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Echaniz-Laguna A, Cauquil C, Chanson JB, Tard C, Guyant-Marechal L, Kuntzer T, Ion IM, Lia AS, Bouligand J, Poinsignon V. EGR2 gene-linked hereditary neuropathies present with a bimodal age distribution at symptoms onset. J Peripher Nerv Syst 2023; 28:359-367. [PMID: 37306961 DOI: 10.1111/jns.12572] [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: 05/03/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Mutations in the Early-Growth Response 2 (EGR2) gene cause various hereditary neuropathies, including demyelinating Charcot-Marie-Tooth (CMT) disease type 1D (CMT1D), congenital hypomyelinating neuropathy type 1 (CHN1), Déjerine-Sottas syndrome (DSS), and axonal CMT (CMT2). METHODS In this study, we identified 14 patients with heterozygous EGR2 mutations diagnosed between 2000 and 2022. RESULTS Mean age was 44 years (15-70), 10 patients were female (71%), and mean disease duration was 28 years (1-56). Disease onset was before age 15 years in nine cases (64%), after age 35 years in four cases (28%), and one patient aged 26 years was asymptomatic (7%). All symptomatic patients had pes cavus and distal lower limbs weakness (100%). Distal lower limbs sensory symptoms were observed in 86% of cases, hand atrophy in 71%, and scoliosis in 21%. Nerve conduction studies showed a predominantly demyelinating sensorimotor neuropathy in all cases (100%), and five patients needed walking assistance after a mean disease duration of 50 years (47-56) (36%). Three patients were misdiagnosed as inflammatory neuropathy and treated with immunosuppressive drugs for years before diagnosis was corrected. Two patients presented with an additional neurologic disorder, including Steinert's myotonic dystrophy and spinocerebellar ataxia (14%). Eight EGR2 gene mutations were found, including four previously undescribed. INTERPRETATION Our findings demonstrate EGR2 gene-related hereditary neuropathies are rare and slowly progressive demyelinating neuropathies with two major clinical presentations, including a childhood-onset variant and an adult-onset variant which may mimic inflammatory neuropathy. Our study also expands the genotypic spectrum of EGR2 gene mutations.
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Affiliation(s)
- Andoni Echaniz-Laguna
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France
- French National Reference Centre for Rare Neuropathies (CERAMIC), Le Kremlin-Bicêtre, France
- INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Cécile Cauquil
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France
- French National Reference Centre for Rare Neuropathies (CERAMIC), Le Kremlin-Bicêtre, France
| | - Jean-Baptiste Chanson
- Department of Neurology and Nord/Est/Ile de France Neuromuscular Reference Center, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Céline Tard
- U1172, Department of Neurology, CHU de Lille, Centre de référence des maladies neuromusculaires Nord/Est/Ile-de-France, Lille, France
| | | | - Thierry Kuntzer
- Nerve-Muscle unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | | | - Anne-Sophie Lia
- Centre Hospitalo-Universitaire (CHU) Limoges, Service de Biochimie et de Génétique Moléculaire, Limoges, France
| | - Jérôme Bouligand
- Department of Molecular Genetics Pharmacogenomics and Hormonology, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - Vianney Poinsignon
- Department of Molecular Genetics Pharmacogenomics and Hormonology, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France
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Leonte MA, Castelnovo G, Ion IM. La toxicité Duodopa révélée par une neuropathie caméléon. Rev Neurol (Paris) 2023. [DOI: 10.1016/j.neurol.2023.01.068] [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: 03/29/2023]
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El Houjeiry E, Ion IM. Étude électrophysiologique chez les patients CANVAS. Rev Neurol (Paris) 2023. [DOI: 10.1016/j.neurol.2023.01.423] [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: 03/29/2023]
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Abstract
CONTEXT Posterior spinal cord lesions are found in patients with ganglionopathy. These are normally found in later stages of the neuronopathy as a consequence of dorsal root ganglia degeneration. Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome (CANVAS) is an emerging neurological disorder. Myelitis lesions have been described in confirmed CANVAS cases. FINDINGS We describe a case of a 68-year-old woman with slowly progressive ataxia with paresthesia. Laboratory tests were normal. Total spine MRI showed a C4 posterior spinal cord lesion. Lumbar puncture was positive for oligoclonal bands with normal IgG index and protein level. Paraneoplastic antibodies were not detected. Electromyography showed nonlength dependent sensory neuropathy. The patient was treated with intravenous immunoglobulin for suspected dysimmune myelitis. Over 6 years, she progressively developed other neurological manifestations evoking CANVAS. Nerve conduction study showed isolated sensory impairment over the years and peripheral nerve ultrasound revealed abnormally small nerves. Further genetic testing confirmed the diagnosis. CONCLUSION This is the first case of CANVAS syndrome presenting initially with an isolated spinal cord lesion mimicking dysimmune myelitis. The purpose of this case report is to add to the current literature about this evolving neurological syndrome and to aid clinicians in their diagnostic approach in clinical practice.
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Affiliation(s)
| | - Sarah Coudray
- Department of Neurophysiology, Nimes University Hospital, Nimes, France
| | - Eric Thouvenot
- Department of Neurology, Nimes University Hospital, Nimes, France.,IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Ioana Maria Ion
- Department of Neurology, Nimes University Hospital, Nimes, France
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Moranne O, Ion IM, Cezar R, Messikh Z, Prelipcean C, Chkair S, Thouvenot E, Tran TA, Corbeau P, Chevallier T. Protocol of comparison of the effects of single plasma exchange and double filtration plasmapheresis on peripheral lymphocyte phenotypes in patients with Chronic Inflammatory Demyelinating Polyradiculoneuropathy: a monocentric prospective study with single-case experimental design. BMC Neurol 2022; 22:293. [PMID: 35931957 PMCID: PMC9354281 DOI: 10.1186/s12883-022-02816-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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), a rare disorder affecting young adults, causes gradual weakness of the limbs, areflexia and impaired sensory function. New CIDP phenotypes without pathogenic antibodies but with modified cell profiles have been described. Treatments include corticotherapy, intravenous immunoglobulins, and plasmapheresis but the latter's action mechanisms remain unclear. Plasmapheresis supposedly removes toxic agents like antibodies from plasma but it is uncertain whether it has an immune-modulating effect. Also, the refining mechanisms of the two main plasmapheresis techniques-single plasma exchange and double filtration plasmapheresis (DFPP) - are different and unclear. This study aims to compare the evolution of peripheral lymphocyte profiles in patients with CIDP according to their treatment (single centrifugation plasmapheresis or DFPP) to better grasp the action mechanisms of both techniques. METHOD In this proof-of-concept, monocentric, prospective, Single-Case Experimental Design study, 5 patients are evaluated by alternating their treatment type (single plasma exchange or DFPP) for 6 courses of treatment after randomization to their first treatment type. Each course of treatment lasts 2-4 weeks. For single plasma exchange, 60 ml/kg plasma will be removed from the patient and replaced with albumin solutes, with a centrifugation method to avoid the immunological reaction caused by the membrane used with the filtration method. For DFPP, 60 ml/kg plasma will be removed from the patient with a plasma separator membrane, then processed via a fractionator membrane to remove molecules of a greater size than albumin before returning it to the patient. This technique requires no substitution solutes, only 20 g of albumin to replace what would normally be lost during a session. The primary outcome is the difference between the two plasmapheresis techniques in the variation of the TH1/TH17 ratio over the period D0H0-D0H3 and D0H0-D7. Secondary outcomes include the variation in lymphocyte subpopulations at each session and between therapeutic plasmapheresis techniques, the clinical evolution, tolerance and cost of treatments. DISCUSSION Understanding the action mechanisms of single plasma exchange and DFPP will help us to offer the right treatment to each patient with CIPD according to efficacy, tolerance and cost. TRIAL REGISTRATION ClinicalTrials.gov under the no. NCT04742374 and date of registration 10 December 2020.
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Affiliation(s)
- O Moranne
- Service de Nephrologie Dialyse Apherese, Hôpital Universitaire de Nîmes, Nîmes, France. .,Desbrest Institute of Epidemiology and Public Health UMR, INSERM - University of Montpellier, Montpellier, France.
| | - I M Ion
- Service de Neurologie, Hôpital Universitaire de Nîmes, Nîmes, France
| | - R Cezar
- Department of Immunology, IRMB, INSERM U1183-Montpellier University, University Hospital of Nîmes, 80 Rue Augustin Fliche, 34295, Montpellier, FrancePlace du Pr Debré, 30029, Nîmes, France
| | - Z Messikh
- Service de Nephrologie Dialyse Apherese, Hôpital Universitaire de Nîmes, Nîmes, France
| | - C Prelipcean
- Service de Nephrologie Dialyse Apherese, Hôpital Universitaire de Nîmes, Nîmes, France
| | - S Chkair
- Department of Biostatistics, Epidemiology, IDIL (Medical Devices Evaluation), Public Health Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - E Thouvenot
- Service de Neurologie, Hôpital Universitaire de Nîmes, Nîmes, France.,Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Tu Anh Tran
- Department of Pediatrics, Nimes University Hospital, Nimes, France INSERM U 1183, IRMB, Montpellier University, Montpellier, France
| | - P Corbeau
- Department of Immunology, Nimes University Hospital, University of Montpellier, Nimes, France
| | - T Chevallier
- Desbrest Institute of Epidemiology and Public Health UMR, INSERM - University of Montpellier, Montpellier, France.,Department of Biostatistics, Epidemiology, IDIL (Medical Devices Evaluation), Public Health Innovation in Methodology, Nimes University Hospital, University of Montpellier, Nimes, France
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Trandafir C, Renard D, Cagnazzo F, Ion IM. Symmetrical isolated globus pallidus infarction due to bilateral carotid artery dissection. Neurol Sci 2022; 43:6597-6599. [PMID: 35915270 PMCID: PMC9343219 DOI: 10.1007/s10072-022-06278-3] [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] [Received: 04/25/2022] [Accepted: 07/09/2022] [Indexed: 11/04/2022]
Abstract
A 43-year-old woman presented 1 day after whiplash injury with behavior change, hypersomnia, and abulia. MRI showed symmetrical globus pallidus infarction and bilateral watershed hypoperfusion. Magnetic resonance angiography (MRA) showed bilateral carotid artery dissection. To our knowledge, isolated symmetrical globus pallidus infarction related to bilateral carotid dissection has never been reported earlier.
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Moranne O, Roux C, Ion IM, Chkair S. [Therapeutic plasmapheresis procedures: An alternative to the disruption of the supply of polyvalent immunoglobulin in autoimmune pathologies. Medico-economic study]. Nephrol Ther 2022; 18:172-179. [PMID: 35644771 DOI: 10.1016/j.nephro.2022.02.004] [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] [Received: 12/03/2021] [Revised: 01/21/2022] [Accepted: 02/14/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The supply of human polyvalent immunoglobulin has been under severe pressure for several years. This has led to a prioritisation of indications and a record increase in the amount of reimbursement without solving the problem of demand. Treatment by therapeutic plasmapheresis appears to be an alternative to be considered for the treatment of certain dysimmune diseseases. To discuss this alternative, we are conducting a medico-economic study comparing the polyvalent immunoglobulin strategy versus different therapeutic plasmapheresis system in the treatment of a chronic dysimmune disease. POPULATION AND METHOD The medico-economic study was conducted using the example of a 75 kg patient with chronic polyradiculoneuritis dependent on chronic therapy with a comparison of sequential treatment with one session of therapeutic plasmapheresis versus a course of intravenous polyvalent immunoglobulin. The medico-economic study includes an evaluation from a public health care system perspective complemented by a hospital-based approach that justifies estimating the cost of different therapeutic plasmapheresis systems based on a bottom-up micro-costing approach. RESULTS From the point of view of the care system, for information, a 20 g bottle of polyvalent immunoglobulin has a similar cost to a therapeutic plasmapheresis session. In our example, the cost of a maintenance treatment repeated every 2 to 4 weeks in chronic polyradiculoneuritis in a 75 kg patient is 1284.13 euros for a therapeutic plasmapheresis session versus 7331.60 to 9426.84 euros for a 1.5 to 2 mg/kg polyvalent immunoglobulin treatment. Furthermore, from the point of view of the hospital system, the cost of the different TT techniques evaluated varies moderately with the cost depending mainly on the quantity of albumin infused or the medical device used. CONCLUSION In the chronic sequential treatment of chronic polyradiculoneuritis, the cost of therapeutic plasmapheresis could be lower than with polyvalent immunoglobulin from a healthcare system perspective. The cost to the health care facility between different therapeutic plasmapheresis techniques differs little. This study provides arguments suggesting that if therapeutic plasmapheresis can be implemented with a dedicated technical platform, it is a serious alternative to be considered without additional costs.
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Affiliation(s)
- Olivier Moranne
- Service nephrology dialyse apherese, hôpital universitaire Caremeau, Nîmes, France; IDESP, UMR-Inserm, Montpellier, France.
| | - Clarisse Roux
- IDESP, UMR-Inserm, Montpellier, France; Service pharmacie, hôpital universitaire Caremeau, Nîmes, France; Observatoire des médicaments, des dispositifs médicaux et des innovations thérapeutiques, OMEDIT Occitanie, Occitanie, France
| | - Ioana Maria Ion
- Service de neurologie, hôpital universitaire Caremeau, Nîmes, France
| | - Sihame Chkair
- IDESP, UMR-Inserm, Montpellier, France; Service Bespim, hôpital universitaire Caremeau, Nîmes, France
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Ion IM, Villessot M, Goulabchand R, Cagnazzo F, Thouvenot E. Tumefactive lesion revealing neuro-Behçet disease. Rheumatology (Oxford) 2022; 61:e352-e353. [PMID: 35333305 DOI: 10.1093/rheumatology/keac194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/13/2022] [Accepted: 03/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ioana Maria Ion
- Department of Neurology, Nîmes University Hospital, Nîmes, France
| | | | - Radjiv Goulabchand
- Department of Internal Medicine, Nîmes University Hospital, Nîmes, France
| | | | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France.,Institut de Génomique Fonctionnelle, UMR5203, INSERM 1191, Université de Montpellier, Montpellier, France
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Ion IM, Thouvenot E, Cheriet M, Renard D. Meningeal vein and subarachnoid FLAIR hyperintensities in polycythaemia vera. BMJ Case Rep 2022; 15:e246655. [PMID: 35256363 PMCID: PMC8905927 DOI: 10.1136/bcr-2021-246655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
| | - Eric Thouvenot
- Neurology, CHU Nîmes, Hôpital Caremeau, Nîmes, France
- INSERM, IGF, Univ. Montpellier, CNRS, Montpellier, France
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Badoiu A, Moranne O, Coudray S, Ion IM. Clinical Variant of Guillain-Barre Syndrome With Prominent Facial Diplegia After AstraZeneca Coronavirus Disease 2019 Vaccine. J Clin Neuromuscul Dis 2021; 23:115-116. [PMID: 34808658 DOI: 10.1097/cnd.0000000000000383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
| | | | - Sarah Coudray
- Electrophysiology, Nîmes University Hospital, France
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