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López-Hernández JC, Galnares-Olalde J, Vargas-Cañas ES. [Authors' reply to the letter "Guillain-Barré syndrome before and during the COVID-19 pandemic"]. GAC MED MEX 2024. [PMID: 38588497 DOI: 10.24875/gmm.24000051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/29/2024] [Indexed: 04/10/2024] Open
Affiliation(s)
- Juan C López-Hernández
- Clínica de Enfermedades Neuromusculares, Instituto Nacional de Neurología y Neurocirugía "Dr. Manuel Velasco Suárez", Ciudad de México, México
- Departamento de Urgencias, Instituto Nacional de Neurología y Neurocirugía "Dr. Manuel Velasco Suárez", Ciudad de México, México
| | - Javier Galnares-Olalde
- Departamento de Neurología, Instituto Nacional de Neurología y Neurocirugía "Dr. Manuel Velasco Suárez", Ciudad de México, México
| | - Edwin S Vargas-Cañas
- Clínica de Enfermedades Neuromusculares, Instituto Nacional de Neurología y Neurocirugía "Dr. Manuel Velasco Suárez", Ciudad de México, México
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López-Hernández JC, Vargas-Cañas ES. Authors' reply to the letter "Guillain-Barré syndrome before and during the COVID-19 pandemic" in a reference center in Mexico. GAC MED MEX 2023; 159:451-452. [PMID: 38096839 DOI: 10.24875/gmm.m23000817] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Juan C López-Hernández
- Neuromuscular Diseases Clinic
- Emergency Department. Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Mexico City, Mexico
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López-Hernández JC, Vargas-Cañas ES, Estrada SA, Galnares-Olalde J. Guillain-Barre syndrome before and during the COVID-19 pandemic in a referral center of Mexico. GAC MED MEX 2023; 159:315-321. [PMID: 37699231 DOI: 10.24875/gmm.m23000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/06/2023] [Indexed: 09/14/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, an increase in the number of Guillain-Barre syndrome (GBS) cases has been reported. OBJECTIVE To describe the clinical characteristics and prognosis of patients with GBS before and during the COVID-19 pandemic. MATERIAL AND METHODS Prospective cohort of GBS patients divided in two subgroups: before (2018-2019) and during (2020-2021) the COVID-19 pandemic. Clinical and paraclinical characteristics, as well as deaths, were recorded. A good prognosis was defined as independent ambulation recovery at three months. RESULTS Two-hundred and one patients were included (123 during and 78 before the pandemic), out of whom 69% were males; age was 45 ± 16 years, and there was 2.5% of in-hospital deaths. During the pandemic, a higher frequency of the demyelinating variant (50%), bulbar cranial nerves involvement (44% vs. 28%), prior history of vaccination (16% vs. 0%), and a lower MRC score (30 ± 16.7 vs. 34.3 ± 17.7) were documented. An increase in the number of cases was observed from July to September (38 vs. 13). There were no significant differences in independent ambulation recovery or in the number of deaths. CONCLUSIONS During the COVID-19 pandemic, a higher number of GBS cases were treated, out of which 16% were associated with the SARS-CoV-2 vaccine; patients treated during the pandemic did not have a worse prognosis.
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Affiliation(s)
| | | | - S Alexander Estrada
- Neurology Department. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
| | - Javier Galnares-Olalde
- Neurology Department. Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico
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Escamilla-Ramírez A, López-Hernández JC, Díaz-Martínez R, Galnares-Olalde J, Vargas-Cañas ES. [Clinical and neurophysiological patterns of early presenting symptoms in acute onset chronic inflammatory demyelinating polyradiculoneuropathy]. Rev Neurol 2022; 75:341-347. [PMID: 36440746 DOI: 10.33588/rn.7511.2022243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The phenotypes of chronic inflammatory demyelinating polyneuropathy (CIDP) include an acute-onset phenotype (A-CIDP) with an evolution time of less than eight weeks from the onset of symptoms. This entity can be confused with Guillain-Barre syndrome of the acute inflammatory demyelinating variety (AIDP), delaying the start of treatment. OBJECTIVE To analyze the clinical and electrophysiological differences between A-CIDP, classic CIDP and AIDP, in order to identify factors that may help in the early differential diagnosis. PATIENTS AND METHODS A cross-sectional study was carried out with patients seen at the neuromuscular disease clinic of the National Institute of Neurology and Neurosurgery with a diagnosis of CIDP according to the criteria of the European Federation of Neurological Societies and Peripheral Nerve Society. Patients with CIDP <8 weeks were categorized as A-CIDP and were compared with patients diagnosed with classic CIDP and AIDP. Clinical, paraclinical and electrophysiological variables were obtained and analyzed. RESULTS Significant differences in history of infection, cranial nerve involvement and dysautonomia were observed between A-CIDP and AIDP. Electrophysiological recordings reported significant differences in motor nerve conduction velocity and sural nerve recordings, being lower in the A-CIDP group. CONCLUSION A history of infection, cranial nerve involvement and dysautonomia are important parameters to take into account for the differential diagnosis of these entities. Electrophysiological analysis is similar between A-CIDP and CIDP. The differential diagnosis between these types of demyelinating polyneuropathy must be based on clinical assessment.
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Affiliation(s)
| | - J C López-Hernández
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México.,Clínica de Enfermedades Neuromusculares, Ciudad de México, México
| | - R Díaz-Martínez
- Clínica de Enfermedades Neuromusculares, Ciudad de México, México
| | - J Galnares-Olalde
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - E S Vargas-Cañas
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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Galnares-Olalde JA, López-Hernández JC, García-Grimshaw M, Valdés-Ferrer SI, Briseño-Godínez ME, de-Sarachaga AJ, Alegría-Loyola MA, Bazán-Rodriguez A, Martínez-Jiménez E, Vargas-Cañas ES. Guillain-Barré Syndrome in Mexico: An Updated Review Amid the Coronavirus Disease 2019 ERA. Rev Invest Clin 2022; 74:121-130. [PMID: 35345064 DOI: 10.24875/ric.22000006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
Guillain-Barré syndrome (GBS) is the most frequent cause of acute flaccid paralysis and if not diagnosed and treated timely, a significant cause of long-term disability. Incidence in Latin America ranges from 0.71 to 7.63 cases/100,000 person-years. Historically, GBS has been linked to infections (mainly gastrointestinal by Campylobacter jejuni) and vaccines (including those against severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]); however, a trigger cannot be detected in most cases. Regarding SARS-CoV-2, epidemiological studies have found no association with its development. Acute motor axonal neuropathy is the most common electrophysiological variant in Mexico and Asian countries. Intravenous immunoglobulin or plasma exchanges are still the treatment cornerstones. Mortality in Mexico can be as high as 12%. Avances in understanding the drivers of nerve injury in GBS that may provide the basis for developing targeted therapies have been made during the past decade; despite them, accurate criteria for selecting patients requiring acute treatment, prognostic biomarkers, and novel therapies are still needed. The newly-developed vaccines against SARS-CoV-2 have raised concerns regarding the potential risk for developing GBS. In the midst of coronavirus disease 2019 and vaccination campaigns against SARS-CoV-2, this review discusses the epidemiology, clinical presentation, management, and outcomes of GBS in Mexico.
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Affiliation(s)
- Javier A Galnares-Olalde
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Juan C López-Hernández
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Miguel García-Grimshaw
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Sergio I Valdés-Ferrer
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - María E Briseño-Godínez
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Adib J de-Sarachaga
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | | | - Anna Bazán-Rodriguez
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Eunice Martínez-Jiménez
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
| | - Edwin S Vargas-Cañas
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, Mexico
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López-Hernández JC, Galnares-Olalde JA, Gutiérrez A, Estrada SA, García-Grimshaw M, Vargas-Cañas ES. Guillain-Barre syndrome in Mexico: clinical features and validation of Brighton Collaboration Group criteria. Rev Neurol 2022; 74:258-264. [PMID: 35383873 DOI: 10.33588/rn.7408.2021437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION As SARS-CoV-2 vaccination is ongoing in Mexico and Guillain-Barre syndrome (GBS) cases have been reported, validation of Brighton criteria in Mexico is necessary. Moreover, epidemiology of GBS in Mexico differs from European and North American countries. OBJECTIVE To describe the clinical, cerebrospinal and electrodiagnostic features in Mexican patients diagnosed with GBS and classify them according to the Brighton Collaboration Group diagnostic criteria. Patrients and methods. An ambispective cohort study was conducted. We included patients that fulfilled the National Institute of Neurological Disorders and Stroke (NINDS) diagnostic criteria for Guillain-Barre syndrome. Patients in this study were classified according to Brighton collaboration group levels of certainty for Guillain-Barre syndrome. RESULTS Sixty eight percent of patients were male. Of the 248 patients included, 58.4% had history of a precedent infection, mean time from symptom onset to admission was 5 (1-30) days. Mean Medical Research Council sum score 30.3 ± 15.5. Almost 98% of patients had a monophasic course. Level 1 of certainty according to Brighton collaboration group criteria was fulfilled by 54.6% of patients, level 2 by 45% and level 4 by 0.6%. Patients meeting level 2 of certainty were mostly because normal cerebrospinal fluid findings or findings in nerve conduction studies not consistent with any GBS variants. CONCLUSION GBS is a frequent autoimmune neuropathy that has been associated with preceding infections and with vaccination campaigns. For SARS-CoV-2 vaccination campaign in Mexico, validation of Brighton Criteria is necessary. Although Mexico's GBS epidemiology has been changing throughout recent years, this study provides similar data compared to other countries.
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Affiliation(s)
- J C López-Hernández
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - J A Galnares-Olalde
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - A Gutiérrez
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - S A Estrada
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - M García-Grimshaw
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - E S Vargas-Cañas
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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Benítez-Alonso EO, López-Hernández JC, Galnares-Olalde JA, Alcalá RE, Vargas-Cañas ES. Short-Communication: Variable Expression of Clinical Symptoms and an Unexpected Finding of Vacuolar Myopathy Related to a Pathogenic Variant in the CACNA1S Gene in a Previous Case Report. Cureus 2022; 14:e23760. [PMID: 35509735 PMCID: PMC9060183 DOI: 10.7759/cureus.23760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/05/2022] Open
Abstract
Several clinical phenotypes have been described related to the CACNA1S gene (calcium channel voltage-dependent L-type alpha-1S subunit), such as autosomal dominant hypokalemic periodic paralysis 1 and autosomal dominant malignant hyperthermia susceptibility and are associated with autosomal dominant and recessive congenital myopathy. Recently, an interesting case of a 58-year-old male patient was published describing an unusual clinical presentation of hypokalemic periodic paralysis where a late-onset limb-girdle myopathy had developed 41 years after paralysis occurred when the patient was 11 years old. Muscle biopsy results were consistent with myopathic changes and revealed the presence of vacuoles, without inflammatory reaction. Later, molecular analysis revealed a pathogenic variant c.3716G>A (p.Arg1239His) in exon 30 of the CACNA1S gene. This technical report provides an extension of the molecular findings and evaluates the clinical and histopathological relationship previously published regarding this case.
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López-Hernández JC, Pérez-Valdez EY, León-Manríquez E, Bazán-Rodríguez L, Galnares-Olalde JA, Jorge-de Saráchaga A, Briseño-Godínez ME, May-Mas RN, Vargas-Cañas ES. Guillain-Barre syndrome during COVID-19 pandemic: experience from a referral healthcare center in Mexico. Rev Neurol 2021; 73:315-320. [PMID: 34676529 DOI: 10.33588/rn.7309.2021364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION To describe clinical characteristics and electrophysiological variants of GBS cases during the pandemic, we carried out a comparative analysis between SARS-CoV2 related GBS and non-SARS-CoV2 patients and then compared to the 2019 cases. PATIENTS AND METHODS We carried out a cross-sectional study of GBS patients diagnosed according to Asbury and Cornblath criteria. We collected information on clinical and paraclinical variables. We defined a SARS-CoV-2 related GBS case according to the description of Ellul et al. We used Hadden criteria to classify the electrophysiological variants. We performed a comparative analysis between groups. RESULTS Fourty-two patients were diagnosed with GBS in 2020, men 64.2%, age 46 ± 17.4 years, patients with obesity/overweight 42.8%, previous diarrhea 31%, history of respiratory tract infection 14.2%. Guillain Barre Disability Scale = 3 points 71.4% and, cranial nerve involvement 69%. The most frequent electrophysiological variant was acute inflammatory demyelinating polyradiculoneuropathy (AIDP) 53.5%. Seven (16.6%) cases were SARS-CoV2 related, four men, age 43.4 ± 13.4 years. When comparing patients with GBS in 2020 vs patients in 2019, we observed a decrease in the previous infection history during 2020 (45.2% vs 73.3%, p-value = 0.005) and a decrease in previous respiratory infection (14.2% vs 33.3%, p = 0.045), as well as a higher frequency of cranial nerve involvement, and albuminocytologic dissociation. CONCLUSIONS SARS-CoV2 virus infection preventive measures may be impacting the presentation of post-infectious diseases such as GBS. We did not observe an increase in GBS cases during 2020. Also, the AIDP variant were more frequent in our population in the COVID-19 pandemic.
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Affiliation(s)
| | - E Y Pérez-Valdez
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - E León-Manríquez
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - L Bazán-Rodríguez
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | | | | | | | - R N May-Mas
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - E S Vargas-Cañas
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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López-Hernández JC, Mercado-Pompa A, Pérez-Torres T, Galnares-Olalde JA, Vargas-Cañas ES. Efficacy of long-term prednisone therapy in patients with chronic inflammatory demyelinating polyneuropathy (CIDP): a retrospective cohort study. Rev Neurol 2021; 73:275-281. [PMID: 34617581 DOI: 10.33588/rn.7308.2021261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Patients with CIDP respond adequately to steroid therapy and intravenous immunoglobulin (IVIG). However, few patients have access to IVIG in developing countries. Little information exists about the clinical response to steroid therapy in Latin American countries. OBJECTIVE to describe the long-term functional clinical response (24 months) to prednisone therapy in CIDP patients. MATERIAL AND METHODS A retrospective cohort was conducted. Selection included patients with definitive CIDP diagnosis according to European criteria from the Neuromuscular Diseases clinic of the National Institute of Neurology and Neurosurgery between January 2016 and December 2020. Good response to steroid therapy was defined as with improvement in at least one point on the GBS disability score. Poor response to steroid therapy was defined as patients who did not show improvement in at least one point on the GBS disability score. Patients were evaluated at 3, 6, 12, 18 and 24 months. RESULTS Forty-seven patients with CIDP were included. Half of them were male and mean age was 46±15 years. Mean time since symptom onset to diagnosis was 6 (IQR 2-12) months. The most common clinical variant was sensory-motor 57.4%, followed by acute-onset CIDP 21.3% and atypical variants 21.2%. At diagnosis our patients presented: mean GBS disability score of 3 (2.25-4) points, MRC score 39.5 ± 12 points, independent gait in 17%, mean prednisone dose of 50 mg (32.5-50). Twenty-four months after prednisone therapy, a less mean GBS disability score -1(0-2) points-, mean MRC score 56.3 ± 5.1 points, independent gait 93% and prednisone dose 1 (0-5) mg. Patients with poor three-month functional clinical response had a delay in diagnosis > 6 months (64.7% vs 27.5%) and atypical clinical variants (47% vs 6.8%). CONCLUSION CIDP patients treated with prednisone have good long-term functional clinical response. Delay in diagnosis and atypical variant are common clinical characteristics for poor functional clinical response in treatment with prednisone.
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Affiliation(s)
| | - A Mercado-Pompa
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | - T Pérez-Torres
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
| | | | - E S Vargas-Cañas
- Instituto Nacional de Neurología y Neurocirugía, Ciudad de México, México
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López-Hernández JC, Colunga-Lozano LE, Galnares-Olalde JA, Vargas-Cañas ES. Electrophysiological subtypes and associated prognosis factors of Mexican adults diagnosed with guillain-barré syndrome, a single center experience. J Clin Neurosci 2021; 86:85-86. [PMID: 33775352 DOI: 10.1016/j.jocn.2020.12.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 12/10/2020] [Indexed: 11/19/2022]
Affiliation(s)
- J C López-Hernández
- Neuromuscular Diseases Clinic, National Institute of Neurology and Neurosurgery, México City, Mexico
| | - L E Colunga-Lozano
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - J A Galnares-Olalde
- Neuromuscular Diseases Clinic, National Institute of Neurology and Neurosurgery, México City, Mexico
| | - E S Vargas-Cañas
- Neuromuscular Diseases Clinic, National Institute of Neurology and Neurosurgery, México City, Mexico.
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López-Hernández JC, Bazán-Rodríguez L, Pérez-Torres T, Delgado-García G, García-Trejo S, Cervantes-Uribe R, Jorge-de Saráchaga A, León-Manríquez E, Vargas-Cañas ES. [Vulpian-Bernhardt syndrome. Its frequency and clinical and electrophysiological features in a tertiary care centre in Mexico]. Rev Neurol 2021; 72:85-91. [PMID: 33506486 DOI: 10.33588/rn.7203.2020126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Vulpian-Bernhardt syndrome (VBS) is an atypical rare clinical phenotype of amyotrophic lateral sclerosis (ALS) that causes a significant delay in diagnosis, and thus it is important to recognise its clinical and electrophysiological features. MATERIALS AND METHODS Retrospective cross-sectional study. We reviewed the clinical records of patients diagnosed with ALS in the period from January to December 2019. Those meeting criteria for VBS were included so as to describe their frequency as well as their clinical and electrophysiological features. RESULTS Twenty patients (15.8%) met criteria for VBS; 55% were female; age at onset of symptoms was 46.6 ± 12.9 years; 40% were smokers; median delay in diagnosis was 24 (12-96) months; median time to involvement of the second body segment was 24 (12-132) months, which was lumbosacral in 65%; mean Revised Amyotrophic Lateral Sclerosis Functional Rating Scale score was 27 ± 7 points; 45% met the El Escorial criteria for ALS defined at diagnosis and 58.8% met the Awaji criteria. There were 19 nerve conduction studies and 17 electromyograms, and an abductor digiti minimi-abductor pollicis brevis (ADM/APB) ratio < 0.6 was found in 63% (split hand). CONCLUSIONS There is a significant delay in the diagnosis of motor neuron diseases in general and more particularly in VBS. Calculating the ADM/APB ratio and applying the Awaji criteria in the electrophysiology study can be a valuable aid to increase diagnostic certainty in this clinical entity.
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Affiliation(s)
- J C López-Hernández
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - L Bazán-Rodríguez
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - T Pérez-Torres
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - G Delgado-García
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - S García-Trejo
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - R Cervantes-Uribe
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - A Jorge-de Saráchaga
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - E León-Manríquez
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
| | - E S Vargas-Cañas
- Instituto Nacional de Neurología y Neurocirugía Dr. Manuel Velasco Suárez, Ciudad de México, México
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