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Lavie C, Rollot F, Durand-Dubief F, Marignier R, Ionescu I, Casey R, Moreau T, Tourniaire P, Hutchinson M, D’Hooghe MB, Laplaud DA, Clavelou P, De Sèze J, Debouverie M, Brassat D, Pelletier J, Lebrun-Frenay C, Le Page E, Castelnovo G, Berger E, Hautecoeur P, Heinzlef O, Durelli L, Clerico M, Trojano M, Patti F, Vukusic S, Alpérovitch A, Carton H, d’Hooghe M, Hommes O, Hutchinson M, Adeleine P, Biron A, Cortinovis-Tourniaire P, Grimaud J, Hours M, Moreau T, Vukusic S, Confavreux C, Chauplannaz G, Confavreux C, Cortinovis-Tourniaire P, Grimaud J, Latombe D, Moreau T, Clanet M, Lau G, Rumbach L, Goas J, Rouhart F, Mazingue A, Roullet E, Madigand M, Hautecoeur P, Brunet P, Edan G, Allaire C, Riffault G, Leche J, Benoit T, Simonin C, Ziegler F, Baron J, Rivrain Y, Dumas R, Loche D, Bourrin J, Huttin B, Delisse B, Gibert I, Boulay C, Verceletto M, Durand G, Bonneviot G, Gil R, Hedreville M, Belair C, Poitevin R, Devoize J, Wyremblewski P, Delestre F, Setiey A, Comi G, Filippi M, Ghezzi A, Martinelli V, Rossi P, Zaffaroni M, Tola M, Amato M, Fioretti C, Meucci G, Inglese M, Mancardi G, Gambi D, Thomas A, Cavazzuti M, Citterio A, Heltberg A, Hansen H, Fernandez O, Romero F, Arbizu T, Hernandez J, De Andres de Frutos C, Geffner Sclarky D, Aladro Benito Y, Reyes Yanes P, Aguilar M, Burguera J, Yaya R, Bonakim Dib W, Arzua-Mouronte D, d’Hooghe M, Sindic C, Carton H, Medaer R, Roose H, Geens K, Guillaume D, Van Zandycke M, Janssens J, Cornette M, Mol L, Weilbach F, Flachenecker P, Hartung H, Haas J, Tendolkar I, Sindrn E, Kölmel H, Reichel D, Rauch M, Preuss S, Poser S, Mauch E, Strausser-Fuchs S, Kolleger H, Hawkins S, Howell S, Rees J, Thompson A, Johnson M, Boggild M, Gregory R, Bates D, Bone I, Hutchinson M, Polman C, Frequin S, Jongen P, Hommes O, Correia de Sa J, Rio M, Huber S, Lechner-Scott J, Kappos L, Ionescu I, Cornu C, Confavreux C, Vukusic S, El-Etr M, Baulieu E, El-Etr M, Schumacher M, Ionescu I, Confavreux C, Cornu C, Vukusic S, Hartung H, Miller D, Hutchinson M, Pugeat M, d’Archangues C, Conard J, Ménard J, Sitruk-Ware R, Pelissier C, Dat S, Belaïsch-Allard J, Athéa N, Büschsenschutz D, Lyon-Caen O, Gonsette R, Boissel J, Ffrench P, Durand-Dubief F, Cotton F, Pachai C, Bracoud L, Vukusic S, Ionescu I, Androdias G, Marignier R, Chauplannaz G, Laplaud D, Wiertlewski S, Lanctin-Garcia C, Moreau T, Couvreur G, Madinier G, Clavelou P, Taithe F, Aufauvre D, Guy N, Ferrier A, De Sèze J, Collongues N, Debouverie M, Viala F, Brassat D, Gerdelat-Mas A, Henry P, Pelletier J, Rico-Lamy A, Lebrun-Frenay C, Lepage E, Deburghraeve V, Edan G, Castelnovo G, Berger E, Hautecoeur P, Blondiau M, Heinzlef O, Coustans M, Clerc C, Rieu L, Lauxerois M, Hinzelin G, Ouallet J, Minier D, Vion P, Gromaire-Fayolle N, Derache N, Thouvenot E, Sallansonnet-Froment M, Tourniaire P, Toureille L, Borgel F, Stankoff B, Grimaud J, Moroianu C, Guennoc A, Tournier-Gervason C, Peysson S, Trojano M, Patti F, D’Amico E, Motti L, Zaffaroni M, Durelli L, Tavella A. Neuraxial analgesia is not associated with an increased risk of post-partum relapses in MS. Mult Scler 2018; 25:591-600. [DOI: 10.1177/1352458518763080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Obstetrical analgesia remains a matter of controversy because of the fear of neurotoxicity of local anesthetics on demyelinated fibers or their potential relationship with subsequent relapses. Objective: To assess the impact of neuraxial analgesia on the risk of relapse during the first 3 months post-partum, with a focus on women who experienced relapses during pregnancy. Methods: We analyzed data of women followed-up prospectively during their pregnancies and at least 3 months post-partum, collected in the Pregnancy in Multiple Sclerosis (PRIMS) and Prevention of Post-Partum Relapses with Progestin and Estradiol in Multiple Sclerosis (POPARTMUS) studies between 1992–1995 and 2005–2012, respectively. The association of neuraxial analgesia with the occurrence of a post-partum relapse was estimated by logistic regression analysis. Results: A total of 389 women were included, 215 from PRIMS and 174 from POPARTMUS. In total, 156 women (40%) had neuraxial analgesia. Overall, 24% experienced a relapse during pregnancy and 25% in the 3 months post-partum. Women with a pregnancy relapse were more likely to have a post-partum relapse (odds ratio (OR) = 1.83, p = 0.02), independently of the use of neuraxial analgesia. There was no association between neuraxial analgesia and post-partum relapse (OR = 1.08, p = 0.78). Conclusion: Neuraxial analgesia was not associated with an increased risk of post-partum relapses, whatever multiple sclerosis (MS) activity during pregnancy.
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Affiliation(s)
- Caroline Lavie
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Fabien Rollot
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | | | - Romain Marignier
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Centre de Recherche en Neurosciences de Lyon,
INSERM U1028, CNRS UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France;
Université de Lyon 1, Lyon, France
| | - Iuliana Ionescu
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France
| | - Romain Casey
- Observatoire Français de la Sclérose en Plaques (OFSEP),
Lyon, France
| | - Thibault Moreau
- Department of Neurology, EA4184, University Hospital of
Dijon, Dijon, France
| | | | - Michael Hutchinson
- School of Medicine and Medical Science, University College
Dublin, Dublin, Ireland/Department of Neurology, St Vincent’s University Hospital,
Dublin, Ireland
| | - Marie Béatrice D’Hooghe
- National MS Center Melsbroek, Melsbroek, Belgium; Center
for Neurosciences, Vrije Universiteit Brussel (VUB), Brussel, Belgium
| | - David-Axel Laplaud
- Service de Neurologie, CHU de Nantes, CIC015 INSERM,
Nantes, France/INSERM UMR1064, Nantes, France
| | - Pierre Clavelou
- Service de Neurologie, CHU de Clermont-Ferrand,
Clermont-Ferrand, France/INSERM UMR1107, Clermont Université, Université d’Auvergne,
Neuro-Dol, Clermont-Ferrand, France
| | - Jérôme De Sèze
- Department of Neurology, Clinical Investigation Center
INSERM 1434, Hôpitaux Universitaires de Strasbourg, FMTS INSERM 1119, Strasbourg,
France
| | - Marc Debouverie
- EA 4360 APEMAC, University of Lorraine, Nancy,
France/Department of Neurology, Nancy University Hospital, Nancy, France
| | - David Brassat
- Pôle Neurosciences, CHU Toulouse Purpan, Toulouse,
France/INSERM U1043, CNRS UMR 5282, Université Toulouse III, Toulouse, France
| | - Jean Pelletier
- Service de Neurologie, Hôpital de la Timone, Pôle de
Neurosciences Cliniques, AP-HM, Aix-Marseille Université, Marseille, France/CNRS,
Aix-Marseille Université, CRMBM UMR7339, Marseille, France
| | | | - Emmanuelle Le Page
- Clinical Neuroscience Centre, CIC-P 1414 INSERM, Rennes
University Hospital, Rennes, France
| | | | - Eric Berger
- Department of Neurology, CHU Besançon, Besançon,
France
| | - Patrick Hautecoeur
- Service de Neurologie, Groupement des Hôpitaux de
l’Institut Catholique de Lille, Lille, France
| | - Olivier Heinzlef
- Department of Neurology, Hôpital CHI de
Poissy/Saint-Germain-en-Laye, Paris, France
| | - Luca Durelli
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Marinella Clerico
- Division of Neurology, Department of Clinical and
Biological Sciences, University of Torino, San Luigi Gonzaga University Hospital,
Orbassano, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and
Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Patti
- Department of Medical and Surgical Sciences, and Advanced
Technologies, G.F. Ingrassia, Multiple Sclerosis Center, University of Catania, Catania,
Italy
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Pierre Wertheimer,
Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques
(OFSEP), Lyon, France/Centre de Recherche en Neurosciences de Lyon, INSERM U1028, CNRS
UMR5292, Equipe Neuro-Oncologie et Neuro-Inflammation, Lyon, France/Université de Lyon
1, Lyon, France
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Kuhle J, Hardmeier M, Disanto G, Gugleta K, Ecsedi M, Lienert C, Amato MP, Baum K, Buttmann M, Bayas A, Brassat D, Brochet B, Confavreux C, Edan G, Färkkilä M, Fredrikson S, Frontoni M, D'Hooghe M, Hutchinson M, De Keyser J, Kieseier BC, Kümpfel T, Rio J, Polman C, Roullet E, Stolz C, Vass K, Wandinger KP, Kappos L. A 10-year follow-up of the European multicenter trial of interferon β-1b in secondary-progressive multiple sclerosis. Mult Scler 2015; 22:533-43. [PMID: 26362898 DOI: 10.1177/1352458515594440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 05/20/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To explore long-term effects of treatment and prognostic relevance of variables assessed at baseline and during the European secondary progressive multiple sclerosis (SPMS) trial of interferon beta 1b (IFNB-1b). METHODS We assessed 362 patients (60% female; median age 41 years; Expanded Disability Status Scale (EDSS): 5.5; 51% randomized to IFNB-1b) for their EDSS and treatment history after 10 years. Non-parametric analysis of covariance (ANCOVA) and multivariate linear regression models were applied. RESULTS Median EDSS was 6.0 at the end of the randomized controlled trial (RCT), in the IFNB-1b and placebo groups, and 7.0 in long-term follow-up patients (those receiving IFNB-1b in the RCT were 6.5 and those receiving placebo in the RCT were 7.0; p = 0.086). 24 patients (6.6%) were deceased. The EDSS at baseline and the EDSS change during the RCT were the most important predictors of the EDSS 10 years later (partial R(2): 0.47). The ability to predict changes in EDSS 10 years after the RCT was limited (R(2): 0.12). Magnetic resonance imaging (MRI) measures remained in the predictive models, but explained < 5% of the variability. CONCLUSIONS The results from this analysis did not provide convincing evidence to support a favorable long-term outcome in those patients allocated IFNB-1b during the RCT, in our SPMS cohort. The progressive stage of the disease remains largely unpredictable by clinical and conventional MRI measures, so better prognostic markers are needed.
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Affiliation(s)
- J Kuhle
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel/Blizard Institute, Queen Mary University of London, Barts, UK/London School of Medicine and Dentistry, UK University Hospital Basel, Switzerland
| | - M Hardmeier
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - G Disanto
- Blizard Institute, Queen Mary University of London, Barts, UK/London School of Medicine and Dentistry, UK. Neurocentre of Southern Switzerland, Ospedale Civico, Lugano, Switzerland
| | - K Gugleta
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - M Ecsedi
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
| | - C Lienert
- Department of Medicine, Neurology, Kantonsspital Baselland Bruderholz, Switzerland
| | - M P Amato
- Department NEUROFARBA, Section Neurosciences, University of Florence, Italy
| | - K Baum
- Department of Neurology, Klinik Hennigsdorf, Germany
| | - M Buttmann
- Department of Neurology, University of Würzburg, Germany
| | - A Bayas
- Department of Neurology, Klinikum Augsburg, Germany
| | - D Brassat
- Unité Institut national de la santé et de la recherche médicale (INSERM) 563, Centre hospitalier universitaire Purpan, Toulouse, France
| | - B Brochet
- Department of Neurology, and INSERM-CHU CIC-P 0005, Centre hospitalier universitaire de Bordeaux, France
| | - C Confavreux
- Centre de coordination EDMUS pour la sclérose en plaques, Hôpital Neurologique Pierre-Wertheimer, Lyon, France
| | - G Edan
- Department of Neurology, Centre hospitalier universitaire Pontchaillou, Rennes, France
| | - M Färkkilä
- Department of Neurology, Central Hospital, Helsinki University, Finland
| | - S Fredrikson
- Karolinska University Hospital Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - M Frontoni
- Department of Neurological Sciences, University of Rome La Sapienza, Italy
| | - M D'Hooghe
- Department of Neurology, National MS Center, Melsbroek, Belgium/Vrije Universiteit Brussel, Belgium
| | - M Hutchinson
- Saint Vincent's University Hospital, University College Dublin, Ireland
| | - J De Keyser
- Departments of Neurology, University Medical Center Groningen, Netherlands
| | - B C Kieseier
- Department of Neurology, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilians University, Munich, Germany
| | - J Rio
- MS Center of Catalonia (Cemcat), Vall d'Hebron University Hospital, Barcelona, Spain
| | - C Polman
- MS Center Amsterdam, Vrije University Medical Center, Netherlands
| | - E Roullet
- Department of Neurology, Hôpital Tenon, Paris, France
| | - C Stolz
- PAREXEL International GmbH, Berlin, Germany
| | - K Vass
- University Clinic of Neurology, Medical University of Vienna, Austria
| | - K P Wandinger
- University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - L Kappos
- Neurology, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel
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Lidove O, Chauveheid MP, Caillaud C, Froissart R, Benoist L, Alamowitch S, Doan S, Szalat R, Baumann N, Alexandra JF, Lavallée P, Klein I, Vuillemet F, Sedel F, Sacré K, Samson Y, Roullet E, Papo T. Aseptic meningitis and ischaemic stroke in Fabry disease. Int J Clin Pract 2009; 63:1663-7. [PMID: 19832823 DOI: 10.1111/j.1742-1241.2009.02115.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Fabry disease (OMIM 301 500) is an X-linked lysosomal storage disease. Neurological symptoms in Fabry disease mainly include stroke, acroparesthesia, cranial nerve palsies and autonomic dysfunction. We report on aseptic meningitis in Fabry patients. METHODS Clinical analysis, brain magnetic resonance imaging, cerebrospinal fluid analysis, treatment and outcome data were analysed in three cases of meningitis associated with Fabry disease. FINDINGS Mean age at meningitis onset was 26.6 (24-28) years. Headache was present in all cases and fever in two cases. Meningitis was always diagnosed before Fabry disease. A familial history of Fabry disease was present in two cases. Non-neurological symptoms caused by Fabry disease were present in all cases. All patients also suffered stroke and sensorineural hearing loss. Cerebrospinal fluid (CSF) analysis showed pleocytosis (mean, 36; range: 8-76 cells/mm(3)) and a high protein level (mean, 63; range, 47-70 mg/dl). C-reactive protein blood levels and erythrocyte sedimentation rate were raised. Diagnosis was assessed by low alpha-galactosidase A dosage and/or gene mutation analysis in all cases. All patients were treated with enzyme replacement therapy (ERT). In two cases, lumbar puncture was repeatedly performed and there was no normalisation of CSF under ERT alone, at 9 and 24 months of follow-up, respectively. One patient who suffered intracranial hypertension was treated efficiently with steroids, associated with azathioprine. The fact that Fabry disease could be an auto-inflammatory disorder is discussed. INTERPRETATION Fabry disease may cause aseptic meningitis.
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Affiliation(s)
- O Lidove
- Department of Internal Medicine, Hôpital Bichat Claude-Bernard, 75877 Paris, France.
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Ory S, Debouverie M, Le Page E, Pelletier J, Malikova I, Gout O, Roullet E, Vermersch P, Edan G. [Use of mitoxantrone in early multiple sclerosis with malignant disease course. Observational study in 30 patients with clinical and MRI outcomes after one year]. Rev Neurol (Paris) 2008; 164:1028-34. [PMID: 18808781 DOI: 10.1016/j.neurol.2008.04.008] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 03/19/2008] [Accepted: 04/02/2008] [Indexed: 10/22/2022]
Abstract
INTRODUCTION In an observational multicenter study, we analyzed retrospectively 30 patients with malignant form of multiple sclerosis (MS) treated with mitoxantrone the year following the first neurological event. METHODS The 30 patients were selected according to Weinshenker criteria of malignant MS (either a "catastrophic" relapse or a quickly aggressive form). We compared clinical and MRI findings the year before with the year following mitoxantrone onset treatment: annualized relapse rates (ARR), EDSS score and percentage of patients with gadolinium enhancing lesions on MRI. RESULTS A total of 87 relapses were observed in the 5.7 months before and 10 during the year following onset of mitoxantrone treatment. The ARR decreased by 95% (6.0+/-2 before and 0.3+/-0.7 after). Twenty-four patients (80%) were relapse-free one year after onset of mitoxantrone treatment. The EDSS score improved in 87% of MS patients and the mean EDSS decreased by 1.9. Ninety-seven percent had at least gadolinium enhancing lesions before the start of mitoxantrone treatment as compared to 17% after. CONCLUSION In our experience, mitoxantrone had a rapid and strong impact on the malignant forms of MS with a short disease duration. In this MS subgroup, mitoxantrone should be considered as an early treatment option.
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Affiliation(s)
- S Ory
- Service de neurologie, hôpital Pontchaillou, rue Henri-Le-Guilloux, 35033 Rennes cedex, France.
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Lallemand C, Meritet JF, Erickson R, Grossberg S, Roullet E, Lyon-Caen O, Lebon P, Tovey M. Quantification of Neutralizing Antibodies to Human Type I Interferons Using Division-Arrested Frozen Cells Carrying an Interferon-Regulated Reporter-Gene. J Interferon Cytokine Res 2008; 28:393-404. [DOI: 10.1089/jir.2007.0142] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C. Lallemand
- Laboratory of Viral Oncology, CNRS FRE, Institut André Lwoff, Jonesboro, AR
| | - J.-F. Meritet
- Laboratory of Virology, Groupe Hospitalier Cochin-Saint-Vincent-de-Paul, Université René Descartes, Paris, France
| | - R. Erickson
- NeutekBio Ltd., Galway Technology Centre, Galway, Ireland
| | - S.E. Grossberg
- Department of Microbiology & Molecular Genetics, Medical College of Wisconsin, Milwaukee, WI
| | - E. Roullet
- Neurology Department, Hôpital Tenon, Jonesboro, AR
| | - O. Lyon-Caen
- Fédération de Neurologie, Hôpital de la Salpetriກre, Paris, France
| | - P. Lebon
- Laboratory of Virology, Groupe Hospitalier Cochin-Saint-Vincent-de-Paul, Université René Descartes, Paris, France
| | - M.G. Tovey
- Laboratory of Viral Oncology, CNRS FRE, Institut André Lwoff, Jonesboro, AR
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Lebrun C, Bensa C, Debouverie M, De Seze J, Wiertlievski S, Brochet B, Clavelou P, Brassat D, Labauge P, Roullet E. Unexpected multiple sclerosis: follow-up of 30 patients with magnetic resonance imaging and clinical conversion profile. J Neurol Neurosurg Psychiatry 2008; 79:195-8. [PMID: 18202208 DOI: 10.1136/jnnp.2006.108274] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [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
The concept of preclinical multiple sclerosis is now well recognised, and a diagnosis of silent brain T2 lesions is frequent because of the ease of performing MRI. Nevertheless, patients with incidental brain MRI fulfilling Barkhof- Tintoré criteria are more rare. We report a descriptive retrospective study of clinical and 5 year MRI follow-up in patients with subclinical demyelinating lesions fulfilling MRI Barkhof-Tintoré criteria with a normal neurological examination. 30 patients were identified and the first brain MRI was performed for various medical events: headaches (n = 14), migraine with (n = 2) or without (n = 4) aura, craniocerebral trauma (n = 3), depression (n = 3), dysmenorrhoea (n = 2), epilepsy (n = 1) and cognitive changes (n = 1). Mean time for the second brain MRI was 6 months (range 3-30). 23 patients had temporospatial dissemination (eight with gadolinium enhancement). 11 patients had clinical conversion: optic neuritis (n = 5), brainstem (n = 3), sensitive symptoms (n = 2) and cognitive deterioration (n = 1). Eight (72%) already had criteria of dissemination to space and time before the clinical event. Mean time between the first brain MRI and clinically isolated syndrome (CIS) was 2.3 years. To our knowledge, this is the first cohort of CIS with preclinical follow-up. Early treatment should be discussed in view of the predictive value on conversion of the MRI burden of the disease.
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Alamowitch S, Plaisier E, Favrole P, Roullet E, Ronco P. Atteinte cérébro-vasculaire dans le syndrome d’angiopathie héréditaire lié à des mutations de COL4A1 (HANAC). Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90895-4] [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: 10/28/2022]
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Bensa C, Heinzlef O, Gross M, Giannesini C, Marro B, Roullet E, Roullet E. F - 3 Étude nationale « PRE-MS » : premiers résultats. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90835-8] [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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Turc G, Bensa C, Heinzlef O, Giannesini C, Roullet E. F - 33 SAPHO ET SEP : une association nouvelle ? à propos d’une observation. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90865-6] [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: 11/26/2022]
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Charlier C, Nunes H, Trinchet JC, Roullet E, Mouthon L, Beaugrand M, Valeyre D. Evolution of previous sarcoidosis under type 1 interferons given for severe associated disease. Eur Respir J 2005; 25:570-3. [PMID: 15738304 DOI: 10.1183/09031936.05.00141703] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sarcoidosis is a granulomatous disorder with a well-known T helper (Th) type 1 cell commitment and a key pathogenic role of interferon (IFN)-gamma. However, little is known about the influence of type 1 IFNs, such as IFN-alpha and IFN-beta, on the course of previous sarcoidosis. The aim of this study was to determine whether type 1 IFNs can safely be used in patients with sarcoidosis for severe associated disease. The present study examined a series of four patients with sarcoidosis, treated by IFN-alpha or IFN-beta for viral hepatitis (three cases) or multiple sclerosis (one case). IFN was initiated soon after apparent recovery (three cases) or during a worsening phase of sarcoidosis (one case). Hydroxychloroquine was added in the case with active disease. Patients received interferon for 6-24 months and had close monitoring during and after IFN therapy. Interestingly, no recurrence or exacerbation of sarcoidosis had occurred at 4 yrs of follow up. Two patients were cured from viral hepatitis, whilst treatment for another failed. No neurological progression was observed in the remaining patient. This series suggests that, despite the T helper type 1 phenotype of sarcoid granulomatous reaction, type 1 interferons do not exacerbate sarcoidosis in remission and this makes their use possible if indicated. However, their effect in persistent forms of the disease needs further evaluation.
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Affiliation(s)
- C Charlier
- Service de Pneumologie, Avicenne Univeristy Hospital, Assistance Publique/Hôpitaux de Paris, 93009 Bobigny, France
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11
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Charlier C, Nunes H, Trinchet J, Roullet E, Mouthon L, Beaugrand M, Valeyre D. 200 La prescription d’interféron de type I chez des patients atteints de sarcoïdose est-elle encore un dilemme ? Rev Mal Respir 2004. [DOI: 10.1016/s0761-8425(04)71826-4] [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: 11/25/2022]
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12
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Heinzlef O, Weill B, Johanet C, Sazdovitch V, Caillat-Zucman S, Tournier-Lasserve E, Roullet E. Anticardiolipin antibodies in patients with multiple sclerosis do not represent a subgroup of patients according to clinical, familial, and biological characteristics. J Neurol Neurosurg Psychiatry 2002; 72:647-9. [PMID: 11971055 PMCID: PMC1737868 DOI: 10.1136/jnnp.72.5.647] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND In multiple sclerosis (MS), case control studies have shown that anticardiolipin antibodies (aCL Ab) are more frequent than in the general population and that aCL Ab positivity may be associated with specific clinical characteristics. OBJECTIVES To determine whether patients with MS who are positive for aCL Ab have specific characteristics. METHODS 285 consecutive patients with MS were tested for aCL Ab positivity. Patients also underwent complete autoimmune screening and were systematically evaluated for clinical characteristics and individual or family history of autoimmune disease. RESULTS aCL Ab positivity was found in 42 patients (15%). The main isotype was aCL IgM (32 patients, 11%). Demographics and clinical characteristics including sex, age at onset, course of the disease, expanded disability status scale score, and progression index were not different between aCL Ab positive and aCL Ab negative patients. Clinical systems involved at onset or during the course of the disease were not different from what is usually observed in MS. aCL Ab positivity was not associated with an increased frequency of autoimmune disease and was not predictive of a family history of autoimmune disease. Patients positive for aCL IgM were more frequently positive for the presence of non-organ specific antibodies (53% v 39%, respectively, p = 0.02). CONCLUSIONS These results do not support the hypothesis that patients with MS with aCL Ab constitute a subgroup of MS according to demographic clinical and familial characteristics. The greater frequency of other antibodies in aCL Ab positive patients suggests that they only reflect a more general autoimmune activation in MS.
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Affiliation(s)
- O Heinzlef
- Department of Neurology, Tenon Hospital, 4 rue de la Chine, 75020 Paris, France.
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13
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Roullet E. [Clinical evaluation of follow-up and disease course]. Rev Neurol (Paris) 2001; 157:1121-3. [PMID: 11787343] [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: 02/23/2023]
Abstract
The clinical assessment of the evolution of Multiple Sclerosis (MS) is based on international criteria. For the definition of relapse and progression, the so-called Schumacher criteria (1965) may be chosen. For the definition of clinical subtypes (relapsing-remitting, secondary progressive, primary progressive, and progressive-relapsing), the criteria issued from a survey conducted by the group of Lublin (1996) are mandatory. One may be cautious to apply such research-driven sets of criteria to clinical practice. Many scales have been elaborated for the evaluation of the handicap caused by MS (i.e. neurological deficit, impairment, and "handicap"). None is perfect, but the Expanded Disability Status Scale (EDSS, Kurtzke, 1983) is widely used. Recent development in the elaboration process of scales ("scalology") may soon lead to the validation of new composite outcome measures.
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Affiliation(s)
- E Roullet
- Service de Neurologie, Hôpital Tenon, 4, rue de la Chine, 75970 Paris.
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14
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Roullet E. [Nursing strategies. Multiple sclerosis, medical and therapeutic strategies]. Soins 2001:30-3. [PMID: 12008583] [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] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Affiliation(s)
- E Roullet
- Service de neurologie, hôpital Tenon, AP-HP
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15
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M'Bappé P, Moguilevski A, Arnal C, Cocheton JJ, Roullet E. Concomitant rheumatoid arthritis and amyotrophic lateral sclerosis. A puzzle illustrated by a new case. Joint Bone Spine 2001; 67:242-4. [PMID: 10875327] [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: 02/16/2023]
Abstract
We report a case of amyotrophic lateral sclerosis in a patient with rheumatoid arthritis. Only three similar cases have been reported. Our case illustrates the diagnostic difficulties raised by early amyotrophic lateral sclerosis responsible for localized or unusual manifestations. Occurrence of the two diseases in the same patient is probably due to chance alone.
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Affiliation(s)
- P M'Bappé
- Department of Internal Medecine, Tenon Hospital, Paris, France
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16
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Roullet E. [Perspectives on managing patients with fatigue]. Rev Neurol (Paris) 2000; 156:1046-7. [PMID: 11119063] [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] [Indexed: 02/18/2023]
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17
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Sazdovitch V, Verdier-Taillefer MH, Heinzlef O, Alamowitch S, Roullet E. [Familial multiple sclerosis: study of 357 consecutive patients]. Rev Neurol (Paris) 2000; 156:638-40. [PMID: 10891798] [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: 02/17/2023]
Abstract
The empiric recurrence risk of multiple sclerosis (MS) of relatives of French MS patients is not known. Using a standardized interview, we collected the family histones of 357 consecutive patients followed at our MS clinic; adequate information was obtained on 4784 relatives up to the third degree. Thirty-five patients (9.8%) had a relative with MS. The risk-curve for relatives was the same as in other studies conducted with a similar methodology in Canada. England and Flanders. but the crude overall MS recurrence risk for relatives was lower in France. The genetic burden of MS may be lower in France than in areas of higher MS prevalence.
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18
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Marrie RA, Wolfson C, Sturkenboom MC, Gout O, Heinzlef O, Roullet E, Abenhaim L. Multiple sclerosis and antecedent infections: a case-control study. Neurology 2000; 54:2307-10. [PMID: 10881258 DOI: 10.1212/wnl.54.12.2307] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To determine whether there is an excess of respiratory tract infections in the 5-week, 3-month, and 12-month periods before MS symptom onset and if there is an association between MS and a history of infectious mononucleosis (IM). BACKGROUND The etiology of MS remains unknown, but infection is frequently suggested as a putative etiologic agent. Epidemiologic studies have produced inconsistent evidence for an etiologic role of respiratory tract infections (RTI) and IM in MS. METHODS The authors performed a case-control study using the General Practice Research Database from the United Kingdom. There were 225 subjects with definite or probable MS, and 900 controls matched for age, sex, and physician practice. Using computerized patient records, the authors compared the mean rates of RTI per patient in the 5-week, 3-month, and 12-month periods before the date of onset of the first symptoms compatible with MS (index date). They also compared histories of IM. RESULTS In all periods, an increased frequency of RTI was associated with a significantly increased risk of MS. A history of IM was associated with greater than five times the risk of MS (OR = 5.5 [95% CI 1.5 to 19.7]). CONCLUSIONS These results support an association between a history of IM and subsequent MS. Respiratory tract infections may precipitate disease onset.
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Affiliation(s)
- R A Marrie
- Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
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19
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Michel M, Piette JC, Roullet E, Duron F, Françès C, Nahum L, Pelletier N, Crassard I, Nunez S, Michel C, Bach J, Tournier-Lasserve E. The R131 low-affinity allele of the Fc gamma RIIA receptor is associated with systemic lupus erythematosus but not with other autoimmune diseases in French Caucasians. Am J Med 2000; 108:580-3. [PMID: 10806289 DOI: 10.1016/s0002-9343(00)00322-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- M Michel
- Unité INSERM U25, Faculté de Médecine Necker, Paris, France
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20
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Heinzlef O, Alamowitch S, Sazdovitch V, Chillet P, Joutel A, Tournier-Lasserve E, Roullet E. Autoimmune diseases in families of French patients with multiple sclerosis. Acta Neurol Scand 2000; 101:36-40. [PMID: 10660150 DOI: 10.1034/j.1600-0404.2000.101001036.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Multiple sclerosis (MS) is associated with autoimmune disorders (AIDs) in individual patients, and limited data suggest a possible familial association of MS and AIDs; however, no systematic study has been conducted on the occurrence of AIDs in the families of MS patients. Using a standardized interview focused on AIDs, we obtained the family histories of 357 consecutive patients from our MS clinic. Adequate information was obtained on 1971 first-degree relatives. Fifty-five patients (15.4%) had first-degree relatives with MS (n=22, 6.2%) another AID (n = 30, 8.4%), or both (n = 3, 0.8%). In 16 families (4.5%), at least 3 first-degree relatives had MS or another AID. MS, Grave's disease, rheumatoid arthritis, vitiligo, type 1 insulin-dependent diabetes mellitus, and uveitis, were the most common AIDs in these families. Such multiplex families (families with MS plus AID) are appropriate for identifying susceptibility genes that may be common to MS and other AIDs.
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Affiliation(s)
- O Heinzlef
- Department of Neurology, Hospital Tenon, Paris, France
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21
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Heinzlef O, Roullet E. [Towards a reliable prognosis for multiple sclerosis]. Rev Prat 1999; 49:1872-5. [PMID: 10598503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Although the general course of multiple sclerosis is well known from natural history studies, the determination of a detailed prognosis in a given individual is almost an insurmountable task. Cerebral magnetic resonance imaging is the best predictor of conversion to definite multiple sclerosis after a first demyelinating event. The main factors indicative of long-term bad prognosis are: onset after the age of 40, initial pyramidal or cerebellar signs, high relapse rate during the first two years, and onset of the progressive phase. Altogether, up to 20% of patients have a benign course.
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Affiliation(s)
- O Heinzlef
- Service de neurologie Hôpital Tenon, Paris
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22
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Denier C, Ducros A, Vahedi K, Joutel A, Thierry P, Ritz A, Castelnovo G, Deonna T, Gérard P, Devoize JL, Gayou A, Perrouty B, Soisson T, Autret A, Warter JM, Vighetto A, Van Bogaert P, Alamowitch S, Roullet E, Tournier-Lasserve E. High prevalence of CACNA1A truncations and broader clinical spectrum in episodic ataxia type 2. Neurology 1999; 52:1816-21. [PMID: 10371528 DOI: 10.1212/wnl.52.9.1816] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the nature of CACNA1A mutations in episodic ataxia type 2 (EA2), to search for mutations in sporadic cases, and to delineate better the clinical spectrum. BACKGROUND EA2 is an autosomal dominant disorder characterized by recurrent acetazolamide-responsive attacks of cerebellar ataxia. The mutated gene, CACNA1A, located on chromosome 19, encodes the alpha1A subunit of a voltage-dependent calcium channel. So far, only three CACNA1A mutations have been identified-in two EA2 families and in one sporadic case. These three mutations disrupted the reading frame and led to truncated proteins. Interestingly, distinct types of CACNA1A mutations have been identified in familial hemiplegic migraine (missense mutations) and spinocerebellar ataxia type 6 (SCA-6) progressive cerebellar ataxia (expanded CAG repeats). However, except for SCA-6, these genotype-phenotype correlations relied on the analysis of very few families. METHODS To characterize CACNA1A mutations, eight familial and seven sporadic EA2 patients were selected. All 47 exons of CACNA1A were screened by a combination of single-strand conformer polymorphism and sequencing analysis. In addition, the length of the CAG repeat has been determined in all patients. RESULTS Seven new mutations were detected in four multiple case families and three sporadic cases. Six of them lead most likely to truncated or aberrant proteins. CAG repeat sizes were in the normal range. CONCLUSION These data clearly establish the specificity of EA2 mutations compared with SCA-6 and familial hemiplegic migraine. Detailed clinical analysis of the mutation carriers showed the highly variable penetrance and expression of this disorder: Several of the carriers did not show any clinical symptom; others displayed atypical or permanent neurologic symptoms (such as recurrent, transient diplopia or severe, permanent, and isolated cerebellar ataxia).
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Affiliation(s)
- C Denier
- INSERM U25, Faculté de Médecine Necker, Paris, France
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23
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Abstract
Toxoplasma encephalitis, cryptococcal meningitis, progressive multifocal leukoencephalopathy (PML), and cytomegalovirus (CMV) encephalitis are the most common opportunistic infections of the central nervous system (CNS) in HIV-infected patients. They occur at variable degrees of immunosuppression, and their diagnosis is based on a systematic evaluation with includes, in a definite order, ongoing prophylactic therapies, extraneurological signs, neuroimaging and CSF studies, and an anti-Toxoplasma therapeutic trial. Concurrent neurological HIV-CNS disease (such as the AIDS dementia complex) is frequent. The development of reliable molecular biology techniques such as the polymerase chain reaction and their application to the CSF have made the diagnosis of virus-related opportunistic infections much easier and has limited the need for cerebral biopsy. The incidence of opportunistic infections has decreased since the introduction of recent antiretroviral therapeutic strategies.
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Affiliation(s)
- E Roullet
- Department of Neurology, Hôpital Tenon, Paris, France
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24
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Abstract
The authors reviewed records from consecutive patients in an MS clinic (n = 1,098) and in a uveitis clinic (n = 1,530) to select patients with "definite MS" and uveitis. A total of 28 of 2,628 patients (1%) were identified: 12 from the MS clinic (12 of 1,098; 1.1%) and 16 from the uveitis clinic (16 of 1,530; 1%). Pars planitis and panuveitis were most commonly encountered. The delay between the onset of neurologic and ocular symptoms (mean, 9 years) emphasizes the importance of a sequential diagnostic search throughout the patient's course.
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Affiliation(s)
- V Biousse
- Department of Neurology, Lariboisière Hospital, Paris, France
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25
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Meynard JL, el Amrani M, Meyohas MC, Fligny I, Gozlan J, Rozenbaum W, Roullet E, Frottier J. Two cases of cytomegalovirus infection revealed by hearing loss in HIV-infected patients. Biomed Pharmacother 1998; 51:461-3. [PMID: 9863506 DOI: 10.1016/s0753-3322(97)82326-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Neurological complications are particularly common during HIV infection. Among various opportunistic diseases, cytomegalovirus (CMV) is one of the most frequent causes of central and peripheral neurological manifestations. Previously, there have been several reports of cranial nerve infection by CMV, but to our knowledge, no cases of auditory nerve involvement have been described. We report two cases in which CMV infection was revealed by involvement of the VIIIth cranial nerves. Cytomegalovirus (CMV) infection is frequent in severely immunodeficient patients infected by human immunodeficiency virus (HIV). The main targets of CMV are the retina, gastrointestinal tract and central nervous system. We describe two cases in which neurologic CMV infection was revealed by hearing loss.
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Affiliation(s)
- J L Meynard
- Service des Maladies Infectieuses et Tropicales, Hôpital Saint-Antoine, Paris, France
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26
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Murphy N, Confavreux C, Haas J, König N, Roullet E, Sailer M, Swash M, Young C, Mérot JL. Quality of life in multiple sclerosis in France, Germany, and the United Kingdom. Cost of Multiple Sclerosis Study Group. J Neurol Neurosurg Psychiatry 1998; 65:460-6. [PMID: 9771766 PMCID: PMC2170316 DOI: 10.1136/jnnp.65.4.460] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess the quality of life (QoL) of patients with multiple sclerosis in France, Germany, and the United Kingdom with a cross sectional study. METHODS Patients were classified into three severity groups according to the expanded disability severity scale (EDSS); stage I, II, and III, corresponding to mild (EDSS 1.0-3.5), moderate (EDSS 4.0-6.0), or severe (EDSS 6.5-8.0) multiple sclerosis respectively. Ninety patients with multiple sclerosis and 30 control patients without multiple sclerosis were recruited in each country. Control patients were matched to the patients with multiple sclerosis according to age and sex. Quality of life was assessed using the functional status questionnaire (FSQ). RESULTS The aspects of QoL that were mostly affected in the three countries under study were physical function and general wellbeing. Social role function decreased with increased severity of disease in France and in particular in Germany. Multiple sclerosis did not seem to have an impact on psychological function. The QoL of control patients was systematically higher than that of patients with multiple sclerosis. CONCLUSIONS Use of such a generic scale showed that progression of multiple sclerosis is accompanied by a decrease in QoL and suggested that this could be a relevant measurement in assessing the effect of treatment and progression of disease. Variation between countries, however, may be important.
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27
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Abstract
Five patients with oropharyngeal cancer treated with 5-fluorouracil and cisplatin had ischemic stroke within 2 to 5 days after the drug infusion. This occurred during the second course of chemotherapy in three patients, and during the third course in two patients. There may be a relation between treatment and brain infarction because 1) there was no other cause identified despite extensive tests, including postmortem examination in one patient; 2) there was a short delay between treatment infusion and stroke; and 3) there was a similar pattern of ischemic stroke after the second or third course of chemotherapy.
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Affiliation(s)
- M El Amrani
- Department of Neurology, Saint-Antoine Hospital, Paris, France
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28
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Roullet E. [Childhood multiple sclerosis]. Rev Neurol (Paris) 1998; 154:619-22. [PMID: 9809377] [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: 02/09/2023]
Abstract
Multiple sclerosis begins before the age of 17 years in 0.4 to 0.5% of the cases, but the diagnosis is exceptionally made before the age of 10 years. Female predominance is more marked in early onset multiple sclerosis. The general features of the disease (clinical expression, progression, prognostic) and the findings of complementary explorations are comparable with those found when the disease begins in adulthood although acute onset and signs of brain stem involvement have been reported. The diagnosis must be made with prudence, especially when progression is slow from the beginning. An analysis of the influence of infective environmental factors and puberty has not provided new insight. Corticosteroids can be used in case of flare-ups. Management requires a multidisciplinary approach to maintain appropriate educational activities.
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Affiliation(s)
- E Roullet
- Service de Neurologie, Hôpital Tenon, Paris
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29
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Murphy N, Confavreux C, Haas J, König N, Roullet E, Sailer M, Swash M, Young C, Mérot JL. Economic evaluation of multiple sclerosis in the UK, Germany and France. Pharmacoeconomics 1998; 13:607-22. [PMID: 17165327 DOI: 10.2165/00019053-199813050-00013] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
A cross-sectional cost-of-care study was performed to assess the economic burden of multiple sclerosis (MS) in France, Germany and the UK. Patients were stratified into 3 groups according to the Expanded Disability Severity Scale (EDSS): stages I, II and III, corresponding to mild (EDSS 1.0 to 3.5), moderate (EDSS 4.0 to 6.0) and severe (EDSS 6.5 to 8.0) MS, respectively. 90 patients with MS and 30 non-MS control patients were recruited in each country. Control patients were matched to the patients with MS on the basis of age and gender. Demographic, clinical and economic data during the 3-month period prior to entry were collected in patient interviews. Total costs included actual expenditures, such as direct medical and non-medical costs, as well as indirect costs. From the societal perspective, the total cost of MS for 3 months was estimated at 1,928 US dollars, 3,941 US dollars and 5,678 US dollars in France, 2,772 US dollars, 2,056 dollars and 5701dollars in Germany, and 5,125 US dollars, 6,751 US dollars and 14, 622 US dollars in the UK, for stage I, II and III patients, respectively. The major medical cost driver in the UK was outpatient consultations, whereas hospitalisations were the major component in Germany and France. The major cost in the UK arose from the dependence of patients with MS on caregivers, which caused high non-medical, societal costs compared with France and Germany. From both the societal and health insurance perspectives in each country, costs for control patients were lower than those for stage I MS patients. MS represents a major financial burden on the individual, the family, health services and society, and these costs increase with MS progression.
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Affiliation(s)
- N Murphy
- Benefit International SNC, Paris, France
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30
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Abstract
Three patients are described who developed a severe neuropathy after chemotherapy with high dose cis-diamine-(1,1-cyclobutane dicarboxylato) platinum (carboplatin). This toxic side effect, which is unusual at conventional doses, might become more frequent as increasing doses are administered to overcome drug resistance in cancer treatment, and might limit its use at very high doses before haematopoietic stem cell transplantation.
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Affiliation(s)
- O Heinzlef
- Department of Neurology, Hôpital Tenon, Paris, France.
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31
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Heinzlef O, Paternotte C, Mahieux F, Prud'homme JF, Dien J, Madigand M, Pouget J, Weissenbach J, Roullet E, Hazan J. Mapping of a complicated familial spastic paraplegia to locus SPG4 on chromosome 2p. J Med Genet 1998; 35:89-93. [PMID: 9507385 PMCID: PMC1051209 DOI: 10.1136/jmg.35.2.89] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Autosomal dominant familial spastic paraplegia (AD-FSP) is a degenerative disorder of the central motor system characterised by progressive spasticity of the lower limbs. AD-FSP has been divided into pure and complicated forms. Pure AD-FSP is genetically heterogeneous; three loci have been mapped to chromosomes 14q (SPG3), 2p (SPG4), and 15q (SPG6), whereas no loci responsible for complicated forms have been identified to date. Here we report linkage to the SPG4 locus in a three generation family with AD-FSP complicated by dementia and epilepsy. Assuming that both forms of AD-FSP are caused by mutations involving the same FSP gene, analysis of recombination events in this family positions the SPG4 gene within a 0 cM interval flanked by loci D2S2255 and D2S2347.
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Affiliation(s)
- O Heinzlef
- Service de Neurologie, Hôpital Tenon, Paris, France
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32
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Roullet E, Heinzlef O, Alamowitch S. [Multiple sclerosis. Lessons drawn from familial incidence]. Presse Med 1997; 26:1539-42. [PMID: 9435837] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- E Roullet
- Service de Neurologie, Hôpital Tenon, Paris
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Heinzlef O, Moguilewski A, Roullet E. [Acute aseptic meningitis after hepatitis B vaccination]. Presse Med 1997; 26:328. [PMID: 9122145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Heinzlef O, Roullet E, Johanet C, Tournier-Lasserve E, Chazouilleres O. Prevalence of serum antibodies to hepatitis C virus is not increased in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 1996; 61:655-6. [PMID: 8971125 PMCID: PMC486672 DOI: 10.1136/jnnp.61.6.655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Heinzlef O, Roullet E. [Multiple sclerosis. Epidemiology, diagnosis, course, prognosis]. Rev Prat 1996; 46:2373-9. [PMID: 8978197] [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] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- O Heinzlef
- Service de neurologie, hôpital Tenon, Paris
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36
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Roullet E, Desfrançois F, Duyckaerts C. [Conference at the Salpêtrière. November 1994. Jerky voice, abnormal movements and fatal outcome in 2 months in a 66-year-old woman]. Rev Neurol (Paris) 1996; 152:563-9. [PMID: 8991182] [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] [Indexed: 02/03/2023]
Affiliation(s)
- E Roullet
- Service de Neurologie, Hôpital Tenon, Paris, France
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Verdier-Taillefer MH, Sazdovitch V, Borgel F, Césaro P, Kurtz A, Millet MF, Roullet E, Marteau R. Occupational environment as risk factor for unemployment in multiple sclerosis. Acta Neurol Scand 1995; 92:59-62. [PMID: 7572062 DOI: 10.1111/j.1600-0404.1995.tb00467.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Few studies have examined the factors of occupational environment related to unemployment in multiple sclerosis (MS). MATERIAL AND METHODS A case control-study was carried out. Cases were patients unemployed for less than five years before the study (n = 77); controls were patients currently employed (n = 94). The odds ratios of the relationship under study adjusted for sex, age, disease form and educational level, were estimated. RESULTS Employment in the public sector, sedentary jobs and possibility of obtaining specific improvements in the work environment were found to be protective factors, while jobs needing force, rigid work schedule, manual precision, frequent moves and a daily work duration over 8 h were found as risk factors. Multivariate analyses showed that the only remaining factors were public sector jobs as protective factor (OR = 0.4), and strenuous work as risk factor (OR = 4.5). Factors were slightly different in male and female patients. CONCLUSION This study suggests that simple and early changes in the occupational environment could maintain MS patients at work.
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Roullet E, Verdier-Taillefer MH, Caillat-Zucman S. Multiple sclerosis with early onset (EOMS) : A case-control study. J Neuroimmunol 1995. [DOI: 10.1016/0165-5728(95)99114-x] [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: 10/27/2022]
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40
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Roullet E, Assuerus V, Gozlan J, Ropert A, Saïd G, Baudrimont M, el Amrani M, Jacomet C, Duvivier C, Gonzales-Canali G. Cytomegalovirus multifocal neuropathy in AIDS: analysis of 15 consecutive cases. Neurology 1994; 44:2174-82. [PMID: 7969979 DOI: 10.1212/wnl.44.11.2174] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.8] [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: 01/28/2023] Open
Abstract
A severe multifocal neuropathy caused by cytomegalovirus (CMV-MN) can occur in the late stage of human immunodeficiency virus (HIV) infection. In a retrospective study, we identified 15 consecutive HIV-positive patients with a diagnosis of CMV-MN based on (1) markedly asymmetric neuropathy, (2) fewer than 100 CD4+ cells per mm3, (3) exclusion of other causes of neuropathy, and (4) characteristic CMV cytopathic changes on neuromuscular biopsy (2 patients), positive CSF culture for CMV (2 patients), or clinical improvement on anti-CMV therapy given for concurrent extraneurologic CMV disease (8 patients) or neuropathy (3 patients). All patients were men and had severe immunosuppression (mean CD4+ cell count, 18 per mm3). The initial symptoms were numbness and painful paresthesias showing a patchy, multifocal distribution. After a mean of 11 weeks (range, 1 to 10 months), the patients developed moderate or severe sensorimotor asymmetric neuropathy. Extraneurologic CMV infection occurred in 10 patients before diagnosis. Electrophysiologic studies showed axonal neuropathy and CMV DNA was present in CSF by the polymerase chain reaction (PCR) technique in 90% of patients tested. Fourteen patients showed a marked improvement 1 to 4 weeks after starting ganciclovir or foscarnet therapy. During follow-up on maintenance therapy (13 patients), the neuropathy relapsed in three patients and probable or confirmed CMV encephalitis occurred in five. Twelve patients died during follow-up, at a mean interval of 9.5 months after their first symptoms. These results extend the clinical spectrum of CMV-MN and show that PCR detection of CMV DNA in CSF may be a useful diagnostic marker.
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Affiliation(s)
- E Roullet
- Department of Neurology, Hôpital Saint-Antoine, France
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41
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Roullet E, Rougemont D, Cohen A, Petitjean C. [Cerebrovascular complications. Round table]. Ann Cardiol Angeiol (Paris) 1994; 43:229-36. [PMID: 8024238] [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] [Indexed: 01/28/2023]
Affiliation(s)
- E Roullet
- Sevice Neurologíe, Hôpital Saint-Antoine, Paris
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42
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Abstract
In all 129 unselected patients with multiple sclerosis (MS) completed a 25 item auto-questionnaire for assessment of disability. Each patient was examined on the same day by a neurologist who was blind to patients' answers and gave Expanded Disability Status Scale (EDSS) scores. From the auto-questionnaire, eight scores were obtained, one for each of the seven functional systems rated by the EDSS and the eighth relating to walking difficulties. Analysis showed that correlation between patients' self assessments and the neurologist's ratings was high (r > 0.50) for five out of the eight scores and low for three, especially for brainstem and mental functions which were excluded from subsequent analysis. Using a linear regression model, it was possible to predict the EDSS scores given by the neurologist (+/- 1 point) from patients' answers in 73% of the cases. The performance of the model was robust and was not influenced by patients' characteristics (sex, age, disease course). This study shows that most aspects of MS disability can be self-assessed by patients, and suggest a useful approach when it is not feasible to examine each MS patient as in large community-based studies. Collaborative studies for defining and validating auto-questionnaires on disability should be encouraged.
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43
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Amarenco P, Lévy C, Cohen A, Touboul PJ, Roullet E, Bousser MG. Causes and mechanisms of territorial and nonterritorial cerebellar infarcts in 115 consecutive patients. Stroke 1994; 25:105-12. [PMID: 8266355 DOI: 10.1161/01.str.25.1.105] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Territorial cerebellar infarcts have mainly a thromboembolic mechanism. Cerebellar infarcts less than 2 cm in diameter have recently been reported as nonterritorial infarcts, but it is not clear whether they are low-flow or embolic infarcts. The aim of the present study was to compare the characteristics and causes of territorial and nonterritorial infarcts in a prospective series of 115 patients. METHODS We collected data from 115 consecutive patients with cerebellar infarcts (79 territorial and 36 nonterritorial [ie, less than 2 cm]), using magnetic resonance imaging (88 patients) and computed tomography. RESULTS Patients with territorial infarcts and those with nonterritorial infarcts had similar vascular risk factors and clinical presentations and an equal frequency of cardiac source of embolism (32% versus 42%; P = NS) and of large artery occlusive disease (23% versus 19%; P = NS). Occlusive lesions of large arteries at angiography occurred at the level of one cerebellar artery (5% versus 0%; P = NS) and proximal to the ostia of the cerebellar arteries (18% versus 19%; P = NS). Infarcts distal to occlusive lesions were subdivided into unilateral vertebral artery occlusive disease (presumed artery-to-artery embolic mechanism; 18% versus 5%; P = NS) and low-flow state distal to bilateral vertebral or basilar artery occlusion (presumed hemodynamic mechanism; 0% versus 14%; P = .004). Patients with nonterritorial infarcts had more frequent hypercoagulable state (17% versus 1.25%; odds ratio, 15.6 [95% confidence interval, 1.8 to 135]). For the remaining patients, the mechanism of the infarct was unknown (34% versus 22%; P = NS). CONCLUSIONS Cerebellar infarcts less than 2 cm in diameter (ie, nonterritorial) have the same high rate of embolic mechanism as territorial infarcts (47% versus 49%; P = NS), have more frequent hypercoagulable state, and sometimes have a hemodynamic mechanism.
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Affiliation(s)
- P Amarenco
- Department of Neurology, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France
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44
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Roullet E, Verdier-Taillefer MH, Amarenco P, Gharbi G, Alperovitch A, Marteau R. Pregnancy and multiple sclerosis: a longitudinal study of 125 remittent patients. J Neurol Neurosurg Psychiatry 1993; 56:1062-5. [PMID: 8410003 PMCID: PMC1015232 DOI: 10.1136/jnnp.56.10.1062] [Citation(s) in RCA: 91] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The relationship between pregnancy and multiple sclerosis (MS) was assessed in a clinic-based, prospectively followed, population of 125 patients with a remittent onset of MS who had been followed for a mean (SD) of 10.3 (0.1) years. Thirty three women had a total of 49 pregnancies of which 32 had been full term and 17 terminated. There was a three-fold increase in the relapse rate per year during the first three months following delivery, compared with the baseline period of the same patients [1.62(0.38) vs 0.51(0.08) p = 0.05]. During pregnancy itself, the relapse-rate was not different from baseline. The overall relapse rate of the pregnancy group was lower than that of a control group without pregnancies after MS onset, but similar to that of patients who had children after MS onset, but no pregnancy during follow up. Pregnancy did not lead to increased disability. These results confirm that post partum increase in relapse rate is the main event related to pregnancy in MS and underline the difficulties of undertaking prospective studies in this field.
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Affiliation(s)
- E Roullet
- Service de Neurologie, Hôpital Saint-Antoine, Paris, France
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45
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Abstract
A panel of autoantigens (myosin, actin, myelin basic protein MBP, and thyroglobulin) was used to analyze antigen recognition by the peripheral blood leukocytes (PBL) of patients with active and stable multiple sclerosis (MS), patients with other neurological diseases (OND) and healthy individuals. The immune responsiveness was studied by examining the in vitro cell proliferation and the increase in the expression of two T-cell-surface activation markers (the interleukin-2 receptor IL-2R, and a late activation antigen recognized by the 19.2 monoclonal antibody). In MS, autoantigen recognition occurred more frequently than in the other groups and it was manifested by moderate proliferation or marked elevation of the expression of the IL-2R, whereas autoantigen recognition in the other groups concerned essentially the expression of the late activation antigen. Results similar to those described above were obtained with enriched T lymphocytes either in the presence or absence of IL-2. Our results suggest that the peripheral immune system in MS patients may recognize and can be activated by different autoantigens and not only by MBP, and that this response is quantitatively and qualitatively different from that of PBL from OND patients and healthy individuals.
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Affiliation(s)
- P Matsiota-Bernard
- URA 359 du CNRS, Unité d'Immunocytochimie, Institut Pasteur, Paris, France
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46
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Gozlan J, Salord JM, Roullet E, Baudrimont M, Caburet F, Picard O, Meyohas MC, Duvivier C, Jacomet C, Petit JC. Rapid detection of cytomegalovirus DNA in cerebrospinal fluid of AIDS patients with neurologic disorders. J Infect Dis 1992; 166:1416-21. [PMID: 1331255 DOI: 10.1093/infdis/166.6.1416] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.4] [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: 12/26/2022] Open
Abstract
A polymerase chain reaction (PCR)-based method was used to detect cytomegalovirus (CMV) DNA in 82 cerebrospinal fluid (CSF) samples from 67 patients infected by human immunodeficiency virus (HIV). The test was positive for 14 patients, 8 of whom had CMV-related neurologic disease proven by viral culture of CSF or histologic examination. Encephalitis was the most frequent manifestation in patients with positive PCR results, but CMV DNA was also present in some patients with peripheral neuropathy or polyradiculomyelitis. All patients with proven CMV neurologic disease were positive by PCR. In contrast, viral culture was negative for 4 of the 8 patients and pathologic studies were available only for 5. The specificity of the PCR-based assay could not be assessed precisely because of the lack of a reference standard, but the results correlated well with clinical course and results of the other methods. These findings suggest that the PCR-based method may be a useful noninvasive tool for the rapid diagnosis of CMV-related neurologic disease.
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Affiliation(s)
- J Gozlan
- Service de Bactériologie-Virologie, Hôpital Saint-Antoine, Paris, France
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Gherardi RK, Mhiri C, Baudrimont M, Roullet E, Berry JP, Poirier J. Iron pigment deposits, small vessel vasculitis, and erythrophagocytosis in the muscle of human immunodeficiency virus-infected patients. Hum Pathol 1991; 22:1187-94. [PMID: 1748426 DOI: 10.1016/0046-8177(91)90100-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Hemosiderin deposition and vascular inflammation were evaluated in muscle specimens from 50 human immunodeficiency virus (HIV)-infected individuals with neuromuscular symptoms. Iron deposits were detected in 25 of 50 cases, and were found more frequently in the distal muscles of lower limbs than in proximal muscles (22 of 30 cases v three of 20 cases; P less than .001). The incidence was higher than in controls (P less than .01). Polyarteritis nodosa was observed in three cases and microvascular inflammation was observed in 27. Direct immunofluorescence showed deposits of both immunoglobulins (mainly immunoglobulin M) and complement in small vessel walls of 19 of 34 patients. The p17 and p24 HIV antigens were detected in three of 27 cases. Both T8 lymphocytes and macrophages were significantly more numerous in patients with Perls'-positive material; these patients also showed vascular inflammation more frequently. Other findings included noninflammatory microangiopathy (18 cases), tubuloreticular inclusions in endothelial cells (one case), and free and intracytoplasmic eosinophilic globules likely representing digested erythrocytes (seven cases). The present study shows that iron pigment deposition in skeletal muscle is a nonspecific finding, frequently observed in the lower extremities of HIV-infected individuals, where it reflects immunopathologic alterations of the microcirculation. Erythrophagocytosis, which may be observed in the muscle of some HIV-infected individuals, may also be implicated.
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Affiliation(s)
- R K Gherardi
- Département de Pathologie (Neuropathologie), Hôpital Henri Mondor, Créteil, France
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48
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Amarenco P, Roullet E, Hannoun L, Marteau R. Progressive supranuclear palsy as the sole manifestation of systemic Whipple's disease treated with pefloxacine. J Neurol Neurosurg Psychiatry 1991; 54:1121-2. [PMID: 1723749 PMCID: PMC1014700 DOI: 10.1136/jnnp.54.12.1121-a] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
A patient with isolated cerebellar dysarthria is reported. Computed tomography showed a small infarct in the left paravermal zone of the rostal cerebellum (lobulus simplex and semilunaris superior) in the territory of the medial branch of the superior cerebellar artery. This patient demonstrates the important role of this area of cerebellum in the control of voice.
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Affiliation(s)
- P Amarenco
- Service de Neurologie, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris, France
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50
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Mhiri C, Baudrimont M, Bonne G, Geny C, Degoul F, Marsac C, Roullet E, Gherardi R. Zidovudine myopathy: a distinctive disorder associated with mitochondrial dysfunction. Ann Neurol 1991; 29:606-14. [PMID: 1892364 DOI: 10.1002/ana.410290607] [Citation(s) in RCA: 162] [Impact Index Per Article: 4.9] [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: 12/29/2022]
Abstract
Muscle biopsy specimens were obtained from 48 human immunodeficiency virus-infected patients suffering from various neuromuscular symptoms. Microscopic examination by conventional and electron microscopy revealed a characteristic structural myopathy associated with mitochondrial changes in 13 patients, all of whom had received long-term zidovudine therapy. The mean cumulative dose they had received (498 +/- 145 gm) was significantly higher than that of the other 14 zidovudine recipients of the study. They suffered from a progressive, usually painful, proximal myopathy with pronounced wasting, normal-to-moderately elevated creatine kinase levels, and a myopathic electromyographic pattern. The condition usually improved after withdrawal of the drug. Assay of mitochondrial enzymes, including succinate-cytochrome c reductase, cytochrome c oxidase, and citrate synthase, showed a decline in respiratory chain capacity. Southern blot analysis of mitochondrial DNA showed no abnormality. It is likely that mitochondrial dysfunction, probably resulting from drug-induced inhibition of the mitochondrial DNA polymerase, is implicated in the pathogenesis of this complication of zidovudine therapy.
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Affiliation(s)
- C Mhiri
- Département de Pathologie (Unités de Médecine Légale et de Neuropathologie), Hôpital Henri Mondor, Créteil, France
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