On the basis of clinical, immuno-pathological and demographic features, three major diseases can be identified: dermatomyositis (DM); polymyositis (PM); and inclusion body myositis (IBM). New diagnostic criteria have recently been introduced, which are crucial for discriminating between the three different subsets of inflammatory myopathies and for excluding other disorders. DM is a complement-mediated microangiopathy affecting skin and muscle. PM and IBM are T cell-mediated disorders, where CD8-positive cytotoxic T cells invade muscle fibres expressing MHC class I antigens, thus leading to fibre necrosis. In IBM, vacuolar formation with amyloid deposits are also present. This article summarizes the main clinical, laboratory, electrophysiological, immunological and histologic features as well as the therapeutic options of the inflammatory myopathies.
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Affiliation(s)
- C Briani
- University of Padova, Department of Neurosciences, Padova, Italy.
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Briani C, Zara G, Rondinone R, Iaccarino L, Ruggero S, Toffanin E, Ermani M, Ghirardello A, Zampieri S, Sarzi-Puttini P, Doria A. Positive and negative effects of thalidomide on refractory cutaneous lupus erythematosus. Autoimmunity 2009; 38:549-55. [PMID: 16373260 DOI: 10.1080/08916930500285790] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [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: 10/25/2022]
Abstract
BACKGROUND Thalidomide is used in cutaneous lupus erythematosus (CLE) refractory to conventional therapies. Peripheral neuropathy (PN) is the most severe side effect, but the incidence of PN and its relation to thalidomide dose are still unclear. OBJECTIVE To prospectively evaluate the efficacy as well as the occurrence of PN in CLE patients treated with thalidomide, and to assess whether PN, when occurs, correlates with thalidomide dose and/or length of treatment. METHODS Fourteen female patients with CLE in low-dose thalidomide therapy were followed for up to 24 months. Prior to, and regularly during treatment patients underwent rheumatological, dermatological, neurological and electrophysiological evaluations. A decline in sural SNAP of 50% or more from baseline value was considered as criterion of sensory axonal PN. RESULTS All patients showed a dramatic improvement of skin manifestations. Ten patients (71.4%) developed a sensory axonal PN. The median time free from this complication was 14 months. No correlations were found between age of the patients nor thalidomide cumulative dose and occurrence of PN (Mann-Whitney U Test; p>0.16). Other adverse effects were: tremor, paresthesias, somnolence, amenhorrea, constipation and thoracic pain. CONCLUSIONS Low does thalidomide is efficacious in treating CLE, but PN is a common complication whose occurrence does not seem to correlate with total thalidomide dose, whereas with the duration of therapy. A closer electrophysiological follow-up is therefore recommended in the long-term treatment.
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Affiliation(s)
- C Briani
- University of Padova, Department of Neurosciences, Via Giustiniani, 5, 35128, Padova, Italy.
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Ghirardello A, Zampieri S, Tarricone E, Iaccarino L, Bendo R, Briani C, Rondinone R, Sarzi-Puttini P, Todesco S, Doria A. Clinical implications of autoantibody screening in patients with autoimmune myositis. Autoimmunity 2009; 39:217-21. [PMID: 16769655 DOI: 10.1080/08916930600622645] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [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: 10/24/2022]
Abstract
OBJECTIVE To evaluate the clinical usefulness of serum autoantibody profiling in patients with autoimmune myositis. METHODS We retrospectively studied 74 consecutive patients: 68 had definite or probable myositis according to Bohan-Peter criteria, six suffered from antisynthetase syndrome with subclinical myopathy. Myositis specific antibodies (MSA) (anti-ARS, -SRP, -Mi-2) were determined by RNA immunoprecipitation or immunoblot, myositis associated antibodies (MAA) (anti-RoRNP, -U1RNP, -PM/Scl, -Ku) by immunoblot. RESULTS Forty-three patients (58%) were positive for MSA: anti-Jo-1 in 15/27 polymyositis (PM) (55%), 4/33 dermatomyositis (DM) (12%), 1/8 overlap (12%) and 2/6 antisynthetase syndrome (33%); anti-ARS non-Jo-1 in 1/27 PM (4%), 2/33 DM (6%) and 4/6 antisynthetase syndrome (67%); anti-Mi-2 in 1/27 PM (4%) and 11/33 DM (33%); anti-SRP in 3/27 PM (11%) and 1/33 DM (3%). One patient was anti-Jo-1/Mi-2 positive, one anti-Jo-1/SRP positive. Moreover, 27 patients (36%) were positive for MAA: anti-Ro/SSA in 8/27 PM (30%), 7/33 DM (21%), 1/8 overlap (12%), and 3/6 antisynthetase syndrome (50%); anti-U1RNP in 1/27 PM (3.7%), 1/33 DM (3%), and 2/8 overlap (25%); anti-PM/Scl in 2/8 overlap (25%), anti-Ku in 2/8 overlap (25%). Anti-Jo-1 was predominantly associated with PM, anti-Mi-2 was almost exclusively found in DM patients. Anti-ARS antibodies were closely associated with interstitial lung disease and polyarthritis; notably, anti-ARS non-Jo-1 was more frequent in patients without overt muscle alterations. Anti-Ro/SSA antibody was not associated with any disease subset, but significantly more frequent in antisynthetase syndrome. CONCLUSIONS Searching for MSA and MAA in patients with autoimmmune myositis is recommended because of its diagnostic and clinical value. Anti-ARS non-Jo-1 antibodies seem to preferentially target patients with pulmonary fibrosis without overt myopathy.
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Affiliation(s)
- A Ghirardello
- University of Padova, Division of Rheumatology, Department of Clinical and Experimental Medicine, Italy
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Del Bo R, Ghezzi S, Corti S, Pandolfo M, Ranieri M, Santoro D, Ghione I, Prelle A, Orsetti V, Mancuso M, Sorarù G, Briani C, Angelini C, Siciliano G, Bresolin N, Comi GP. TARDBP(TDP-43) sequence analysis in patients with familial and sporadic ALS: identification of two novel mutations. Eur J Neurol 2009; 16:727-32. [DOI: 10.1111/j.1468-1331.2009.02574.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Cima V, Logroscino G, D'Ascenzo C, Palmieri A, Volpe M, Briani C, Pegoraro E, Angelini C, Soraru G. Epidemiology of ALS in Padova district, Italy, from 1992 to 2005. Eur J Neurol 2009; 16:920-4. [PMID: 19473365 DOI: 10.1111/j.1468-1331.2009.02623.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Several studies have reported an increase in ALS incidence in recent years but population-based studies in Europe do not confirm this trend. To analyze ALS incidence over time we conducted a retrospective incidence study in the Padova district of Italy (1992 to 2005). We had previously conducted a survey in the same area in the years 1980-1991. METHODS We used the archives of all the neurological wards of the Padova district to identify all subjects with a discharge diagnosis of ALS or motor neuron disease and resident in the Padova district. RESULTS We ascertained 182 patients (85 males and 97 females; male:female ratio 0.88:1) over the 14-year study period. The annual incidence rates adjusted by sex and age increased from 1.31/100,000/year in the years 1992-1994 to 1.92/100,000/year in the years 2004-2005. CONCLUSIONS This study confirmed an ALS incidence increase over the last 25 years in the Padova district. The increase in incidence may be partially explained by the ageing of the general population rather than by an improved diagnostic assessment.
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Affiliation(s)
- V Cima
- Department of Neurosciences, University of Padova, Padova, Italy
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Briani C, Lucchetta M, Ghirardello A, Toffanin E, Zampieri S, Ruggero S, Scarlato M, Quattrini A, Bassi N, Ermani M, Battistin L, Doria A. Neurolupus is associated with anti-ribosomal P protein antibodies: An inception cohort study. J Autoimmun 2009; 32:79-84. [DOI: 10.1016/j.jaut.2008.12.002] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 12/12/2008] [Accepted: 12/17/2008] [Indexed: 01/27/2023]
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Benedetti L, Briani C, Franciotta D, Carpo M, Padua L, Zara G, Zambello R, Sormani MP, Mancardi GL, Nobile-Orazio E, Schenone A. Long-term effect of rituximab in anti-mag polyneuropathy. Neurology 2008; 71:1742-4. [PMID: 19015493 DOI: 10.1212/01.wnl.0000335268.70325.33] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [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)
- L Benedetti
- Department of Neurosciences, Ophthalmology and Genetics, University of Genova, Genova, Italy.
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Del Bo R, Ghezzi S, Corti S, Santoro D, Prelle A, Mancuso M, Siciliano G, Briani C, Murri L, Bresolin N, Comi GP. DPP6 gene variability confers increased risk of developing sporadic amyotrophic lateral sclerosis in Italian patients. J Neurol Neurosurg Psychiatry 2008; 79:1085. [PMID: 18708572 DOI: 10.1136/jnnp.2008.149146] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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