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Tozza S, Palumbo G, Severi D, Iovino A, Spina E, Aruta F, Cassano E, Iodice R, Dubbioso R, Ruggiero L, Nolano M, Santoro L, Manganelli F. Heterogenous electrophysiological features in early stage of hereditary transthyretin amyloidosis neuropathy. Neurol Sci 2024; 45:1685-1689. [PMID: 37870643 PMCID: PMC10942904 DOI: 10.1007/s10072-023-07140-w] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Hereditary transthyretin-mediated amyloidosis (ATTRv, v for variant) is a progressive disease caused by mutations in the TTR gene, leading to sensory-motor, axonal and length-dependent neuropathy. However, some patients may show variable electrophysiological pattern. The aim of this study was to evaluate the electrophysiological features of TTR amyloid neuropathy at the time of the first nerve conduction study (NCS) to assess whether there were distinguishing features useful for early diagnosis. METHODS We retrospectively revised the first electrophysiological findings of ATTRv patients, and we categorized the neuropathy based on nerve conduction slowing, type of involved fibres and distribution pattern of PNS involvement. Cluster analysis was performed to evaluate the prevalence of neuropathy features between the early and late stage of disease, based on disease duration and disability burden assessed by NIS. RESULTS We recruited 33 patients (27 males) with mean age 63.9 ± 10.8 years, mean disease duration 2.8 ± 2.4 years and mean NIS 47.6 ± 41.8. Overall, the frequency analysis showed that the most common features of ATTRv neuropathy included the categories of axonal, sensory-motor and neuronopathic-like pattern. This electrophysiological pattern of PNS involvement was constant in patients in late stage of disease, whereas ATTRv patients in early stage of disease displayed variable electrophysiological pattern of PNS involvement. DISCUSSION Our findings demonstrated that ATTRv neuropathy may present at first NCS in a variable way, and it changes over the course of disease. Such heterogeneity makes the suspicion of ATTRv even more challenging at the time of first electrophysiological examination.
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Affiliation(s)
- Stefano Tozza
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Giovanni Palumbo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Daniele Severi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Aniello Iovino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Francesco Aruta
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Emanuele Cassano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
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Severi D, Aruta F, Iovino A, Spina E, Nolano M, Manganelli F, Tozza S. Can we identify hereditary TTR amyloidosis by the screening of carpal tunnel syndrome patients? Neurol Sci 2022; 43:3435-3438. [DOI: 10.1007/s10072-021-05851-6] [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] [Received: 12/01/2021] [Accepted: 12/20/2021] [Indexed: 10/19/2022]
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Capaldo G, Pelosi C, Corbo A, Fiori P, Massarelli M, Allegorico L, Aruta F, Romano P, Rinaldi R, Monaco A, Santorelli FM, Bellizzi A, Ruggiero L. Mitochondrial neuro-gastro-intestinal encephalomyopathy: A case report. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.119371] [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: 11/30/2022]
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Capasso N, Palladino R, Montella E, Pennino F, Lanzillo R, Carotenuto A, Petracca M, Iodice R, Iovino A, Aruta F, Pastore V, Buonomo AR, Zappulo E, Gentile I, Triassi M, Morra VB, Moccia M. Prevalence of SARS-CoV-2 antibodies in multiple sclerosis: The hidden part of the iceberg. J Neurol Sci 2021. [PMCID: PMC8498489 DOI: 10.1016/j.jns.2021.118116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Aruta F, Severi D, Iovino A, Spina E, Barghigiani M, Ruggiero L, Iodice R, Santorelli FM, Manganelli F, Tozza S. Proximal weakness involvement in the first Italian case of Charcot-Marie-Tooth 2CC harboring a novel frameshift variant in NEFH. J Peripher Nerv Syst 2021; 26:231-234. [PMID: 33987933 DOI: 10.1111/jns.12454] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/13/2022]
Abstract
Charcot-Marie-Tooth (CMT) diseases are a clinically and genetically heterogeneous group of disorders. Different variants in the neurofilament heavy chain (NEFH) gene have been described to cause the CMT2CC subtype. Here we report the first Italian patient affected by CMT2CC, harboring a novel variant in NEFH. In describing our patient, we also reviewed previously CMT2CC individuals, and suggested to consider NEFH variant if patients have an axonal sensory-motor neuropathy with a prominent proximal muscles involvement with early requirement of walking aids or wheelchair, remembering a motor neuron disorder.
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Affiliation(s)
- Francesco Aruta
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Daniele Severi
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | | | - Lucia Ruggiero
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | | | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
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Tozza S, Severi D, Spina E, Iovino A, Aruta F, Ruggiero L, Dubbioso R, Iodice R, Nolano M, Manganelli F. The neuropathy in hereditary transthyretin amyloidosis: A narrative review. J Peripher Nerv Syst 2021; 26:155-159. [PMID: 33960565 PMCID: PMC8360044 DOI: 10.1111/jns.12451] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/26/2021] [Accepted: 05/01/2021] [Indexed: 01/10/2023]
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a condition with adult onset, caused by mutation of the transthyretin (TTR) gene and characterized by extracellular deposition of amyloid fibrils in tissue, especially in the peripheral nervous system (PNS) and heart. PNS involvement leads to a rapidly progressive and disabling sensory‐motor axonal neuropathy. Although awareness among neurologists increased in recent years thanks to new treatment options, ATTRv is frequently misdiagnosed, and thus a correct diagnosis can be delayed by several years. This review aims to draw the history and features of polyneuropathy in ATTRv based on pathological and electrophysiological correlates. We assessed original articles and case reports based on their relevance to ATTRv neuropathy and we included those appropriate for the scheme of this narrative review. Amyloid fibrils initially deposit in ganglia, causing an axonal neuropathy without amyloid deposits in distal segments (eg, sural nerve biopsy). Over time, amyloid fibrils spread along the nerves, leading to some demyelinating features in the context of severe axonal loss. This review highlights how the features of neuropathy change based on type of ATTRv (early vs late onset) and stage of disease.
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Affiliation(s)
- Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Daniele Severi
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Francesco Aruta
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
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Tozza S, Bruzzese D, Severi D, Spina E, Iodice R, Ruggiero L, Dubbioso R, Iovino A, Aruta F, Nolano M, Santoro L, Manganelli F. The impact of symptoms on daily life as perceived by patients with Charcot-Marie-Tooth type 1A disease. Neurol Sci 2021; 43:559-563. [PMID: 33899151 PMCID: PMC8724072 DOI: 10.1007/s10072-021-05254-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/10/2021] [Indexed: 12/03/2022]
Abstract
Introduction In Charcot-Marie-Tooth type 1A (CMT1A) patients, daily life is mainly influenced by mobility and ambulation dysfunctions. The aim of our work was to evaluate the perception of disturbances that mostly impact on daily life in CMT1A patients and its difference on the basis of age, gender, disability, and quality of life. Methods Forty-one CMT1A patients underwent neurological assessment focused on establishing clinical disability through the Charcot-Marie-Tooth Neuropathy Score (CMTNS) and quality of life through the Short Form-36 (SF-36) questionnaire. We identified from CMT disturbances 5 categories [weakness in lower limbs (WLL), weakness in upper limbs (WUL), skeletal deformities (SD), sensory symptoms (SS), balance (B)] and patients classified the categories from the highest to the lowest impact on daily life (1: highest; 5: lowest). Ranking of the 5 categories, in the overall sample and in the different subgroups (dividing by gender, median of age and disease duration, CMTNS, domains of SF-36), was obtained and differences among subgroups were assessed using a bootstrap approach. Results Rank analysis showed that WLL was the most important disturbance on daily life whereas WUL had the lowest impact. In the older CMT1A group, the most important disturbance on daily life was B that was also the most relevant disturbance in patients with a greater disability. SD influenced daily life in younger patients. SS had less impact on daily life, with the exception of patients with a milder disability. Discussion Our findings demonstrated that the perception of disturbances that mostly impact on CMT1A patients’ daily life changes over the lifetime and with degree of disability.
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Affiliation(s)
- Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Dario Bruzzese
- Department of Public Health, University of Naples "Federico II", Naples, Italy
| | - Daniele Severi
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Aniello Iovino
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Francesco Aruta
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Lucio Santoro
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
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Iovino A, Aruta F, Dubbioso R, Ruggiero L, Tozza S, Spina E, Manganelli F, Iodice R. Primary Progressive Multiple Sclerosis Under Anti-TNFα Treatment: A Case Report. J Cent Nerv Syst Dis 2021; 12:1179573520973820. [PMID: 33424233 PMCID: PMC7755935 DOI: 10.1177/1179573520973820] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 10/24/2020] [Indexed: 11/17/2022] Open
Abstract
Antagonists of tumour necrosis factor α (TNFα) are a common therapeutic choice for autoimmune diseases. Although they are effective and relatively safe, an increasing number of immune-mediated adverse events have been reported. Among these, neurological adverse effectsm such as consisting of demyelinating events in the central and peripheral nervous system were described. Demyelination of the central nervous system is a rare complication after treatment with TNFα antagonists. Here, we report a case of multiple sclerosis under treatment with TNFα antagonists and discuss its etiopathogenesis. This 45-year-old female patient developed signs and symptoms suggestive of primary progressive multiple sclerosis during treatment with adalinumab for nodular cystic acne, and magnetic resonance imaging of the patient showed typical lesions of demyelinating disease.
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Affiliation(s)
- Aniello Iovino
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy.,Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Francesco Aruta
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Lucia Ruggiero
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Rosa Iodice
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy.,IRCCS SDN, Napoli, Naples, Italy
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Iovino A, Del Vecchio W, Aruta F, Iodice R. CLIPPERS. Pract Neurol 2020; 21:practneurol-2020-002857. [PMID: 33376153 DOI: 10.1136/practneurol-2020-002857] [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] [Accepted: 12/01/2020] [Indexed: 11/03/2022]
Abstract
We present the clinical case of a woman suffering from CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids). The images obtained from the brain magnetic resonance show the lesions typical of the disease.
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Affiliation(s)
- Aniello Iovino
- Department of Neurosciences, Reproductive and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Walter Del Vecchio
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Francesco Aruta
- Department of Neurosciences, Reproductive and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
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Ruggiero L, Iovino A, Dubbioso R, Cocozza S, Trovato R, Aruta F, Pontillo G, Barghigiani M, Brunetti A, Santorelli FM, Manganelli F, Iodice R. Multimodal evaluation of an Italian family with a hereditary spastic paraplegia and POLR3A mutations. Ann Clin Transl Neurol 2020; 7:2326-2331. [PMID: 33085208 PMCID: PMC7664249 DOI: 10.1002/acn3.51221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/29/2020] [Accepted: 09/17/2020] [Indexed: 12/27/2022] Open
Abstract
We describe an Italian family with adult‐onset pure hereditary spastic paraplegia due to biallelic variants in POLR3A gene [c.1909 + 22G > A and c.3839dupT (p.M1280fs*20]. MRI showed a mild hyperintensity of superior cerebellar peduncles and cervical spinal cord atrophy. The neurophysiological metrics about intracortical excitability showed higher values of motor thresholds and a significant reduction of short interval intracortical inhibition (SICI) in the patient with a more severe phenotype. Our multimodal evaluation further expands the wide phenotypic spectrum associated with mutations in the POLR3A gene. An extensive genotype–phenotype correlation study is necessary to explain the role of the many new mutations on the function of protein.
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Affiliation(s)
- Lucia Ruggiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Aniello Iovino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Rosanna Trovato
- Molecular Medicine, IRCCS Fondazione Stella Maris, Calambrone, Pisa, Italy
| | - Francesco Aruta
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Giuseppe Pontillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Arturo Brunetti
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | | | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University Federico II of Naples, Naples, Italy.,IRCCS SDN (Istituto di Ricovero e Cura a Carattere Scientifico), Naples, Italy
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Campana P, Flocco V, Aruta F, Cacciatore F, Abete P. Can aldosterone increase interleukin-6 levels in Covid-19 pneumonia? J Med Virol 2020; 93:622-623. [PMID: 32749708 PMCID: PMC7436813 DOI: 10.1002/jmv.26382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/25/2020] [Accepted: 08/02/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Pasquale Campana
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Veronica Flocco
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Francesco Aruta
- Department of Neuroscience, University Federico II, Naples, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Pasquale Abete
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
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Iodice R, Ugga L, Aruta F, Iovino A, Ruggiero L. Facioscapulohumeral muscular dystrophy (FSHD) and multiple sclerosis: a case report. Acta Myol 2020; 39:29-31. [PMID: 32607477 PMCID: PMC7315893 DOI: 10.36185/2532-1900-005] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 03/05/2020] [Indexed: 11/23/2022]
Abstract
Facioscapulohumeral muscular dystrophy 1 (FSHD1) is an autosomal dominant neuromuscular disorder, associated with reduction of tandemly arrayed repetitive DNA elements D4Z4 (DRA), at 4q35. Few cases, especially carriers of 1-3 DRA show a syndromic form. Anecdotally the association of FSHD with multiple sclerosis (MS) is reported. Herein we report a 33 years old Caucasian with a molecular diagnosis of FSHD1 with classical phenotype (clinical category A2) and concomitant white matter lesions suggestive of MS. White matter lesions in patients with FSHD have often been described but rarely investigated in order to evaluate a possible diagnosis of MS. We think that MS and FSHD remain clearly distinct diseases, but growing evidences show a widespread and variable activation of the immune system in patients suffering from FSHD probably an hypotheses on a potential common pathogenetic mechanism between these two disorders could should be better investigated.
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Affiliation(s)
- Rosa Iodice
- Department of Neurosciences, Odontostomatology and Reproductive Sciences, University "Federico II", Naples, Italy
| | - Lorenzo Ugga
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Francesco Aruta
- Department of Neurosciences, Odontostomatology and Reproductive Sciences, University "Federico II", Naples, Italy
| | - Aniello Iovino
- Department of Neurosciences, Odontostomatology and Reproductive Sciences, University "Federico II", Naples, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Odontostomatology and Reproductive Sciences, University "Federico II", Naples, Italy
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Aruta F, Iovino A, Costa C, Manganelli F, Iodice R. Lichenoid rash: A new side effect of oral Cladribine. Mult Scler Relat Disord 2020; 41:102023. [PMID: 32146431 DOI: 10.1016/j.msard.2020.102023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/04/2023]
Abstract
Cladribine is an approved drug for the treatment of highly active multiple sclerosis. We report a 28-years-old man with a poor response to previous treatments, elected to treatment with Cladribine. He developed a lichenoid rash two weeks after taking the first and second treatment cycles. This symptom regressed with specific therapy. A lichenoid drug eruption is a rare side effect which can occur following the administration of several different medications, but it has never been described after treatment with oral Cladribine.
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Affiliation(s)
- Francesco Aruta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples,Via Sergio Pansini, 580131 Naples Italy.
| | - Aniello Iovino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples,Via Sergio Pansini, 580131 Naples Italy
| | - Claudia Costa
- Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples,Via Sergio Pansini, 580131 Naples Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples,Via Sergio Pansini, 580131 Naples Italy
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Dubbioso R, Ruggiero L, Esposito M, Tarantino P, De Angelis M, Aruta F, Pappatà S, Ugga L, Piperno A, Iorio R, Santoro L, Iodice R, Manganelli F. Different cortical excitability profiles in hereditary brain iron and copper accumulation. Neurol Sci 2019; 41:679-685. [PMID: 31773358 DOI: 10.1007/s10072-019-04147-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 11/08/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIM Neurodegeneration with brain iron accumulation (NBIA) and Wilson's disease (WD) is considered the prototype of neurodegenerative disorders characterised by the overloading of iron and copper in the central nervous system. Growing evidence has unveiled the involvement of these metals in brain cortical neurotransmission. Aim of this study was to assess cortical excitability profile due to copper and iron overload. METHODS Three patients affected by NBIA, namely two patients with a recessive hereditary parkinsonism (PARK9) and one patient with aceruloplasminemia and 7 patients with neurological WD underwent transcranial magnetic stimulation (TMS) protocols to assess cortical excitability. Specifically, we evaluated the motor thresholds that reflect membrane excitability related to the voltage-gated sodium channels in the neurons of the motor system and the ease of activation of motor cortex via glutamatergic networks, and ad hoc TMS protocols to probe inhibitory-GABAergic (short interval intracortical inhibition, SICI; short-latency afferent inhibition, SAI; cortical silent period, CSP) and excitatory intracortical circuitry (intracortical facilitation, ICF). RESULTS Patients with NBIA exhibited an abnormal prolongation of CSP respect to HC and WD patients. On the contrary, neurological WD displayed higher motor thresholds and reduced CSP and SICI. CONCLUSION Hereditary conditions due to overload of copper and iron exhibited peculiar cortical excitability profiles that can help during differential diagnosis between these conditions. Moreover, such results can give us more clues about the role of metals in acquired neurodegenerative disorders, such as Parkinson disease, Alzheimer disease, and multiple sclerosis.
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Affiliation(s)
- Raffaele Dubbioso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy.
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marcello Esposito
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Paola Tarantino
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Marcello De Angelis
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Francesco Aruta
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Sabina Pappatà
- Institute of Biostructure and Bioimaging, National Council of Research, Via S. Pansini, 5 IT-80131, Napoli, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Alberto Piperno
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Raffaele Iorio
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples "Federico II", Naples, Italy
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