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Nuzhnyi EP, Antonova KV, Tanashyan MM, Illarioshkin SN. [Neurological manifestations of hypoparathyroidism: diagnostic difficulties. Case report]. TERAPEVT ARKH 2023; 95:864-869. [PMID: 38159019 DOI: 10.26442/00403660.2023.10.202429] [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: 05/14/2022] [Indexed: 01/03/2024]
Abstract
Hypoparathyroidism is a rare condition characterized by reduced production of parathyroid hormone or tissue resistance which leads to hypocalcemia and hyperphosphatemia. Neurological manifestations often occur as the first symptoms of hypoparathyroidism and are characterized by a wide variety of symptoms of both the central and peripheral nervous systems dysfunction, which requires a differential diagnosis with a wide range of neurological diseases. Two clinical cases illustrating the features of subacute and chronic hypoparathyroidism are presented. In the case of subacute hypoparathyroidism, a young woman presented with severe tetany involving the oculomotor muscles (paroxysmal strabismus), laryngeal muscles (respiratory stridor), body muscles (opisthotonus, «obstetrician's hand») and the development of secondary myopathy. In another case with a long-term chronic course of postoperative hypoparathyroidism, the patient's adaptation to severe hypocalcemia was noted; the clinical features were dominated by cerebral syndromes due to brain structures calcification (Fahr's syndrome). Possible reasons for late diagnosis of hypoparathyroidism, the importance of active detection of symptoms of neuromuscular hyperexcitability and laboratory testing of phosphorus and calcium metabolism are discussed.
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Nuzhnyi EP, Arestova AS, Rossokhin AV, Protopopova AO, Abramycheva NY, Suponeva NA, Illarioshkin SN. Case report: A novel CACNA1S mutation associated with hypokalemic periodic paralysis. Front Neurol 2023; 14:1267426. [PMID: 37840943 PMCID: PMC10570449 DOI: 10.3389/fneur.2023.1267426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Background Hypokalemic periodic paralysis (HypoKPP) is a rare neuromuscular genetic disorder causing recurrent episodes of flaccid paralysis. Most cases are associated with CACNA1S mutation, causing defect of calcium channel and subsequent impairment of muscle functions. Due to defined management approaches early diagnosis is crucial for promptly treatment and prevention new attacks. Materials and methods We report a case of HypoKPP associated with previously unreported mutation in CACNA1S gene (p.R900M). Molecular modeling of CaV1.1 was applied to evaluate its pathogenicity. Results As a patient referred between attacks neurological status, laboratory and neurophysiological examination were unremarkable. Molecular modeling predicted that the p.R900M mutation affects the process of calcium channels activation. Conclusion Novel CACNA1S mutation, associated with HypoKPP was identified. Monte-Carlo energy minimization of the CaV1.1 model supported the association of this mutation with this disease.
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Nuzhnyi EP, Brsikyan LA, Fedotova EY, Illarioshkin SN. [Cerebellar degeneration associated with HIV infection]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:123-130. [PMID: 37315251 DOI: 10.17116/jnevro2023123051123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To describe the features of the clinical presentation and evaluate the incidence of HIV-associated cerebellar degeneration in patients with progressive cerebellar ataxia. MATERIAL AND METHODS Three hundred and seventy-seven patients with progressive cerebellar ataxia were studied. Brain MRI study, assessment by the Scale for the Assessment and Rating of Ataxia (SARA), screening for cognitive impairment by the Montreal Cognitive Assessment Scale (MoCA) were performed. In patients with HIV infection, autoimmune, deficient and other causes of ataxia, as well as opportunistic infections, multiple system atrophy and frequent forms of hereditary spinocerebellar ataxias were excluded. RESULTS Five patients (1.3%) were identified with a combination of cerebellar ataxia and HIV infection (2 men, 3 women, aged 31 to 52 years). The median duration of HIV infection was 5 years, the duration of ataxia was 1 year. In the clinical findings, in addition to progressive ataxia, pyramidal signs, dysphagia, less often ophthalmoparesis, dystonia, postural hand tremor, affective and mild cognitive impairment were observed. In three patients, brain MRI revealed signs of olivopontocerebellar atrophy, two patients had isolated cerebellar degeneration (mainly of the vermis). All patients received combination of antiretroviral therapy in various regimens, but despite this, ataxia was progressive. CONCLUSION HIV infection is a rare cause of cerebellar degeneration. This diagnosis remains a diagnosis of exclusion to this day. Cerebellar degeneration can occur and progress even after achieving a stable remission of HIV infection while taking highly active antiretroviral therapy.
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Affiliation(s)
- E P Nuzhnyi
- Research Center of Neurology, Moscow, Russia
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Korshunova ES, Korshunov MN, Nuzhnyi EP, Zakroyshhikova IV, Zabirova AK, Korshunov DM, N SA, Darenkov SP. [Neurogenic overactive bladder: focus on cognitive function]. Urologiia 2021:35-40. [PMID: 34743429] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND An overactive bladder and cognitive impairment are two medical and social problems, which have an outmost importance, affecting the quality of life. Both disorders are common in the practice of a urologist, neurologist, internist, and other physicians. Parkinsons disease and multiple sclerosis are the most common neurological diseases, which often manifest by pelvic dysfunction and cognitive dysfunction. The clinician needs to understand the pathogenesis of the underlying disease and the pharmacologic properties of drugs, which can be used both in neurology and urology, as well as in other related specialties. AIM To evaluate cognitive functions in patients with neurogenic overactive bladder treated with trospium chloride. MATERIALS AND METHODS A total of 45 patients with neurological disease (28 with Parkinsons disease [group 1] and 17 with multiple sclerosis [group 2]) were included in the study. All patients had symptoms of an overactive bladder. Trospium chloride was administered in an individually adjusted dose for 12 weeks. Cognitive functions were assessed using the international Montreal Cognitive Assessment (MoCA) before and after the therapy. A change of total scores over time was assessed using the paired Wilcoxon test. The level of significance of <0.05 was used (confidence level of 95%). RESULTS A significant decrease in all studied parameters of an overactive bladder in both groups was seen. The baseline evaluation of the total score on the MoCA scale prior to the start of taking trospium chloride revealed the presence of moderate cognitive impairment (21.3+/-2.9 points) in patients of the group 1. After 12 weeks of therapy, no significant change in cognitive functions was observed (21.7+/-3.1 points; p>0.05). In group 2, moderate cognitive impairment (MoCA 22.5+/-3.7 points) was found at baseline. After taking trospium chloride, no significant changes were noted (MoCA 22.9+/-4.1 points) (p>0.05). No central nervous system side effects were reported in any group. CONCLUSION Trospium chloride is an effective drug, which does not affect cognitive functions in patients with neurogenic overactive bladder. This drug is safe to use in both Parkinsons disease and multiple sclerosis, considering the low risk of cognitive impairment in polypharmacy.
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Affiliation(s)
- E S Korshunova
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - M N Korshunov
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - E P Nuzhnyi
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - I V Zakroyshhikova
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - A Kh Zabirova
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - D M Korshunov
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Suponeva A N
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - S P Darenkov
- FGBNU Research Center of Neurology, Moscow, Russia
- FGBU Central state medical academy of Administrative Directorate of the President of Russian Federation, Moscow, Russia
- A.I. Evdokimovs Moscow State University of Medicine and Dentistry, Moscow, Russia
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Nuzhnyi EP, Abramycheva NY, Klyushnikov SA, Seliverstov YA, Vetchinova AS, Pogoda TV, Ershova MV, Fedotova EY, Illarioshkin SN. [Diagnostic algorithm for autosomal recessive ataxia]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:74-82. [PMID: 31626222 DOI: 10.17116/jnevro201911909174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To develop a complex algorithm for autosomal recessive ataxia (ARA) diagnosis applicable for Russian patients with degenerative ataxias. MATERIAL AND METHODS 48 patients with of presumably degenerative ataxias were examined. Clinical evaluation was performed with the use of the SARA and ICARS scales (for ataxia) and MoCA (cognitive functions), and a set of laboratory tests was carried out, including electromyography, brain MRI, and DNA analysis of mutations responsible for Friedreich's disease and spinocerebellar ataxias (SCAs) types 1, 2, 3, 6 and 17. 28 patients underwent mutation screening using a multigenic MPS panel. RESULTS 8 patients (16.7%) with non-hereditary causes of ataxia were identified: cerebellar alcoholic degeneration (n = 6) and multiple system atrophy of cerebellar type (n = 2); 3 patients (6.3%) with genetic ataxias were identified using routine DNA tests, such as with SCA type 1, 2 and 17, and 9 (18.8%) patients with Friedreich's disease. The MPS panel enabled molecular diagnosis of ARA in 8 patients (28.6%): ataxia-telangiectasia (n = 2), SANDO syndrome (n = 2), ataxia with oculomotor apraxia type 2 (n = 1), SCAR10 (n = 1), SCAR16 (n = 1), and atypical form of neuroaxonal dystrophy (n = 1). The diagnosis was not established in 20 patients. CONCLUSION We have proposed an appropriate algorithm for degenerative ataxia diagnosis which is recommended to be used when examining patients with sporadic and autosomal recessive cases of the disorders with dyscoordination of movements.
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Affiliation(s)
- E P Nuzhnyi
- Research Center of Neurology, Moscow, Russia
| | | | | | | | | | - T V Pogoda
- Research Center of Neurology, Moscow, Russia
| | - M V Ershova
- Research Center of Neurology, Moscow, Russia
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Nuzhnyi EP, Yakimovskii AF, Timofeeva AA, Usenko TS, Nikolaev MA, Emelyanov AK, Amosov VI, Bubnova EV, Boukina AM, Zakharova EY, Pchelina SN. [Mutation del 1,02kb in the CLN3 gene and extrapyramidal syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:50-53. [PMID: 27635612 DOI: 10.17116/jnevro20161168150-53] [Citation(s) in RCA: 2] [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: 11/17/2022]
Abstract
Mutations in the GBA and SMPD1 genes, which lead to the development of lysosomal storage diseases, are high risk factors for Parkinson's disease and dementia with Lewy bodies. We screened the mutations in the GALC and CLN3 genes in patients with Parkinson's disease and control subjects. A heterozygous CLN3 mutation (del 1.02 kb) carrier with clinical features of the unusual extrapyramidal syndrome was identified. A role of CLN3 mutations in the development of neurodegenerative disorders is discussed.
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Affiliation(s)
- E P Nuzhnyi
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - A F Yakimovskii
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - A A Timofeeva
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - T S Usenko
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia; Konstantinov St. Petersburg Institute of Nuclear Physics, St. Petersburg, Russia
| | - M A Nikolaev
- Konstantinov St. Petersburg Institute of Nuclear Physics, St. Petersburg, Russia
| | - A K Emelyanov
- Konstantinov St. Petersburg Institute of Nuclear Physics, St. Petersburg, Russia
| | - V I Amosov
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | - E V Bubnova
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia
| | | | | | - S N Pchelina
- Pavlov First St. Petersburg State Medical University, St. Petersburg, Russia; Konstantinov St. Petersburg Institute of Nuclear Physics, St. Petersburg, Russia
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Pchelina SN, Nuzhnyi EP, Emelyanov AK, Boukina TM, Usenko TS, Nikolaev MA, Salogub GN, Yakimovskii AF, Zakharova EY. Increased plasma oligomeric alpha-synuclein in patients with lysosomal storage diseases. Neurosci Lett 2014; 583:188-93. [PMID: 25265039 DOI: 10.1016/j.neulet.2014.09.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 09/08/2014] [Accepted: 09/18/2014] [Indexed: 01/14/2023]
Abstract
A link between lysosomal storage diseases (LSDs) and neurodegenerative disorders associated with accumulation of presynaptic protein alpha-synuclein has been shown. Particularly, Gaucher disease (GD) patients with a deficiency of the lysosomal enzyme glucocerebrosidase (GBA) and carriers of GBA mutations are at increased risk of Parkinson's disease (PD). It remains unclear whether this link is due to increased alpha-synuclein oligomerization. Here we show that level of oligomeric alpha-synuclein form, associated with PD development, is increased in plasma of GD patients (n=41, median=22.9pg/mL, range1.57-444.58pg/mL; controls (n=40, median=6.02pg/mL, range 1.05-103.14pg/mL, p<0.0001). This difference is absent in GD patients receiving enzyme replacement therapy (ERT) for more than 5 years. Moreover, the levels of alpha-synuclein oligomers in plasma are also higher in patients with other LSDs (Niemann-Pick type C, Krabbe disease, Wolman disease) compared to the median value in controls. Therefore, we suggest that mutations in the GBA gene and at least in several other LSDs genes may be associated with an increase in oligomeric alpha-synuclein in plasma. ERT applied for recovering of GBA functions in GD treatment might decrease formation of plasma oligomeric alpha-synuclein.
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Affiliation(s)
- S N Pchelina
- Petersburg Nuclear Physics Institute, St. Petersburg, Russia; First Pavlov's State Medical University of Saint-Petersburg, St. Petersburg, Russia; St. Petersburg Academic University - Nanothecnology Research and Education Centre, RAS, St. Petersburg, Russia.
| | - E P Nuzhnyi
- First Pavlov's State Medical University of Saint-Petersburg, St. Petersburg, Russia
| | - A K Emelyanov
- Petersburg Nuclear Physics Institute, St. Petersburg, Russia; First Pavlov's State Medical University of Saint-Petersburg, St. Petersburg, Russia; St. Petersburg Academic University - Nanothecnology Research and Education Centre, RAS, St. Petersburg, Russia
| | - T M Boukina
- Medical-genetics Scientific Center, Moscow, Russia
| | - T S Usenko
- Petersburg Nuclear Physics Institute, St. Petersburg, Russia; First Pavlov's State Medical University of Saint-Petersburg, St. Petersburg, Russia
| | - M A Nikolaev
- Petersburg Nuclear Physics Institute, St. Petersburg, Russia; St. Petersburg Academic University - Nanothecnology Research and Education Centre, RAS, St. Petersburg, Russia
| | - G N Salogub
- First Pavlov's State Medical University of Saint-Petersburg, St. Petersburg, Russia
| | - A F Yakimovskii
- First Pavlov's State Medical University of Saint-Petersburg, St. Petersburg, Russia
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