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Kim JS, Park M, Park S, Chae J, Hong YH, Park KS, Sung JJ, Choi SJ. Prognosis of amyotrophic lateral sclerosis patients after tracheostomy invasive ventilation in Korea. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:271-281. [PMID: 38340017 DOI: 10.1080/21678421.2024.2314064] [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: 09/20/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Background: Tracheostomy invasive ventilation (TIV) is applied to a subset of amyotrophic lateral sclerosis (ALS) patients; however, its frequency and impact on prognosis vary across countries. Methods: We conducted a nationwide retrospective cohort study using Korean National Health Insurance claims data. All patients diagnosed with sporadic ALS from 2012 to 2017 were included, with the observation period until 2020. The survival time between the TIV and non-TIV groups was compared using propensity score matching analysis, and prognostic factors were assessed within the TIV group. Results: This study included 3484 ALS patients (mean [standard deviation] age, 62.4 [11.9] years, 60.4% male), among whom 1230 (35.3%) underwent TIV. After 1:1 propensity score matching, the survival duration between the two groups was not significantly different (28 vs. 25 months, p = 0.057). Cox regression indicated that older age (hazard ratios [HRs] for each decade compared to <40 years: 3.89, 3.83, 5.30, 6.78, and 8.40 [≥ 80 years]; p < 0.005 for all) and lower income (HR, 1.28; 95% confidence interval [CI], 1.09-1.52; p = 0.003) negatively impacted survival, while gastrostomy (HR, 0.57; 95% CI, 0.50-0.66; p < 0.001) and supportive care services (HR, 0.43; 95% CI, 0.32-0.59; p < 0.001) were associated with prolonged survival. Conclusions: TIV was administered to more than one-third of Korean ALS patients without significant survival prolongation. Older age, lower income, lack of gastrostomy, and insufficient supportive care were independent poor prognostic factors for survival, underscoring the importance of comprehensive management for ALS patients.
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Affiliation(s)
- Jong-Su Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Minae Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Sojeong Park
- Data Science Team, Hanmi Pharm. Co., Ltd, Seoul, Republic of Korea
| | - Juhee Chae
- Department of Neurology, Jeonbuk National University College of Medicine, Jeonju, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Centre, Seoul, Republic of Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea, and
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Centre for Hospital Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Min YG, Lee SY, Lim E, Park MY, Kim DH, Byun JM, Koh Y, Hong J, Shin DY, Yoon SS, Sung JJ, Oh SB, Kim I. Genetic risk factors for bortezomib-induced neuropathic pain in an Asian population: A genome-wide association study in South Korea. J Pain 2024:104552. [PMID: 38692398 DOI: 10.1016/j.jpain.2024.104552] [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] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 03/22/2024] [Accepted: 04/22/2024] [Indexed: 05/03/2024]
Abstract
Bortezomib-induced neuropathic pain (BINP) poses a challenge in multiple myeloma (MM) treatment. Genetic factors play a key role in BINP susceptibility, but research has predominantly focused on Caucasian populations. This research explored novel genetic risk loci and pathways associated with BINP development in Korean MM patients, while evaluating reproducibility of variants from Caucasians. Clinical data and buffy coat samples from 185 MM patients on bortezomib were collected. The cohort was split into discovery and validation cohorts through random stratification of clinical risk factors for BINP. GWAS was performed on the discovery cohort (n=74) with Infinium Global Screening Array-24 v3.0 BeadChip (654,027 SNPs). Relevant biological pathways were identified using pathway scoring algorithm (PASCAL). The top 20 SNPs were validated in the validation cohort (n=111). Previously reported SNPs were validated in the entire cohort (n=185). Pathway analysis of the GWAS results identified 31 relevant pathways, including immune systems and endosomal vacuolar pathways. Among top 20 SNPs from discovery cohort, 16 were replicated, which included intronic variants in ASIC2 and SMOC2, recently implicated in nociception, as well as intergenic variants or long non-coding RNAs. None of the 17 previously reported SNPs remained significant in our cohort (rs2274578, p=0.085). This study represents the first investigation of novel genetic loci and biological pathways associated with BINP occurrence. Our findings, in conjunction with existing Caucasian studies, expand the understanding of personalized risk prediction and disease mechanisms. PERSPECTIVE: This article is the first to explore novel genetic loci and pathways linked to bortezomib-induced neuropathic pain (BINP) in Korean multiple myeloma patients, offering novel insights beyond the existing research focused on Caucasian populations, into personalized risk assessment and therapeutic strategies of BINP.
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Affiliation(s)
- Young Gi Min
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | - Ja Min Byun
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Junshik Hong
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong-Yeop Shin
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seog Bae Oh
- Department of Neurobiology and Physiology, School of Dentistry, and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Inho Kim
- Department of Internal Medicine, Seoul National University Hospital, Biomedical Research Institute, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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Min YG, Ju W, Sung JJ. Superior oblique palsy as the initial manifestation of anti-contactin-1 IgG4 autoimmune nodopathy: A case report. J Neuroimmunol 2024; 391:578348. [PMID: 38688208 DOI: 10.1016/j.jneuroim.2024.578348] [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: 02/09/2024] [Revised: 03/22/2024] [Accepted: 04/21/2024] [Indexed: 05/02/2024]
Abstract
Autoimmune nodopathy (AN) is a group of peripheral neuropathies caused by antibodies targeting the nodes of Ranvier or paranodes. It typically presents with sensory ataxia, distal limb weakness, and tremor, and often has a subacute onset, with limited response to immunoglobulin or corticosteroids. We report a case of anti-contactin-1 neuropathy initially manifesting as isolated superior oblique palsy, aiming to broaden the clinical spectrum of the disease. A 68-year-old male with well-controlled diabetes, hypertension, and hyperlipidemia developed acute binocular vertical diplopia, progressing over two months to include distal paresthesia, sensory ataxia, ageusia, and dysarthria. Concurrent nephrotic syndrome was identified. Nerve conduction studies supported demyelination. Despite treatment with intravenous methylprednisolone followed by long-term immunosuppression, some disability persisted. Serum archived during his admission tested positive for anti-contactin-1 IgG, with IgG4 as the predominant subclass, in the flow cytometry assay for AN. This case extends the clinical spectrum of AN. Some cases of isolated cranial nerve palsies, especially in the relevant context like nephrotic syndrome, may be attributed to AN. Prompt initiation of more effective therapies, such as rituximab, could significantly improve outcomes.
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Affiliation(s)
- Young Gi Min
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woohee Ju
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
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Lee DY, Kwon YN, Lee K, Kim SJ, Sung JJ. Dual effects of TGF-β inhibitor in ALS - inhibit contracture and neurodegeneration. J Neurochem 2024. [PMID: 38515326 DOI: 10.1111/jnc.16102] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 02/25/2024] [Accepted: 03/05/2024] [Indexed: 03/23/2024]
Abstract
As persistent elevation of transforming growth factor-β (TGF-β) promotes fibrosis of muscles and joints and accelerates disease progression in amyotrophic lateral sclerosis (ALS), we investigated whether inhibition of TGF-β would be effective against both exacerbations. The effects of TGF-β and its inhibitor on myoblasts and fibroblasts were tested in vitro and confirmed in vivo, and the dual action of a TGF-β inhibitor in ameliorating the pathogenic role of TGF-β in ALS mice was identified. In the peripheral neuromuscular system, fibrosis in the muscles and joint cavities induced by excessive TGF-β causes joint contracture and muscular degeneration, which leads to motor dysfunction. In an ALS mouse model, an increase in TGF-β in the central nervous system (CNS), consistent with astrocyte activity, was associated with M1 microglial activity and pro-inflammatory conditions, as well as with neuronal cell death. Treatment with the TGF-β inhibitor halofuginone could prevent musculoskeletal fibrosis, resulting in the alleviation of joint contracture and delay of motor deterioration in ALS mice. Halofuginone could also reduce glial cell-induced neuroinflammation and neuronal apoptosis. These dual therapeutic effects on both the neuromuscular system and the CNS were observed from the beginning to the end stages of ALS; as a result, treatment with a TGF-β inhibitor from the early stage of disease delayed the time of symptom exacerbation in ALS mice, which led to prolonged survival.
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Affiliation(s)
- Do-Yeon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Kwangkook Lee
- Research Department, Curamys Co., Ltd., Seoul, South Korea
| | - Sang Jeong Kim
- Department of Physiology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, South Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea
- Wide River Institute of Immunology, Seoul National University, Hongcheon, Gangwon-do, South Korea
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Jang MS, Yoo SH, Kim MS, Cho B, Kim KH, Shin J, Hwang I, Choi SJ, Sung JJ, Lee SY. Healthcare Utilization and Supportive Care Timing in South Korean People Living With Amyotrophic Lateral Sclerosis: A Single-Center Retrospective Study. J Clin Neurol 2024; 20:166-174. [PMID: 38212665 PMCID: PMC10921051 DOI: 10.3988/jcn.2023.0211] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/19/2023] [Accepted: 09/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND AND PURPOSE Despite the growing demands and challenges faced by patients with amyotrophic lateral sclerosis (ALS) in accessing healthcare services, our understanding of this access remains poor. This study aimed to investigate the healthcare utilization patterns and timing of nutritional and respiration support in patients with ALS in South Korea. METHODS A retrospective cohort study was conducted on patients diagnosed with ALS at a single tertiary hospital between 2016 and 2019 and followed up for 2 years. We evaluated patient characteristics, healthcare utilization (hospital admissions, outpatient visits, and emergency department [ED] visits), and the timing of nutritional and respiration support (noninvasive positive pressure ventilation [NIPPV], tracheostomy, gastrostomy, and nasogastric tube) at 6-month intervals from the first outpatient visit. RESULTS Among the 143 included patients, 73.4% were admitted at least once, 18.9% experienced unplanned admissions, and 30.1% visited the ED at least once during the study period. The most-common reason for ED visits was neurological symptoms during the first 6 months (59.1%), followed by respiratory symptoms. One fifth of patients who visited the ED underwent tracheostomy (20.9%) or NIPPV (20.9%). Two years after the first visit, 32.2% used a ventilator, and 13.3%, 26.6%, and 6.3% had undergone tracheostomy, gastrostomy, and nasogastric tube insertion, respectively. CONCLUSIONS During the 2 years following their first outpatient visit, 20% of patients with ALS experienced unplanned admissions and 30% visited the ED. An active and prompt supportive-care program should be implemented to ensure timely functional support in order to reduce these risks of unplanned admissions.
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Affiliation(s)
- Min Seol Jang
- Seoul National University Graduate School of Public Health, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, Seoul, Korea
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min Sun Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Belong Cho
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
- Institute on Aging, Seoul National University College of Medicine, Seoul, Korea
| | - Kyae Hyung Kim
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Jeongmi Shin
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Inyoung Hwang
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Department of Human Systems Medicine, Seoul National University College of Medicine, Seoul, Korea
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea.
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Min YG, Moon Y, Kwon YN, Lee BJ, Park KA, Han JY, Han J, Lee HJ, Baek SH, Kim BJ, Kim JS, Park KS, Kim NH, Kim M, Nam TS, Oh SI, Jung JH, Sung JJ, Jang MJ, Kim SJ, Kim SM. Prognostic factors of first-onset optic neuritis based on diagnostic criteria and antibody status: a multicentre analysis of 427 eyes. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333133. [PMID: 38418215 DOI: 10.1136/jnnp-2023-333133] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/22/2024] [Indexed: 03/01/2024]
Abstract
BACKGROUND Optic neuritis (ON) prognosis is influenced by various factors including attack severity, underlying aetiologies, treatments and consequences of previous episodes. This study, conducted on a large cohort of first ON episodes, aimed to identify unique prognostic factors for each ON subtype, while excluding any potential influence from pre-existing sequelae. METHODS Patients experiencing their first ON episodes, with complete aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing, and clinical data for applying multiple sclerosis (MS) diagnostic criteria, were enrolled. 427 eyes from 355 patients from 10 hospitals were categorised into four subgroups: neuromyelitis optica with AQP4 IgG (NMOSD-ON), MOG antibody-associated disease (MOGAD-ON), ON in MS (MS-ON) or idiopathic ON (ION). Prognostic factors linked to complete recovery (regaining 20/20 visual acuity (VA)) or moderate recovery (regaining 20/40 VA) were assessed through multivariable Cox regression analysis. RESULTS VA at nadir emerged as a robust prognostic factor for both complete and moderate recovery, spanning all ON subtypes. Early intravenous methylprednisolone (IVMP) was associated with enhanced complete recovery in NMOSD-ON and MOGAD-ON, but not in MS-ON or ION. Interestingly, in NMOSD-ON, even a slight IVMP delay in IVMP by >3 days had a significant negative impact, whereas a moderate delay up to 7-9 days was permissible in MOGAD-ON. Female sex predicted poor recovery in MOGAD-ON, while older age hindered moderate recovery in NMOSD-ON and ION. CONCLUSION This comprehensive multicentre analysis on first-onset ON unveils subtype-specific prognostic factors. These insights will assist tailored treatment strategies and patient counselling for ON.
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Affiliation(s)
- Young Gi Min
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Yeji Moon
- Department of Ophthalmology, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Young Nam Kwon
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Byung Joo Lee
- Department of Ophthalmology, University of Ulsan College of Medicine, Seoul, Korea (the Republic of)
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Seoul, Korea (the Republic of)
| | - Jae Yong Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Haeng-Jin Lee
- Department of Ophthalmology, Jeonbuk National University Hospital, Jeonju, Korea (the Republic of)
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Seoul, Korea (the Republic of)
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Ilsan, Korea (the Republic of)
| | - Martha Kim
- Department of Ophthalmology, Dongguk University Ilsan Hospital, Ilsan, Korea (the Republic of)
| | - Tai-Seung Nam
- Department of Neurology, Chonnam University Hospital, Hwasun, Korea (the Republic of)
| | - Seong-Il Oh
- Department of Neurology, Kyung Hee University Hospital, Seoul, Korea (the Republic of)
- Department of Neurology, Busan Paik Hospital, Busan, Korea (the Republic of)
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Jung-Joon Sung
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Sung-Min Kim
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Department of Neurology, Seoul National University Hospital, Seoul, Korea (the Republic of)
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Min YG, Han HJ, Shin HY, Baek JG, Kim JS, Park KS, Baek SH, Yoo I, Huh SY, Kwon YN, Choi SJ, Kim SM, Hong YH, Sung JJ. Therapeutic Outcomes and Electrophysiological Biomarkers in Anti-Myelin-Associated Glycoprotein Neuropathy: A Multicenter Cohort Study in South Korea. J Clin Neurol 2024; 20:50-58. [PMID: 38179632 PMCID: PMC10782088 DOI: 10.3988/jcn.2023.0127] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND AND PURPOSE Unlike other immune-mediated neuropathies, anti-myelin-associated glycoprotein (MAG) neuropathy is often refractory to immunotherapy. It is necessary to compare the relative efficacies of various immunotherapies and develop objective biomarkers in order to optimize its clinical management. METHODS This study recruited 91 patients with high anti-MAG antibody titers from 7 tertiary hospitals in South Korea. We analyzed the baseline characteristics, therapeutic outcomes, and nerve conduction study (NCS) findings of 68 patients and excluded 23 false positive cases. RESULTS The rate of positive responses to treatment was highest using zanubrutinib (50%) and rituximab (36.4%), followed by corticosteroids (16.7%), immunosuppressants (9.5%), intravenous immunoglobulin (5%), and plasma exchange (0%). Disability and weakness were significantly associated with multiple NCS parameters at the time of diagnosis, especially distal compound muscle action potential (CMAP) amplitudes. Moreover, the longitudinal trajectory of the average CMAP amplitudes paralleled the clinical courses, with a 16.2 percentile decrease as an optimal cutoff for predicting a clinical exacerbation (area under the receiver operating characteristic curve=0.792). CONCLUSIONS Our study supports the use of NCS as an objective marker for estimating disease burden and tracking clinical changes in patients with anti-MAG neuropathy. We have described the beneficial effects of rituximab and a new drug, zanubrutinib, compared with conventional immunotherapies.
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Affiliation(s)
- Young Gi Min
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hee-Jo Han
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Gyu Baek
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Ilhan Yoo
- Department of Neurology, Nowon Eulji Medical Center, Seoul, Korea
| | - So-Young Huh
- Department of Neurology, Kosin Medical University Hospital, Busan, Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Yoon-Ho Hong
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jung-Joon Sung
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Korea.
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Kim M, Choi KS, Hyun RC, Hwang I, Kwon YN, Sung JJ, Kim SM, Kim JH. Structural disconnection is associated with disability in the neuromyelitis optica spectrum disorder. Brain Imaging Behav 2023; 17:664-673. [PMID: 37676409 DOI: 10.1007/s11682-023-00792-4] [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] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system. Accumulating evidence suggests there is a distinct pattern of brain lesions characteristic of NMOSD, and brain MRI has potential prognostic implications. However, the question of how the brain lesions in NMOSD are associated with its distinct clinical course remains incompletely understood. Here, we aimed to investigate the association between neurological impairment and brain lesions via brain structural disconnection. METHODS Twenty patients were diagnosed with NMOSD according to the 2015 International Panel for NMO Diagnosis criteria. The white matter lesions were manually drawn section by section. Whole-brain structural disconnection was estimated, and connectome-based predictive modeling (CPM) was used to estimate the patient's Expanded Disability Status Scale score (EDSS) from their disconnection severity matrix. Furthermore, correlational tractography was performed to assess the fractional anisotropy (FA) and axial diffusivity (AD) of white matter fibers, which negatively correlated with the EDSS score. RESULTS CPM successfully predicted the EDSS using the disconnection severity matrix (r = 0.506, p = 0.028; q2 = 0.274). Among the important edges in the prediction process, the majority of edges connected the motor to the frontoparietal network. Correlational tractography identified a decreased FA and AD value according to EDSS scores in periependymal white matter tracts. DISCUSSION Structural disconnection-based predictive modeling and local connectome analysis showed that frontoparietal and periependymal white matter disconnection is predictive and associated with the EDSS score of NMOSD patients.
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Affiliation(s)
- Minchul Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu Sung Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Ryoo Chang Hyun
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Inpyeong Hwang
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea
| | - Sung Min Kim
- Department of Neurology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea.
| | - Ji-Hoon Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, Seoul, 110-744, Republic of Korea.
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Choi SJ, Yoon SH, Sung JJ, Lee JH. Association Between Fat Depletion and Prognosis of Amyotrophic Lateral Sclerosis: CT-Based Body Composition Analysis. Ann Neurol 2023; 94:1116-1125. [PMID: 37612833 DOI: 10.1002/ana.26775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVE The purpose of this study was to present the results of our investigation of the prognostic value of adipopenia and sarcopenia in patients with amyotrophic lateral sclerosis (ALS). METHODS Consecutive patients with ALS with abdominal computed tomography (CT) were retrospectively identified at a single tertiary hospital between January 2010 and July 2021. Deep learning-based volumetric CT body composition analysis software was used to obtain abdominal waist fat volume, fat attenuation, and skeletal muscle area at the L3 level, then normalized to the fat volume index (FVI) and skeletal muscle index (SMI). Adipopenia and sarcopenia were defined as the sex-specific lowest quartile and SMI reference values, respectively. The associations of CT-derived body composition parameters with clinical variables, such as body mass index (BMI) and creatinine, were evaluated by Pearson correlation analyses, and associations with survival were assessed using the multivariable Cox regression analysis. RESULTS Eighty subjects (40 men, 65.5 ± 9.4 years of age) were investigated (median interval between disease onset and CT examination = 25 months). The mean BMI at the CT examination was 20.3 ± 4.3 kg/m2 . The BMI showed a positive correlation with both FVI (R = 0.70, p < 0.001) and SMI (R = 0.63, p < 0.001), and the serum creatinine level was associated with SMI (R = 0.68, p < 0.001). After adjusting for sex, age, King's stage, BMI, creatinine, progression rate, and sarcopenia, adipopenia was associated with shorter survival (hazard ratio [HR] = 5.94, 95% confidence interval [CI] = 1.01, 35.0, p = 0.049). In a subgroup analysis for subjects with nutritional failure (stage 4a), the HR of adipopenia was 15.1 (95% CI = 2.45, 93.4, p = 0.003). INTERPRETATION Deep learning-based CT-derived adipopenia in patients with ALS is an independent poor prognostic factor for survival. ANN NEUROL 2023;94:1116-1125.
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Affiliation(s)
- Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jong Hyuk Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
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Sung W, Kim JA, Kim YS, Park J, Oh KW, Sung JJ, Ki CS, Kim YE, Kim SH. An analysis of variants in TARDBP in the Korean population with amyotrophic lateral sclerosis: comparison with previous data. Sci Rep 2023; 13:18805. [PMID: 37914747 PMCID: PMC10620191 DOI: 10.1038/s41598-023-45593-3] [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: 07/22/2023] [Accepted: 10/21/2023] [Indexed: 11/03/2023] Open
Abstract
The TARDBP gene variant is a known major cause of amyotrophic lateral sclerosis (ALS), with limited reports of Korean patients with ALS harboring the variants in TARDBP. This large cohort study introduces four ALS patients who share the p.M337V variant of the TARDBP, allowing for an investigation of clinical characteristics and prognosis by analyzing previously reported cases with the same variant. From November 2014 to August 2022, participants were recruited from two tertiary hospitals in Seoul, Korea. Clinical characteristics of patients diagnosed with ALS carrying the variant in TARDBP were evaluated. Previous articles demonstrating subjects' characteristics were reviewed. Four patients were identified with the pathogenic missense variant (c.1009A>G; p.M337V) in the TARDBP. The mean age of onset was 55 years old, and none of the patients showed severe cognitive impairment. Sixty-three patients carrying the p.M337V variant in TARDBP from this study and previous reports delineated young age of onset (51.6 years), high frequency of bulbar onset patients (61.9%), and low comorbidity of frontotemporal dementia. This study reveals the presence of pathogenic variant of TARDBP in Korea and emphasizes the importance of genetic screening of the TARDBP gene, in diagnosing ALS and evaluating prognosis among familial and simplex ALS patients in Korea.
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Affiliation(s)
- Wonjae Sung
- Department of Neurology, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jin-Ah Kim
- Department of Translational Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yong Sung Kim
- Department of Neurology, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jinseok Park
- Department of Neurology, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Ki-Wook Oh
- Department of Neurology, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea
| | - Jung-Joon Sung
- Department of Translational Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | | | - Young-Eun Kim
- Department of Laboratory Medicine, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea.
| | - Seung Hyun Kim
- Department of Neurology, College of Medicine, Hanyang University, Wangsimni-ro 222, Seongdong-gu, Seoul, 04763, Republic of Korea.
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Kim JA, Jang H, Choi Y, Min YG, Hong YH, Sung JJ, Choi SJ. Subclinical articulatory changes of vowel parameters in Korean amyotrophic lateral sclerosis patients with perceptually normal voices. PLoS One 2023; 18:e0292460. [PMID: 37831677 PMCID: PMC10575489 DOI: 10.1371/journal.pone.0292460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
The available quantitative methods for evaluating bulbar dysfunction in patients with amyotrophic lateral sclerosis (ALS) are limited. We aimed to characterize vowel properties in Korean ALS patients, investigate associations between vowel parameters and clinical features of ALS, and analyze subclinical articulatory changes of vowel parameters in those with perceptually normal voices. Forty-three patients with ALS (27 with dysarthria and 16 without dysarthria) and 20 healthy controls were prospectively collected in the study. Dysarthria was assessed using the ALS Functional Rating Scale-Revised (ALSFRS-R) speech subscores, with any loss of 4 points indicating the presence of dysarthria. The structured speech samples were recorded and analyzed using Praat software. For three corner vowels (/a/, /i/, and /u/), data on the vowel duration, fundamental frequency, frequencies of the first two formants (F1 and F2), harmonics-to-noise ratio, vowel space area (VSA), and vowel articulation index (VAI) were extracted from the speech samples. Corner vowel durations were significantly longer in ALS patients with dysarthria than in healthy controls. The F1 frequency of /a/, F2 frequencies of /i/ and /u/, the VSA, and the VAI showed significant differences between ALS patients with dysarthria and healthy controls. The area under the curve (AUC) was 0.912. The F1 frequency of /a/ and the VSA were the major determinants for differentiating ALS patients who had not yet developed apparent dysarthria from healthy controls (AUC 0.887). In linear regression analyses, as the ALSFRS-R speech subscore decreased, both the VSA and VAI were reduced. In contrast, vowel durations were found to be rather prolonged. The analyses of vowel parameters provided a useful metric correlated with disease severity for detecting subclinical bulbar dysfunction in ALS patients.
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Affiliation(s)
- Jin-Ah Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Hayeun Jang
- Division of English, Busan University of Foreign Studies, Busan, Republic of Korea
| | - Yoonji Choi
- Department of Korean Language and Literature, Seoul National University, Seoul, Republic of Korea
| | - Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Center for Hospital Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Park SY, Kwon YN, Kim S, Kim SH, Kim JK, Kim JS, Nam TS, Min YG, Park KS, Park JS, Seok JM, Sung JJ, Sohn E, Shin KJ, Shin JH, Shin HY, Oh SI, Oh J, Yoon BA, Lee S, Lee JM, Lee HL, Choi K, Huh SY, Jang MJ, Min JH, Kim BJ, Kim SM. Early rituximab treatment reduces long-term disability in aquaporin-4 antibody-positive neuromyelitis optica spectrum. J Neurol Neurosurg Psychiatry 2023; 94:800-805. [PMID: 37268404 DOI: 10.1136/jnnp-2022-330714] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 05/12/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) causes relapsing inflammatory attacks in the central nervous system, leading to disability. As rituximab, a B-lymphocyte-depleting monoclonal antibody, is an effective in preventing NMOSD relapses, we hypothesised that earlier initiation of rituximab can also reduce long-term disability of patients with NMOSD. METHODS This multicentre retrospective study involving 19 South Korean referral centres included patients with NMOSD with aquaporin-4 antibodies receiving rituximab treatment. Factors associated with the long-term Expanded Disability Status Scale (EDSS) were assessed using multivariable regression analysis. RESULTS In total, 145 patients with rituximab treatment (mean age of onset, 39.5 years; 88.3% female; 98.6% on immunosuppressants/oral steroids before rituximab treatment; mean disease duration of 121 months) were included. Multivariable analysis revealed that the EDSS at the last follow-up was associated with time to rituximab initiation (interval from first symptom onset to initiation of rituximab treatment). EDSS at the last follow-up was also associated with maximum EDSS before rituximab treatment. In subgroup analysis, the time to initiation of rituximab was associated with EDSS at last follow-up in patients aged less than 50 years, female and those with a maximum EDSS score ≥6 before rituximab treatment. CONCLUSIONS Earlier initiation of rituximab treatment may prevent long-term disability worsening in patients with NMOSD, especially among those with early to middle-age onset, female sex and severe attacks.
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Affiliation(s)
- Su Yeon Park
- Department of Neurology, Korea Cancer Center Hospital, Seoul, Korea (the Republic of)
| | - Young Nam Kwon
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Sunyoung Kim
- Department of Neurology, Ulsan University Hospital College of Medicine, Ulsan, Korea (the Republic of)
| | - Seung-Hyun Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Korea (the Republic of)
| | - Jong Kuk Kim
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea (the Republic of)
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Korea (the Republic of)
| | - Young Gi Min
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea (the Republic of)
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea (the Republic of)
| | - Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea (the Republic of)
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
| | - Eunhee Sohn
- Department of Neurology, Chungnam National University, College of Medicine, Daejeon, Korea (the Republic of)
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University, Busan, Korea (the Republic of)
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Korea (the Republic of)
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea (the Republic of)
| | - Seong-Il Oh
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea (the Republic of)
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (the Republic of)
| | - Byeol-A Yoon
- Department of Neurology, Dong-A University College of Medicine, Busan, Korea (the Republic of)
| | - Sanggon Lee
- Department of Neurology, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea (the Republic of)
| | - Jong-Mok Lee
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu, Korea (the Republic of)
| | - Hye Lim Lee
- Department of Neurology, Korea University College of Medicine, Seoul, Korea (the Republic of)
| | - Kyomin Choi
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea (the Republic of)
| | - So-Young Huh
- Department of Neurology, Kosin University College of Medicine, Busan, Korea (the Republic of)
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea (the Republic of)
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea (the Republic of)
| | - Sung-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
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Keun CH, Choi SJ, Kim YJ, Kim SM, Hong YH, Sung JJ. Suicide Attempts in Patients With Amyotrophic Lateral Sclerosis: An Analysis of the Korean National Health Insurance Database. J Clin Psychiatry 2023; 84:22m14754. [PMID: 37728482 DOI: 10.4088/jcp.22m14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Objective: The knowledge of the common risk factors for suicide attempts may not be simply applicable to patients with amyotrophic lateral sclerosis (ALS). We aimed to identify risk factors associated with suicide attempts in patients with ALS and to determine the annual prevalence and periods of vulnerability associated with attempts. Methods: This nationwide cohort study was performed using the Korean National Health Insurance Database. All patients with ALS concomitantly registered for the Exempted Calculation of Health Insurance for rare, incurable diseases between 2011 and 2017 were identified. We used the Cox proportional hazards regression model and competing risk model to identify the risk factors for suicide attempts. The multivariable models were adjusted for potential risk factors from the univariate analysis. Results: Among 2,955 incident patients, 47 attempted suicide. After adjusting for sex, previous attempts, and previous psychiatric disorders, the hazard ratios for psychiatric hospitalization before ALS diagnosis were 3.17 (95% confidence interval [CI], 1.31-7.70; P = .01) and 3.02 (95% CI, 1.32-6.90; P = .01) in the Cox regression model and the competing risk model, respectively. The annual prevalence of suicide attempts was 0.29%-1.12%. Twenty (42.6%) and 9 (19.1%) attempts occurred within 3 months and 12-18 months after diagnosis, respectively. Conclusions: Psychiatric hospitalization increased the risk of suicide attempts, which clustered at the early stage or on losing autonomy. Those with a history of psychiatric hospitalization should receive an in-depth evaluation and be cautiously monitored.
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Affiliation(s)
- C Hyung Keun
- Department of Psychiatry, Asan Medical Center, Songpa-gu, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Jongno-gu, Seoul, Republic of Korea
- Center for Hospital Medicine, Seoul National University Hospital, Jongno-gu, Seoul, Republic of Korea
- Corresponding Author: Seok-Jin Choi, MD, Department of Neurology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
| | | | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Dongjak-gu, Seoul, Republic of Korea
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Lee J, Kim A, Choi SJ, Cho E, Seo J, Oh SI, Jung J, Kim JS, Sung JJ, Abrahams S, Hong YH. Development and Validation of the Korean Version of the Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis Screen (ECAS-K). J Clin Neurol 2023; 19:454-459. [PMID: 37488957 PMCID: PMC10471544 DOI: 10.3988/jcn.2022.0403] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/23/2022] [Accepted: 01/16/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND AND PURPOSE Cognitive and behavioral changes are common in amyotrophic lateral sclerosis (ALS), with about 15% of patients presenting with overt frontotemporal dementia and 30%-50% with varying degrees of impairments. We aimed to develop and validate the Korean version of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS-K), a brief multidomain assessment tool developed for ALS patients with physical disability. METHODS We developed the ECAS-K according to the translation guidelines, and administered it to 38 patients with ALS and 26 age- and education-level-matched controls. We also administered the Montreal Cognitive Assessment (MoCA) and Frontal Assessment Battery (FAB) to investigate convergent validity, and the Center for Neurologic Study-Liability Scale to assess the association between pseudobulbar affect and cognitive/behavioral changes. RESULTS Internal consistency among the ECAS-K test items was found to be high, with a Cronbach's alpha of 0.87. Significant differences were found between patients with ALS and the controls in language, fluency, and memory functions (p<0.05). Abnormal performance based on the ECAS total score was noted in 39.4% of patients, and 66.6% presented behavioral changes in at least one domain. Significant correlations were observed between the scores of the ECAS-K and those of other cognitive screening tools (MoCA and FAB, with correlation coefficients of 0.69 and 0.55, respectively; p<0.01). CONCLUSIONS We developed and validated the ECAS-K which could be used as an effective tool to screen the cognitive and behavioral impairments in Korean patients with ALS.
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Affiliation(s)
- Jeeun Lee
- Department of Neurology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Ahwon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Seok-Jin Choi
- Department of Neurology, Center for Hospital Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eric Cho
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Seong-Il Oh
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jinho Jung
- Department of Neurology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ji-Sun Kim
- Department of Neurology, Incheon Sejong Hospital, Incheon, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sharon Abrahams
- Euan MacDonald Centre for Motor Neurone Disease Research, Human Cognitive Neuroscience, School of Philosophy, Psychology and Language Science, University of Edinburgh, Edinburgh, UK
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea.
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Kang J, Kim M, Yoon DY, Kim WS, Choi SJ, Kwon YN, Kim WS, Park SH, Sung JJ, Park M, Lee JS, Park JE, Kim SM. AXL +SIGLEC6 + dendritic cells in cerebrospinal fluid and brain tissues of patients with autoimmune inflammatory demyelinating disease of CNS. Clin Immunol 2023; 253:109686. [PMID: 37414380 DOI: 10.1016/j.clim.2023.109686] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 03/19/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2023]
Abstract
Inflammatory demyelinating disease of the CNS (IDD) is a heterogeneous group of autoimmune diseases, and multiple sclerosis is the most common type. Dendritic cells (DCs), major antigen-presenting cells, have been proposed to play a central role in the pathogenesis of IDD. The AXL+SIGLEC6+ DC (ASDC) has been only recently identified in humans and has a high capability of T cell activation. Nevertheless, its contribution to CNS autoimmunity remains still obscure. Here, we aimed to identify the ASDC in diverse sample types from IDD patients and experimental autoimmune encephalomyelitis (EAE). A detailed analysis of DC subpopulations using single-cell transcriptomics for the paired cerebrospinal fluid (CSF) and blood samples of IDD patients (total n = 9) revealed that three subtypes of DCs (ASDCs, ACY3+ DCs, and LAMP3+ DCs) were overrepresented in CSF compared with their paired blood. Among these DCs, ASDCs were also more abundant in CSF of IDD patients than in controls, manifesting poly-adhesional and stimulatory characteristics. In the brain biopsied tissues of IDD patients, obtained at the acute attack of disease, ASDC were also frequently found in close contact with T cells. Lastly, the frequency of ASDC was found to be temporally more abundant in acute attack of disease both in CSF samples of IDD patients and in tissues of EAE, an animal model for CNS autoimmunity. Our analysis suggests that the ASDC might be involved in the pathogenesis of CNS autoimmunity.
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Affiliation(s)
- Junho Kang
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Moonhang Kim
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Da-Young Yoon
- Department of Biomedical Sciences, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woo-Seok Kim
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Republic of Korea
| | - Young-Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Republic of Korea
| | - Won-Seok Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Republic of Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Republic of Korea
| | - Myungsun Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jung Seok Lee
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Jong-Eun Park
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea.
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University of Medicine, Seoul, Republic of Korea.
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Kim JA, Park C, Sung JJ, Seo DJ, Choi SJ, Hong YH. Small RNA sequencing of circulating small extracellular vesicles microRNAs in patients with amyotrophic lateral sclerosis. Sci Rep 2023; 13:5528. [PMID: 37016037 PMCID: PMC10073149 DOI: 10.1038/s41598-023-32717-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/31/2023] [Indexed: 04/06/2023] Open
Abstract
Dysregulation of microRNAs (miRNA) in small extracellular vesicles (sEV) such as exosomes have been implicated in the pathogenesis of amyotrophic lateral sclerosis (ALS). Although circulating cell-free miRNA have been extensively investigated in ALS, sEV-derived miRNAs have not been systemically explored yet. Here, we performed small RNA sequencing analysis of serum sEV and identified 5 differentially expressed miRNA in a discovery cohort of 12 patients and 11 age- and sex-matched healthy controls (fold change > 2, p < 0.05). Two of them (up- and down-regulation of miR-23c and miR192-5p, respectively) were confirmed in a separate validation cohort (18 patients and 15 healthy controls) by droplet digital PCR. Bioinformatic analysis revealed that these two miRNAs interact with distinct sets of target genes and involve biological processes relevant to the pathomechanism of ALS. Our results suggest that circulating sEV from ALS patients have distinct miRNA profiles which may be potentially useful as a biomarker of the disease.
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Affiliation(s)
- Jin-Ah Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Genomic Medicine Institute, Medical Research Center, Seoul National University, Seoul, Republic of Korea
| | - Canaria Park
- Department of Neurobiology, Harvard Medical School, Boston, MA, USA
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Jin Seo
- Department of Neurology, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Neuroscience Research Institute, Medical Research Council, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, 20 Boramaero-5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea.
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Han JY, Seo J, Choi Y, Im W, Ban JJ, Sung JJ. CRISPR-Cas9 mediated genome editing of Huntington's disease neurospheres. Mol Biol Rep 2023; 50:2127-2136. [PMID: 36550260 DOI: 10.1007/s11033-022-08175-6] [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: 04/26/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Huntington's disease (HD) is a fatal genetic disease caused by polyglutamine aggregation encoded by an expanded CAG repeat in the huntingtin gene (HTT). In this study, we cultured neurospheres derived from R6/2 mice, a representative animal model of HD, as an in vitro model. GuideRNAs were designed to induce large deletion or frameshift indel mutation of CAG expansion. These gRNAs and Cas9 were delivered to the R6/2 neurospheres and disease-related phenotypes were observed. METHODS AND RESULTS Deletion or indel mutation of the CAG repeat was confirmed by PCR, T7E1 assay and sequencing of the edited neurospheres. Edited neurospheres showed decreased polyglutamine aggregation compared with control HD neurospheres. In the edited neurosphere, we confirmed the upregulation of peroxisome proliferator-activated receptor gamma coactivator-1 alpha (PGC-1α) and brain-derived neurotrophic factor (BDNF), whose reduced expressions are closely involved in the disease progression. In addition, flow cytometry result showed an increase in cell viability with an overall decrease in necrotic and apoptotic populations among edited R6/2 neurospheres. Additional siRNA experiments confirmed that the increased viability was decreased through inhibition of PGC-1α or BDNF. CONCLUSION Our study confirmed that CAG repeat of R6/2 mouse-derived neurospheres can be edited through CRISPR-Cas9. Editing of CAG repeat sequence decreases polyglutamine aggregation and cellular apoptosis of HD neurospheres, which may be related to the increased expressions of PGC-1α and BDNF. Our data provide the evidence that CRISPR-Cas9 mediated genome editing has therapeutic potential on HD neuronal cells.
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Affiliation(s)
- Ji Yun Han
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jaewoo Seo
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yoori Choi
- Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.,Department of Nuclear Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Wooseok Im
- Department of Obstetrics and Gynecology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea.,Institute of Women's Life Medical Science, Yonsei University College of Medicine, Seoul, South Korea
| | - Jae-Jun Ban
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea.
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea. .,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea. .,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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18
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Lee WJ, Kwon YN, Kim B, Moon J, Park KI, Chu K, Sung JJ, Lee SK, Kim SM, Lee ST. MOG antibody-associated encephalitis in adult: clinical phenotypes and outcomes. J Neurol Neurosurg Psychiatry 2023; 94:102-112. [PMID: 36261287 DOI: 10.1136/jnnp-2022-330074] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/04/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND We investigated the clinical characteristics and outcomes of myelin oligodendrocyte glycoprotein (MOG) antibody-associated autoimmune encephalitis (MOGAE) in adult patients. METHODS From an institutional cohort, we analysed adult patients with MOGAE followed-up for more than 1 year. Disease severity was assessed using the modified Rankin scale (mRS) and Clinical Assessment Scale in Autoimmune Encephalitis scores. Immunotherapy profiles, outcomes and disease relapses were evaluated along with serial brain MRI data. RESULTS A total of 40 patients were enrolled and categorised into cortical encephalitis (18 patients), limbic encephalitis (LE, 5 patients) and acute disseminated encephalomyelitis (ADEM, 17 patients). 80.0% of patients achieved good clinical outcomes (mRS 0‒2) and 40.0% relapsed. The LE subtype was associated with an older onset age (p=0.004) and poor clinical outcomes (p=0.014) than the other subtypes but with a low rate of relapse (0.0%). 21/25 (84.0%) relapse attacks were associated with an absence or short (≤6 months) immunotherapy maintenance. On MRI, the development of either diffuse cerebral or medial temporal atrophy within the first 6 month was correlated with poor outcomes. MOG-antibody (MOG-Ab) was copresent with anti-N-methyl-D-aspartate receptor (NMDAR)-antibody in 13 patients, in whom atypical clinical presentation (cortical encephalitis or ADEM, p<0.001) and disease relapse (46.2% vs 0.0%, p<0.001) were more frequent compared with conventional NMDAR encephalitis without MOG-Ab. CONCLUSIONS Outcomes are different according to the three phenotypes in MOGAE. Short immunotherapy maintenance is associated with relapse, and brain atrophy was associated with poor outcomes. Patients with dual antibodies of NMDAR and MOG have a high relapse rate.
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Affiliation(s)
- Woo-Jin Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea.,Department of Neurology, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Boram Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jangsup Moon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyung-Il Park
- Department of Neurology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, South Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
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19
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Kwon YN, Woodhall M, Sung JJ, Kim KK, Lim YM, Kim H, Kim JE, Baek SH, Kim BJ, Park JS, Seok HY, Kim DS, Kwon O, Park KH, Sohn E, Bae JS, Yoon BN, Kim NH, Ahn SW, Choi K, Oh J, Park HJ, Shin KJ, Lee S, Park J, Kim SH, Seok JI, Bae DW, An JY, Joo IS, Choi SJ, Nam TS, Kim S, Park KJ, Kwon KH, Waters P, Hong YH. Clinical pitfalls and serological diagnostics of MuSK myasthenia gravis. J Neurol 2023; 270:1478-1486. [PMID: 36396811 PMCID: PMC9971039 DOI: 10.1007/s00415-022-11458-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/22/2022] [Accepted: 10/25/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed to evaluate the diagnostic accuracy of enzyme-linked immunosorbent assay (ELISA) for anti-muscle specific tyrosine kinase (MuSK) antibody (Ab) in a large cohort of anti-acetylcholine receptor (AChR) Ab-negative generalized myasthenia gravis (MG), and also to investigate clinical contexts for the diagnosis of MuSK MG. METHODS A retrospective study of 160 patients with a clinical suspicion of AChR Ab-negative generalized MG was performed. The serum samples were tested for anti-clustered AChR Ab by cell-based assay (CBA), anti-MuSK Ab by ELISA, CBA and/or radioimmunoprecipitation assay (RIPA). Clinical data were compared between anti-MuSK Ab-positive MG and double seronegative (AChR and MuSK) MG groups. RESULTS After excluding non-MG and clustered AChR Ab-positive patients, we identified 89 patients as a cohort of AChR Ab-negative generalized MG. Anti-MuSK Ab was positive by ELISA in 22 (24.7%) patients. While CBA identified five additional anti-MuSK Ab-positive patients, the results of ELISA were mostly consistent with CBA and RIPA with Cohen's kappa of 0.80 and 0.90, respectively (p < 0.001). The most frequent differential diagnosis was motor neuron disease particularly of bulbar onset which showed remarkably overlapping clinical and electrophysiological features with MuSK MG at presentation. CONCLUSION While confirming the highest sensitivity of CBA for detecting anti-MuSK Ab, our results highlight the clinical pitfalls in making a diagnosis of MuSK MG and may support a diagnostic utility of MuSK-ELISA in clinical practice.
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Affiliation(s)
- Young Nam Kwon
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Neuroimmunology Group, University of Oxford, John Radcliffe Hospital, Level 5, West Wing, Headley Way, Oxford, OX3 9DU, UK
| | - Jung-Joon Sung
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurology, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-Eun Kim
- Department of Neurology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hung Youl Seok
- Department of Neurology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ohyun Kwon
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | - Kee Hong Park
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Eunhee Sohn
- Department of Neurology, Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Byung-Nam Yoon
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Kyomin Choi
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Neurology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sanggon Lee
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jinseok Park
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jung Im Seok
- Department of Neurology, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Dae Woong Bae
- Department of Neurology, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jae Young An
- Department of Neurology, College of Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - In Soo Joo
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Tai-Seung Nam
- Department of Neurology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sunyoung Kim
- Department of Neurology, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Ki-Jong Park
- Department of Neurology, College of Medicine, Gyeongsang National University, Gyeonsang Institute of Health Science, Jinju, Republic of Korea
| | - Ki-Han Kwon
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Neuroimmunology Group, University of Oxford, John Radcliffe Hospital, Level 5, West Wing, Headley Way, Oxford, OX3 9DU, UK.
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, Republic of Korea.
- Department of Neurology, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, 20 Boramae-Ro 5-Gil, Dongjak-Gu, Seoul, 07061, Republic of Korea.
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20
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Min YG, Ju W, Ha YE, Ban JJ, Shin JY, Kim SM, Hong YH, Park SH, Sung JJ. Skin Biopsy as a Novel Diagnostic Aid in Immune-Mediated Neuropathies. J Neuropathol Exp Neurol 2022; 81:1018-1025. [PMID: 36137254 PMCID: PMC9677240 DOI: 10.1093/jnen/nlac085] [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] [Indexed: 01/06/2023] Open
Abstract
Immune-mediated neuropathies are a heterogenous group of inflammatory peripheral nerve disorders. They can be classified according to the domain where the autoimmune process begins: the internode, paranode, or node. However, conventional diagnostic tools, electrodiagnosis (EDX), and autoantibody testing do not fully address this issue. In this institutional cohort study, we investigated the value of dermal myelinated fiber analysis for target domain-based classification. Twenty-seven consecutive patients with immune-mediated neuropathies underwent skin biopsies. The sections were stained with antibodies representative of myelinated fiber domains and were scanned using a confocal microscope. Clinical and pathological features of each patient were reviewed comprehensively. Quantitative morphometric parameters were subjected to clustering analysis, which stratified patients into 3 groups. Cluster 1 ("internodopathy") was characterized by prominent internodal disruption, intact nodes and paranodes, demyelinating EDX pattern, and absence of nodal-paranodal antibodies. Cluster 2 ("paranodopathy") was characterized by paranodal disruption and corresponding antibodies. Morphological changes were restricted to the nodes in cluster 3; we designated this cluster as "nodopathy." This report highlights the utility of skin biopsy as a diagnostic aid to gain pathogenic insight and classify patients with immune-mediated neuropathies.
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Affiliation(s)
- Young Gi Min
- From the Department of Neurology, Seoul National University Hospital, Seoul, Korea,Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Woohee Ju
- From the Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Ye-Eun Ha
- From the Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Jun Ban
- From the Department of Neurology, Seoul National University Hospital, Seoul, Korea,Neuroscience Research Institute, Biomedical Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Je-Young Shin
- From the Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sung-Min Kim
- From the Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Hospital, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Soul, Korea
| | - Jung-Joon Sung
- Send correspondence to: Jung-Joon Sung, MD, PhD, Department of Neurology, Seoul National University Hospital, Department of Translational Medicine, Seoul National University College of Medicine, 101 Daehangno, Jongnogu, Seoul 03080, Korea; E-mail:
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21
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Choi SJ, Kim JS, Ju W, Sung JJ, Hyuk Lee J. TH-233. Association between adipopenia and the prognosis of amyotrophic lateral sclerosis: CT-based deep learning approaches. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.419] [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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22
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Gi Min Y, Ju W, Kim JS, Han JE, Choi SJ, Sung JJ. TH-266. Skin biopsy complements electrodiagnosis in the diagnosis of immune-mediated neuropathies. Clin Neurophysiol 2022. [DOI: 10.1016/j.clinph.2022.07.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Park CHK, Choi SJ, Kim YJ, Hong YH, Sung JJ. National prescription patterns of antidepressants among patients with amyotrophic lateral sclerosis: an analysis of the Korean National Health Insurance database. Muscle Nerve 2022; 66:312-318. [PMID: 35707968 DOI: 10.1002/mus.27663] [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: 10/04/2021] [Revised: 06/08/2022] [Accepted: 06/11/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION/AIMS The current status of antidepressant use in patients with amyotrophic lateral sclerosis (ALS), such as the prevalence and factors associated with it, has not been systematically investigated. We aimed to analyze the prevalence and patterns of antidepressant prescriptions in patients with ALS and depression, and to identify factors associated with antidepressant prescriptions following the diagnosis of ALS. METHODS The data of patients with ALS and the prescription of antidepressants were retrieved from the Korean National Health Insurance claims data. A multivariate logistic regression model was used to identify factors associated with antidepressant prescriptions. RESULTS In total, 533 of 2,955 patients had depressive disorders, and 426 were prescribed antidepressants. Selective serotonin reuptake inhibitors and tricyclic antidepressants were the most frequently prescribed drugs. Adjusted odds ratios (ORs) were 1.379 for the prescription of antidepressants in females. For various age groups, compared with those aged 80 years and older, adjusted ORs were 1.889 for those in their 70s, 2.319 for those in their 60s, 2.872 for those in their 50s, 2.854 for those in their 40s, and 3.363 for those under 40 years of age. Adjusted ORs were 1.662 for patients with a history of a psychiatric disorder and 1.861 for those with a history of psychiatric pharmacotherapy (all p < 0.05). DISCUSSION Most patients with ALS who had depression received antidepressant prescriptions. In young females with a previous psychiatric disorder or pharmacotherapy, an in-depth evaluation for a depressive disorder should be performed. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Inha University Hospital, Incheon, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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24
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Nam JY, Lee TY, Kim K, Chun S, Kim MS, Shin JH, Sung JJ, Kim BJ, Kim BJ, Oh KW, Kim KS, Kim SH. Efficacy and safety of Lenzumestrocel (Neuronata-R® inj.) in patients with amyotrophic lateral sclerosis (ALSUMMIT study): study protocol for a multicentre, randomized, double-blind, parallel-group, sham procedure-controlled, phase III trial. Trials 2022; 23:415. [PMID: 35585556 PMCID: PMC9115933 DOI: 10.1186/s13063-022-06327-4] [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: 11/21/2021] [Accepted: 04/23/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A single cycle (two repeated treatments) with intrathecal autologous bone marrow-derived mesenchymal stem cells (BM-MSCs, 26-day interval) showed safety and provided therapeutic benefit lasting 6 months in patients with ALS but did not demonstrate long-term efficacy. This phase III clinical trial (ALSUMMIT) protocol was developed to evaluate the long-term efficacy and safety of the combined protocol of single-cycle intrathecal therapy and three additional booster injections of BM-MSC (Lenzumestrocel) treatment in patients with ALS. METHODS ALSUMMIT is a multicentre, randomized, double-blind, parallel-group, sham procedure-controlled, phase III trial for ALS. The 115 subjects will be randomized (1:2:2) into three groups: (1) study Group 1 (single-cycle, two repeated injections with 26-day interval), (2) study Group 2 (single-cycle + three additional booster injections at 4, 7, and 10 months), and (3) the control group. Participants who have an intermediate rate of disease progression will be included in this trial to reduce clinical heterogeneity. The primary endpoint will be evaluated by combined assessment of function and survival (CAFS), also known as joint rank scores (JRS), at 6 months (study Group 1 vs. control) and 12 months (study Group 2 vs. control) after the first Lenzumestrocel or placebo administration. Safety assessment will be performed throughout the study period. Additionally, after the 56-week main study, a long-term follow-up observational study will be conducted to evaluate the long-term efficacy and safety up to 36 months. DISCUSSION Lenzumestrocel is the orphan cell therapy product for ALS conditionally approved by the South Korea Ministry of Food and Drug Safety (MFDS). This ALSUMMIT protocol was developed for the adoption of enrichment enrolment, add-on design, and consideration of ethical issues for the placebo group. TRIAL REGISTRATION ClinicalTrials.gov NCT04745299 . Registered on Feb 9, 2021. Clinical Research Information Service (CRIS) KCT0005954 . Registered on Mar 4, 2021.
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Affiliation(s)
- Jae-Yong Nam
- Central Research Center, Corestem Inc, Seoul, South Korea
| | - Tae Yong Lee
- Central Research Center, Corestem Inc, Seoul, South Korea.,College of Pharmacy, Chungbuk National University, Cheongju, South Korea
| | - Kwijoo Kim
- Central Research Center, Corestem Inc, Seoul, South Korea
| | - Sehwan Chun
- Central Research Center, Corestem Inc, Seoul, South Korea
| | - Min Sung Kim
- Central Research Center, Corestem Inc, Seoul, South Korea.,College of Pharmacy, Chungbuk National University, Cheongju, South Korea
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University, Yangsan, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University, Seoul, South Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Seoul, South Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Ki-Wook Oh
- Department of Neurology, Hanyang University Hospital, Seoul, South Korea
| | - Kyung Suk Kim
- Central Research Center, Corestem Inc, Seoul, South Korea.
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University Hospital, Seoul, South Korea.
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25
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Min YG, Kim JE, Hwang JY, Shin JY, Sung JJ, Hong YH. Parsonage-Turner syndrome following COVID-19 vaccination. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2021-328182. [PMID: 35387865 PMCID: PMC9606495 DOI: 10.1136/jnnp-2021-328182] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 02/23/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Young Gi Min
- Neurology, Seoul National University Hospital, Seoul, South Korea
- Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jee-Eun Kim
- Neurology, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Ji Young Hwang
- Radiology, College of Medicine, Ewha Womans University, Seoul, South Korea
| | - Je-Young Shin
- Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Joon Sung
- Neurology, Seoul National University Hospital, Seoul, South Korea
- Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Yoon-Ho Hong
- Neurology, Neuroscience Research Institute, Medical Research Council, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
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26
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Choi SJ, Park CHK, Hong YH, Sung JJ. Previous psychiatric disorders in the multistep hypothesis of amyotrophic lateral sclerosis: a South Korean population study. Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:601-607. [PMID: 35164606 DOI: 10.1080/21678421.2022.2035765] [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: 11/01/2022]
Abstract
Objective: There is accumulating evidence about an association between amyotrophic lateral sclerosis (ALS) and psychiatric disorders. We aimed to investigate the prevalence of previous psychiatric disorders before ALS onset and evaluate the contribution of psychiatric disorders to the number of steps toward developing ALS.Methods: We analyzed the National Health Insurance claims data from 2011 to 2017 and calculated the incidence of ALS. We created a multistep model using the linear least squares method with regression of the log incidence against the log age.Results: The mean annual incidence of ALS was 0.95/100,000 and frequency of familial ALS (fALS) was 5.89%. The proportions of patients who had psychiatric disorders before ALS diagnosis were 36.8% and 47.0% in fALS and sporadic ALS (sALS), respectively (p = 0.009). In both fALS and sALS, depressive disorders and anxiety and stress disorders were relatively frequent, whereas psychotic disorders and bipolar disorders were rare. Further, the slope estimates for regression analyses were 3.50 (R2 = 0.94) and 3.56 (R2 = 0.99) for fALS and sALS, respectively, suggesting a 4-5-step process to ALS onset. However, slope estimates did not differ between sALS patients with pre-symptomatic psychiatric disorders and those without.Conclusions: The incidence of ALS is relatively low in Korea and fewer steps are required to develop ALS compared to Western populations (all 6 steps). Although the prevalence of previous depression or anxiety is seemingly high, the multistep model provides no evidence that these conditions modify the risk of developing ALS in our cohort.
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Affiliation(s)
- Seok-Jin Choi
- Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.,Biomedical Research Institute, Inha University Hospital, Incheon, Republic of Korea
| | - C Hyung Keun Park
- Department of Psychiatry, Asan Medical Center, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University, Hongcheon, Republic of Korea.,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
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27
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Kim JE, Min YG, Shin JY, Kwon YN, Bae JS, Sung JJ, Hong YH. Guillain–Barré Syndrome and Variants Following COVID-19 Vaccination: Report of 13 Cases. Front Neurol 2022; 12:820723. [PMID: 35153993 PMCID: PMC8833101 DOI: 10.3389/fneur.2021.820723] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 11/23/2021] [Accepted: 12/29/2021] [Indexed: 12/24/2022] Open
Abstract
Background Amidst growing concern about an increased risk of Guillain–Barré syndrome (GBS) following COVID-19 vaccination, clinical and electrodiagnostic features have not been fully characterized. Methods We retrospectively reviewed medical records of the patients diagnosed with GBS and its variants following COVID-19 vaccination at four referral hospitals during the period of the mass vaccination program in South Korea (February to October 2021). Results We identified 13 patients with GBS and variants post COVID-19 vaccination: AstraZeneca vaccine (Vaxzevria) in 8, and Pfizer-BioNTech vaccine (Comirnaty) in 5. The mean time interval from vaccination to symptom onset was 15.6 days (range 4–30 days). Electrodiagnostic classification was demyelinating in 7, axonal in 4 and normal in 2 cases. Clinical manifestations were diverse with varying severity: classical GBS in 8 cases, paraparetic variant in 3, Miller-Fisher syndrome in 1 and acute cervicobrachial weakness in 1. Four patients developed respiratory failure, and 2 of them showed treatment-related fluctuations. Conclusion Our observations suggest that COVID-19 vaccines may be associated with GBS of distinctive clinical features characterized by severe quadriplegia, disproportionately frequent bilateral facial palsy or atypical incomplete variants. Continuous surveillance and further studies using robust study designs are warranted to fully assess the significance of the association.
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Affiliation(s)
- Jee-Eun Kim
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
- Department of Translational Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Hanlym University Hospital, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
- *Correspondence: Yoon-Ho Hong
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28
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Yoo D, Lee W, Lee SJ, Sung JJ, Jeon GS, Ban JJ, Shin C, Kim J, Kim HS, Ahn TB. A Novel TFG Mutation in a Korean Family with α-Synucleinopathy and Amyotrophic Lateral Sclerosis. Mov Disord 2021; 37:384-391. [PMID: 34779525 DOI: 10.1002/mds.28857] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 06/29/2021] [Revised: 10/24/2021] [Accepted: 10/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Tropomyosin-receptor kinase fused gene (TFG) functions as a regulator of intracellular protein packaging and trafficking at the endoplasmic reticulum exit sites. TFG has recently been proposed as a cause of multisystem proteinopathy. OBJECTIVES Here, we describe a Korean family presenting with Parkinson's disease or amyotrophic lateral sclerosis caused by a novel variant of TFG (c.1148 G > A, p.Arg383His). METHODS We collected clinical, genetic, dopamine transporter imaging, nerve conduction, and electromyography data from the seven subjects. To verify the pathogenicity of the R383H variant, we studied cell viability and the abnormal aggregation of α-synuclein and TAR DNA-binding protein 43 (TDP-43) in HeLa cells expressing R383H-TFG. RESULTS The clinical phenotypes of the R383H-TFG mutation varied; of the five family members, one had Parkinson's disease, three had subclinical parkinsonism, and one (the proband) had amyotrophic lateral sclerosis. The individual with multiple system atrophy was the proband's paternal cousin, but the TFG genotype was not confirmed due to unavailability of samples. Our in vitro studies showed that R383H-TFG overexpression impaired cell viability. In cells co-expressing R383H-TFG and α-synuclein, insoluble α-synuclein aggregates increased in concentration and were secreted from the cells and co-localized with R383H-TFG. The levels of cytoplasmic insoluble aggregates of TDP-43 increased in HeLa cells expressing R383H-TFG and co-localized with R383H-TFG. CONCLUSIONS Clinical and in vitro studies have supported the pathogenic role of the novel TFG mutation in α-synucleinopathy and TDP-43 proteinopathy. These findings expand the phenotypic spectrum of TFG and suggest a pivotal role of endoplasmic reticulum dysfunction during neurodegeneration. © 2021 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Dallah Yoo
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Wonjae Lee
- Department of Biomedical Sciences, Neuroscience Research Institute, and Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.,Neuramedy Co., Ltd, Seoul, Republic of Korea
| | - Seung-Jae Lee
- Department of Biomedical Sciences, Neuroscience Research Institute, and Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gye Sun Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Jun Ban
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chaewon Shin
- Department of Neurology, Neuroscience Center, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong-si, Republic of Korea
| | - Jungho Kim
- Laboratory of Molecular and Cellular Biology, Department of Life Science, Sogang University, Seoul, Republic of Korea
| | - Hyo Sun Kim
- Laboratory of Molecular and Cellular Biology, Department of Life Science, Sogang University, Seoul, Republic of Korea
| | - Tae-Beom Ahn
- Department of Neurology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul, Republic of Korea
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29
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Kwon YN, Kim B, Kim JS, Mo H, Choi K, Oh SI, Kim JE, Nam TS, Sohn EH, Heo SH, Kim SB, Park KC, Yoon SS, Oh J, Baek SH, Kim BJ, Park KS, Sung JJ, Jung JH, Kim SJ, Park SH, Waters P, Kim SM. Myelin Oligodendrocyte Glycoprotein-Immunoglobulin G in the CSF: Clinical Implication of Testing and Association With Disability. Neurol Neuroimmunol Neuroinflamm 2021; 9:9/1/e1095. [PMID: 34711644 PMCID: PMC8554713 DOI: 10.1212/nxi.0000000000001095] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 09/08/2021] [Indexed: 11/29/2022]
Abstract
Background and Objective To investigate the clinical relevance of CSF myelin oligodendrocyte glycoprotein-immunoglobulin G (MOG-IgG) testing in a large multicenter cohort. Methods In this multicenter cohort study, paired serum-CSF samples from 474 patients with suspected inflammatory demyelinating disease (IDD) from 11 referral hospitals were included. After serum screening, patients were grouped into seropositive myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD, 31), aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG + NMOSD, 60), other IDDs (217), multiple sclerosis (MS, 45), and non-IDDs (121). We then screened CSF for MOG-IgG and compared the clinical and serologic characteristics of patients uniquely positive for MOG-IgG in the CSF to seropositive patients with MOGAD. Results Nineteen patients with seropositive MOGAD (61.3%), 9 with other IDDs (CSF MOG + IDD, 4.1%), 4 with MS (8.9%), but none with AQP4-IgG + NMOSD nor with non-IDDs tested positive in the CSF for MOG-IgG. The clinical, pathologic, and prognostic features of patients uniquely positive for CSF MOG-IgG, with a non-MS phenotype, were comparable with those of seropositive MOGAD. Intrathecal MOG-IgG synthesis, observed from the onset of disease, was shown in 12 patients: 4 of 28 who were seropositive and 8 who were uniquely CSF positive, all of whom had involvement of either brain or spinal cord. Both CSF MOG-IgG titer and corrected CSF/serum MOG-IgG index, but not serum MOG-IgG titer, were associated with disability, CSF pleocytosis, and level of CSF proteins. Discussion CSF MOG-IgG is found in IDD other than MS and also in MS. In IDD other than MS, the CSF MOG-IgG positivity can support the diagnosis of MOGAD. The synthesis of MOG-IgG in the CNS of patients with MOGAD can be detected from the onset of the disease and is associated with the severity of the disease. Classification of Evidence This study provides Class II evidence that the presence of CSF MOG-IgG can improve the diagnosis of MOGAD in the absence of an MS phenotype, and intrathecal synthesis of MOG-IgG was associated with increased disability.
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Affiliation(s)
- Young Nam Kwon
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Boram Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Jun-Soon Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Heejung Mo
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Kyomin Choi
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Seong-Il Oh
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jee-Eun Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Tai-Seung Nam
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Eun Hee Sohn
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sung Hyuk Heo
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sang Beom Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Key-Chung Park
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sung Sang Yoon
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jeeyoung Oh
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Seol-Hee Baek
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Byung-Jo Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Kyung Seok Park
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jung-Joon Sung
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Jae Ho Jung
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Seong-Joon Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Sung-Hye Park
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Patrick Waters
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sung-Min Kim
- From the Department of Neurology, Seoul National University Hospital (Y.N.K., J.J.S., S.M.K); Department of Neurology, Neuroscience Research Institute, Seoul National University College of Medicine (B.K., J.J.S., S.M.K); Department of Neurology (J.S.K.), Seoul National University Bundang Hospital, Seongnam; Department of Neurology (H.M.), Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong; Department of Neurology (K.C.), Konkuk University School of Medicine, Konkuk University Medical Center; Department of Neurology (S-.i.O.), Busan Paik Hospital, Inje University College of Medicine, Busan; Department of Neurology (J.-E.K.), Seoul Hospital, Ewha Womans University College of Medicine; Department of Neurology (T.-S.N.), Chonnam National University Medical School, Gwangju; Department of Neurology (E.H.S.), Chungnam National University College of Medicine, Chungnam National University Hospital, Daejeon; Department of Neurology (S.H.H., K-C.P., S.S.Y.), Kyung Hee University Hospital, Kyung Hee University School of Medicine; Department of Neurology (S.B.K.), Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine; Department of Neurology (S-H.B., B.-J.K.), Korea University College of Medicine, Korea University Anam Hospital; Department of Ophthalmology (J.H.J., S.-J.K.), Seoul National University College of Medicine; Department of Pathology (S.-H.P.), Seoul National University Hospital, Seoul National University, College of Medicine, Seoul; Autoimmune Neurology Group (P.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
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Min YG, Ju W, Ha YE, Ban JJ, Lee SA, Sung JJ, Shin JY. Sensory Guillain-Barre syndrome following the ChAdOx1 nCov-19 vaccine: Report of two cases and review of literature. J Neuroimmunol 2021; 359:577691. [PMID: 34416410 PMCID: PMC8349403 DOI: 10.1016/j.jneuroim.2021.577691] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 01/12/2023]
Abstract
Massive vaccination against COVID-19 has become a global priority. Simultaneously, concerns regarding the safety of vaccines are growing. We describe two patients who developed sensory Guillain-Barre syndrome (GBS) shortly after the first dose of the ChAdOx1 vaccine. We also summarize 12 published cases of GBS after ChAdOx1 vaccination, highlighting their unique clinical and paraclinical features. We propose a possible association between the risk of GBS and the ChAdOx1 vaccine and recommend surveillance for GBS following vaccination. Population-based studies are needed to determine causality and whether specific subpopulations are susceptible.
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Affiliation(s)
- Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Woohee Ju
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ye-Eun Ha
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Jun Ban
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Biomedical Research Institute, Seoul, Republic of Korea
| | - Seol Ah Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea; Department of Translational Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.
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Yoo WH, Lee SI, Kim TH, Sung JJ, Kim SM, Hua F, Sumarsono B, Park SH. Safety of Tacrolimus in Autoimmune Disease: Results From Post-marketing Surveillance in South Korea. J Rheum Dis 2021; 28:202-215. [PMID: 37476363 PMCID: PMC10324909 DOI: 10.4078/jrd.2021.28.4.202] [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: 12/28/2020] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 07/22/2023]
Abstract
Objective Tacrolimus, a macrolide immunosuppressant, is approved in Korea for the treatment of rheumatoid arthritis (RA), lupus nephritis (LN) and myasthenia gravis (MG) We report three prospective post-marketing surveillance studies of tacrolimus conducted in South Korea in these indications. Methods Studies were conducted according to South Korean Ministry of Food and Drug Safety requirements Patients were followed up for the duration of the study (up to 4 years) or until treatment discontinuation Occurrence and likely relationship with tacrolimus of adverse events (AEs), adverse drug reactions (ADRs; defined as AEs where causal relationship to tacrolimus could not be excluded) and serious AEs were recorded Association of AEs with demographic and medical factors was evaluated by multivariable analysis. Results The studies included 740 (RA), 307 (LN) and 104 (MG) patients The incidence of AEs was 127% in RA (642% of AEs potentially related to tacrolimus), 209% (378% potentially related) in LN and 298% (568% potentially related) in MG The incidence of ADRs was 84%, 98% and 202%, respectively Serious AEs were reported in 07%, 72% and 87%, respectively The most common AEs were abdominal pain (RA), pharyngitis (LN) and diarrhea (MG) Unexpected AEs occurred in 35% of patients with RA, 29% in LN and 87% in MG; no pattern of unexpected AEs was apparent Multivariable analysis demonstrated that patients with comorbidity had higher probability of experiencing an AE in RA and MG studies. Conclusion The incidence of AEs and the safety profile of tacrolimus in each indication was consistent with previous reports.
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Affiliation(s)
- Wan-Hee Yoo
- Division of Rheumatology, Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Korea
| | - Sang-Il Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Tae-Hwan Kim
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Fan Hua
- Astellas Pharma Singapore Pte Ltd., Singapore, Korea
| | | | - Sung Hwan Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Kim A, Choi SJ, Kang CH, Lee S, Son H, Kim JA, Shin JY, Kim SM, Hong YH, Sung JJ. Risk factors for developing post-thymectomy myasthenia gravis in patients with thymoma. Muscle Nerve 2021; 63:531-537. [PMID: 33434360 DOI: 10.1002/mus.27169] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thymectomy is required for the treatment of thymoma-associated myasthenia gravis (MG). However, MG may develop only after thymectomy, a condition known as post-thymectomy MG. This study aimed to investigate the risk factors for post-thymectomy MG in patients with thymoma. METHODS We retrospectively identified 235 patients with thymoma who underwent thymectomy at a single hospital from January 2008 to December 2017: 44 with preoperatively diagnosed MG were excluded, leaving 191 patients in the final analysis. Univariable survival analyses using Cox proportional hazards regression model and Kaplan-Meier estimate were conducted to identify risk factors for post-thymectomy MG. RESULTS Post-thymectomy MG developed in 4.2% (8/191) of the patients with thymoma between 18 days and 108 mo after surgery. Hazard ratios (HRs) of pre- and postoperative anti-acetylcholine receptor antibody (AChR-Ab) titers were 2.267 (P = .002) and 1.506 (P < .001), respectively. Patients with extended thymectomy had a low chance of post-thymectomy MG (HR 0.035, P = .007). Larger thymoma (HR, 1.359; P = .005) and type A or AB thymoma according to World Health Organization histological classification (HR, 11.92; P = .021) were associated with higher chances of post-thymectomy MG. Within the subgroup of preoperatively AChR-Ab seropositive patients, post-thymectomy MG developed in 22.2% (6/27). CONCLUSIONS Pre- and postoperative AChR-Ab levels should be measured in patients with thymoma. A large thymoma and partial thymectomy appear to be associated with a higher probability of post-thymectomy MG.
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Affiliation(s)
- Ahwon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seonkyung Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Ah Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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Kwon YN, Kim B, Ahn S, Seo J, Kim SB, Yoon SS, Sung JJ, Choi YS, Kim SM. Serum level of IL-1β in patients with inflammatory demyelinating disease: Marked upregulation in the early acute phase of MOG antibody associated disease (MOGAD). J Neuroimmunol 2020; 348:577361. [DOI: 10.1016/j.jneuroim.2020.577361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/09/2020] [Accepted: 08/11/2020] [Indexed: 01/21/2023]
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Lee DY, Jeon GS, Sung JJ. ALS-Linked Mutant SOD1 Associates with TIA-1 and Alters Stress Granule Dynamics. Neurochem Res 2020; 45:2884-2893. [PMID: 33025330 DOI: 10.1007/s11064-020-03137-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/30/2019] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a degenerative disorder caused by motor neuron loss. T-cell intracellular antigen-1 (TIA-1), a cytotoxic T lymphocyte granule-associated RNA binding protein, is a key component of stress granules. However, it remains uncertain whether ALS-causing superoxide dismutase-1 (SOD1) toxicity alters the dynamics of stress granules. Thus, through mouse and cell line models, and human cells and tissues, we showed the subcellular location of TIA-1 and its recruitment by stress granules following mutant SOD1-related stimuli. An overexpression of MTSOD1 resulted in increased TIA-1-positive cytoplasmic inclusions in the spinal cord tissue of SOD1G93A transgenic mouse and the SOD1G86S familial ALS patient. Moreover, we demonstrated the stages of ALS-like disease-dependent increase in TIA-1 in the spinal cord of transgenic mice. A similar increase of TIA-1 was found in the spinal cord of the SOD1G86S patient and induced pluripotent stem cell-derived neural stem cells from the SOD1G17S patient. By using immunoprecipitation assays in wild type (WT) human SOD1 (hSOD1) or mutant (MT) hSOD1-transfected motor neuronal cell lines and SOD1G93A transgenic mouse model, we observed that MTSOD1 interacts with TIA-1. In WT or MT hSOD1-transfected HEK293 and NSC-34 cells, the formation of TIA-1-positive stress granules was delayed in MTSOD1 by sodium arsenite treatment. These findings suggest that MTSOD1 could affect the dynamics of stress granules through the abnormal MTSOD1-TIA-1 interaction. Consequently, the resulting pathological TIA-1 may be involved in RNA metabolism found in ALS.
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Affiliation(s)
- Do-Yeon Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Gye Sun Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea. .,Biomedical Research Institute, Seoul National University Hospital College of Medicine, Seoul, South Korea.
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea. .,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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Abstract
The aim of the present study was to investigate the frequency and clinical features of Guillain-Barré syndrome (GBS) with hyperCKemia. We retrospectively identified 139 patients with GBS at 2 teaching hospitals in South Korea. We excluded patients with Miller-Fisher syndrome (n = 19), acute bulbar palsy (n = 3), and those whose serum creatine kinase (CK) levels were not measured (n = 45). Twelve of 72 patients (16.7%) had transient hyperCKemia, defined as serum CK ≥300 IU/L. The frequency of male sex and non-demyelinating electrodiagnostic features were higher in patients with hyperCKemia than those without. Transient hyperCKemia, occasionally seen in patients with GBS may be associated with the non-demyelinating subtype.
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Affiliation(s)
- Seok-Jin Choi
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea.,Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea, .,Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea,
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Affiliation(s)
- Young Nam Kwon
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.) and Departments of Ophthalmology (J.H.J., S.-J.K.) and Neurology (J.-J.S., S.-M.K.), College of Medicine, Seoul National University, Seoul National University Hospital; and Department of Neurology (Y.N.K.), The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Korea
| | - Jae Ho Jung
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.) and Departments of Ophthalmology (J.H.J., S.-J.K.) and Neurology (J.-J.S., S.-M.K.), College of Medicine, Seoul National University, Seoul National University Hospital; and Department of Neurology (Y.N.K.), The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Korea
| | - Seong-Joon Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.) and Departments of Ophthalmology (J.H.J., S.-J.K.) and Neurology (J.-J.S., S.-M.K.), College of Medicine, Seoul National University, Seoul National University Hospital; and Department of Neurology (Y.N.K.), The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Korea.
| | - Jung-Joon Sung
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.) and Departments of Ophthalmology (J.H.J., S.-J.K.) and Neurology (J.-J.S., S.-M.K.), College of Medicine, Seoul National University, Seoul National University Hospital; and Department of Neurology (Y.N.K.), The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Korea
| | - Sung-Min Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.) and Departments of Ophthalmology (J.H.J., S.-J.K.) and Neurology (J.-J.S., S.-M.K.), College of Medicine, Seoul National University, Seoul National University Hospital; and Department of Neurology (Y.N.K.), The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Korea.
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Kim KY, Kim YR, Choi KW, Lee M, Lee S, Im W, Shin JY, Kim JY, Hong YH, Kim M, Kim JI, Sung JJ. Downregulated miR-18b-5p triggers apoptosis by inhibition of calcium signaling and neuronal cell differentiation in transgenic SOD1 (G93A) mice and SOD1 (G17S and G86S) ALS patients. Transl Neurodegener 2020; 9:23. [PMID: 32605607 PMCID: PMC7328278 DOI: 10.1186/s40035-020-00203-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 05/22/2019] [Accepted: 06/01/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND MicroRNAs (miRNAs) are endogenous non-coding RNAs that regulate gene expression at the post-transcriptional level and are key modulators in neurodegenerative diseases. Overexpressed miRNAs play an important role in ALS; however, the pathogenic mechanisms of deregulated miRNAs are still unclear. METHODS We aimed to assess the dysfunction of RNAs or miRNAs in fALS (SOD1 mutations). We compared the RNA-seq of subcellular fractions in NSC-34 WT (hSOD1) and MT (hSOD1 (G93A)) cells to find altered RNAs or miRNAs. We identified that Hif1α and Mef2c were upregulated, and Mctp1 and Rarb were downregulated in the cytoplasm of NSC-34 MT cells. RESULTS SOD1 mutations decreased the level of miR-18b-5p. Induced Hif1α which is the target for miR-18b increased Mef2c expression as a transcription factor. Mef2c upregulated miR-206 as a transcription factor. Inhibition of Mctp1 and Rarb which are targets of miR-206 induces intracellular Ca2+ levels and reduces cell differentiation, respectively. We confirmed that miR-18b-5p pathway was also observed in G93A Tg, fALS (G86S) patient, and iPSC-derived motor neurons from fALS (G17S) patient. CONCLUSIONS Our data indicate that SOD1 mutation decreases miR-18b-5p, which sequentially regulates Hif1α, Mef2c, miR-206, Mctp1 and Rarb in fALS-linked SOD1 mutation. These results provide new insights into the downregulation of miR-18b-5p dependent pathogenic mechanisms of ALS.
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Affiliation(s)
- Ki Yoon Kim
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Yu Ri Kim
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Kyung Won Choi
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Mijung Lee
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Somyung Lee
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Wooseok Im
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Jin Young Kim
- Division of Mass Spectrometry Research, Korea Basic Science Institute, Daejun, South Korea
| | - Yoon Ho Hong
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Manho Kim
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea
| | - Jong-Il Kim
- Department of Biochemistry and Molecular Biology, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital 28 yongon-Dong, Chongno-gu, Seoul, 110-744, Republic of Korea.
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Kwon YN, Koh J, Jeon YK, Sung JJ, Park SH, Kim SM. A case of MOG encephalomyelitis with T- cell lymphoma. Mult Scler Relat Disord 2020; 41:102038. [PMID: 32155461 DOI: 10.1016/j.msard.2020.102038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 02/21/2020] [Accepted: 03/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein immunoglobulin-G (IgG)-associated encephalomyelitis (MOG-EM) is a distinct inflammatory demyelinating disease. We present an unusual MOG-EM cases with concomitant T-cell lymphoma. CASE REPORT A 38-year-old Caucasian male presented with bilateral optic neuritis and multifocal transverse myelitis. He tested positive for MOG-IgG1 and his neurologic symptoms improved with high dose steroid treatment. Six months after his first MOG-EM symptoms, he developed ulcerative skin lesions on his leg and was diagnosed with primary cutaneous γδ T-cell lymphoma. The immunohistochemistry study, performed on his cancer tissue, was negative for MOG. CONCLUSION Diagnosis of MOG-EM can be considered in patients with concomitant hematologic malignancy, which might be associated with the dysregulated adaptive immunity rather than the direct presentation of the onconeural antigen by cancer. Further studies need to be conducted for the risks and incidence of malignancy in a larger cohort of MOG-EM.
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Affiliation(s)
- Young Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea; Department of Neurology, The Catholic University of Korea, Eunpyeong St. Mary's Hospital, Seoul, Korea; Department of Medicine, Graduate School Kyung Hee University, Seoul, Korea
| | - Jiwon Koh
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon Kyung Jeon
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Korea; Department of Neurology, Seoul National University College of Medicine, Seoul, Korea.
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Choi SJ, Hong YH, Kim SM, Shin JY, Suh YJ, Sung JJ. High neutrophil-to-lymphocyte ratio predicts short survival duration in amyotrophic lateral sclerosis. Sci Rep 2020; 10:428. [PMID: 31949271 PMCID: PMC6965090 DOI: 10.1038/s41598-019-57366-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [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: 06/07/2019] [Accepted: 12/27/2019] [Indexed: 02/07/2023] Open
Abstract
The present study aimed to investigate the prognostic importance of the neutrophil-to-lymphocyte ratio (NLR) in patients with amyotrophic lateral sclerosis (ALS). Among 322 patients diagnosed as having definite, probable, or possible ALS at a single tertiary hospital, 194 patients were included in the final analysis. Patients were divided into three groups (T1, T2, and T3) according to the tertile of their NLR. Survival rate was significantly lower in T3 compared to the other groups (log-rank test; T1 vs. T3, p = 0.009; T2 vs. T3, p = 0.008). Median survival duration was 37.0 (24.0–56.0), 32.5 (19.5–51.2), and 22.0 (17.0–38.0) months in T1, T2, and T3, respectively. In a multivariable Cox proportional hazards regression analysis, the hazard ratio of age at onset, bulbar-onset, and NLR (T3/T1) was 1.04 (1.02–1.06, p < 0.001), 1.68 (1.10–2.57, p = 0.015), and 1.60 (1.01–2.51, p = 0.041), respectively. A high baseline NLR may serve as a useful indicator for short survival duration in patients with ALS.
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Affiliation(s)
- Seok-Jin Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University School of Medicine, Incheon, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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40
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Min YG, Park C, Kwon YN, Shin JY, Sung JJ, Hong YH. B Cell Immunophenotyping and Transcriptional Profiles of Memory B Cells in Patients with Myasthenia Gravis. Exp Neurobiol 2019; 28:720-726. [PMID: 31902159 PMCID: PMC6946110 DOI: 10.5607/en.2019.28.6.720] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/17/2019] [Accepted: 12/17/2019] [Indexed: 12/13/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune neuromuscular junction disorders mediated by various autoantibodies. Although most patients with MG require chronic immunosuppressive treatment to control disease activity, appropriate surveillance biomarkers that monitor disease activity or potential toxicity of immunosuppressants are yet to be developed. Herein, we investigated quantitative distribution of peripheral blood B cell subsets and transcriptional profiles of memory B cells (CD19+ CD27+) in several subgroups of MG patients classified according to the Myasthenia Gravis Foundation of America (MGFA) Clinical Classification. This study suggests potential immunologic B-cell markers that may guide treatment decision in future clinical settings.
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Affiliation(s)
- Young Gi Min
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea
| | - Canaria Park
- Seoul National University College of Medicine and Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul 03080, Korea
| | - Young-Nam Kwon
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea.,Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul 03080, Korea.,Seoul National University College of Medicine and Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul 03080, Korea
| | - Yoon-Ho Hong
- Seoul National University College of Medicine and Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul 03080, Korea.,Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul 07061, Korea
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Byun JM, Kwon YN, Koh Y, Yoon SS, Sung JJ, Kim I. Distinctive patterns of peripheral neuropathy across the spectrum of plasma cell disorders. Sci Rep 2019; 9:16769. [PMID: 31727997 PMCID: PMC6856063 DOI: 10.1038/s41598-019-53289-w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/25/2019] [Indexed: 11/11/2022] Open
Abstract
Many patients with plasma cell disorders suffer from peripheral neuropathy, but differential diagnosis with chronic inflammatory demyelinating polyneuropathy (CIDP) is difficult. We aimed to (1) identify factors useful for differential diagnosis between peripheral neuropathy associated with plasma cell disorders versus CIDP and (2) determine whether neuropathy presentations and severity varied across the spectrum of different plasma cell disorders. A retrospective chart review of 18 monoclonal gammopathy of unknown significance (MGUS) patients, 15 POEMS syndrome patients and 34 CIDP patients between January 2005 and December 2016 was conducted. The peripheral neuropathy associated with plasma cell disorders seemed to be more sensory oriented compared to CIDP. MGUS patients were significantly older than CIDP patients (median age 70 vs. 59, respectively, p = 0.027). POEMS syndrome patients showed significantly higher platelet count at the time of neuropathy presentation compared to CIDP (p = 0.028). Lambda type MGUS patients were associated with less severe symptoms compared to POEMS syndrome patients despite harboring lambda monoclonal gammopathy as a common denominator. Kappa type MGUS patients showed predominantly axonal type neuropathy compared to its counterpart and POEMS syndrome. Careful inspection of clinical profiles and symptoms of patients presenting with neuropathy can help to discriminate those with underlying plasma cell disorders. The phenotype of neuropathy, platelet count and age at presentation seem to be the most useful indicators.
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Affiliation(s)
- Ja Min Byun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Nam Kwon
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Youngil Koh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Sung-Soo Yoon
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
| | - Inho Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea.
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Choi K, Hong YH, Ahn SH, Baek SH, Kim JS, Shin JY, Sung JJ. Repeated low-dose rituximab treatment based on the assessment of circulating B cells in patients with refractory myasthenia gravis. Ther Adv Neurol Disord 2019; 12:1756286419871187. [PMID: 31555344 PMCID: PMC6751534 DOI: 10.1177/1756286419871187] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 02/10/2019] [Accepted: 07/29/2019] [Indexed: 01/28/2023] Open
Abstract
Background: The objective of this study was to evaluate the efficacy and safety of
repeated low-dose rituximab treatment guided by monitoring circulating CD19+
B cells in patients with refractory myasthenia gravis (MG). Methods: Patients with refractory MG who had received rituximab treatment at two
teaching hospitals between September 2013 and January 2017 were reviewed
retrospectively. The treatment protocol consisted of an induction treatment
with low-dose rituximab (375 mg/m2 twice with a 2-week interval),
followed by retreatment (375 mg/m2 once). Retreatment was based
on either circulating CD19+ B-cell repopulation or clinical relapse. Outcome
measures included the MG Foundation of America (MGFA) clinical
classification and postintervention status, prednisolone dose, CD19+ B-cell
counts, clinical relapse, and adverse effects. Results: Of 17 patients, 11 (65%) achieved the primary endpoint, defined as the
minimal manifestation or better status with prednisolone ⩽5 mg/day, after
median 7.6 months (range, 2–17 months) following rituximab treatment. Over a
median follow up of 24 months (range, 7–49 months), a total of 30
retreatments were undertaken due to clinical relapse without B-cell
repopulation (n = 6), on the basis of B-cell repopulation
alone (n = 16) and both (n = 8). B-cell
recovery appeared to be in parallel with clinical relapse on the group
level, although the individual-level association appeared to be modest, with
B-cell repopulation observed only at 57% (8/14) of clinical relapses. Conclusions: The repeated low-dose rituximab treatment based on the assessment of
circulating B-cell depletion could be a cost-effective therapeutic option
for refractory MG. Further studies are needed to verify the potentially
better cost-effectiveness of low-dose rituximab, and to identify biomarkers
that help optimize treatment in MG patients.
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Affiliation(s)
- Kyomin Choi
- Department of Neurology, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul Metropolitan Boramae Medical Center, Seoul, Republic of Korea
| | - So-Hyun Ahn
- Department of Neurology, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University College of Medicine, Korea University Medical Center, Seoul, Republic of Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yeongeon-dong, Jongno-gu, Seoul, 03080, Republic of Korea
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Shin HJ, Hyun JW, Kim SH, Park MS, Sohn EH, Baek SH, Kim BJ, Choi K, Oh J, Cho JY, Kwon O, Kim W, Kim JE, Min JH, Kim BJ, Oh SY, Bae JS, Park KH, Oh JH, Sohn SY, Jang MJ, Sung JJ, Kim HJ, Kim SM. Changing patterns of multiple sclerosis in Korea: Toward a more baseline MRI lesions and intrathecal humoral immune responses. Mult Scler Relat Disord 2019; 35:209-214. [PMID: 31401425 DOI: 10.1016/j.msard.2019.08.004] [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] [Received: 12/20/2018] [Revised: 07/11/2019] [Accepted: 08/04/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The environmental risks of multiple sclerosis (MS), including adolescent obesity and vitamin D deficiency, are increasing in Korea. We aimed to determine whether the patterns and/or severity of MS in Korea can change according to the year of birth or disease onset. METHODS Two hundred and sixty-six patients with adult-onset MS, including 164 with an available baseline magnetic resonance imaging (MRI), were retrospectively included from 17 nationwide referral hospitals in Korea. The demographics, MRI T2 lesion burden at disease onset, cerebrospinal fluid markers, and prognosis were assessed. RESULTS The birth year, time from disease onset to first MRI, and female sex were associated with a higher number of baseline MRI T2 lesions. The birth year was also associated with the presence of oligoclonal band in the cerebrospinal fluid and high immunoglobin G index. An increased female/male ratio was observed among those with a more recent year of birth and/or disease onset. CONCLUSIONS In Korea, the disease pattern of adult-onset MS may be changing toward a more baseline T2 MRI lesions, intrathecal humoral immune responses, and also higher female ratio.
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Affiliation(s)
- Hyun-June Shin
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea; Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Republic of Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Min Su Park
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Eun Hee Sohn
- Department of Neurology, Chungnam National University School of Medicine, Deajeon, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyomin Choi
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Joong-Yang Cho
- Department of Neurology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Republic of Korea
| | - Ohyun Kwon
- Department of Neurology, Nowon Eulji Medical Center, Eulji University College of Medicine, Seoul, Republic of Korea
| | - Woojun Kim
- Department of Neurology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Jee-Eun Kim
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea
| | - Sun-Young Oh
- Department of Neurology, Chonbuk National University School of Medicine, Jeonju, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Kee Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung-Hwan Oh
- Department of Neurology, Jeju National University School of Medicine, Jeju, Republic of Korea
| | - Sung-Yeon Sohn
- Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
| | - Sung-Min Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Kwon YN, Waters PJ, Kim M, Choi YS, Kim JW, Sung JJ, Park SH, Kim SM. Peripherally derived macrophages as major phagocytes in MOG encephalomyelitis. Neurol Neuroimmunol Neuroinflamm 2019; 6:6/5/e600. [PMID: 31454776 PMCID: PMC6705630 DOI: 10.1212/nxi.0000000000000600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/18/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Young Nam Kwon
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Patrick J Waters
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Moonhang Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Youn Soo Choi
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Jung-Joon Sung
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Sung-Hye Park
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Sung-Min Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
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Baek SH, Hong YH, Choi SJ, Ahn SH, Park KH, Shin JY, Sung JJ. Electrodiagnostic data-driven clustering identifies a prognostically different subgroup of patients with chronic inflammatory demyelinating polyneuropathy. J Neurol Neurosurg Psychiatry 2019; 90:674-680. [PMID: 30904899 DOI: 10.1136/jnnp-2018-319758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/25/2018] [Accepted: 01/04/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study aimed to explore the correlations between electrodiagnostic (EDX) features in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and to investigate whether EDX data-driven clustering can identify a distinct subgroup regarding clinical phenotype and treatment response. METHODS We reviewed clinical and EDX data of 56 patients with definite CIDP fulfilling the 2010 European Federation of Neurological Societies and Peripheral Nerve Society criteria at two teaching hospitals. A hierarchical agglomerative clustering algorithm with complete linkage was used to partition the patients into subgroups with similar EDX features. A stepwise logistic regression analysis was performed to evaluate predictors of the long-term outcome. RESULTS EDX data-driven clustering partitioned the patients into two clusters, identifying a distinct subgroup characterised by coexistence of prominent conduction slowing and markedly reduced distally evoked compound muscle action potential (CMAP) amplitudes. This cluster of patients was significantly over-represented by an atypical subtype (distal acquired demyelinating symmetric polyneuropathy) compared with the other cluster (70% vs 26.1%, p=0.042). Furthermore, patients in this cluster invariably showed favourable long-term treatment outcome (100% vs 63%, p=0.023). In logistic regression analyses, the initial disability (OR 6.1, 95% CI 2.4 to 25.4), F-wave latency (OR 0.93, 95% CI 0.86 to 0.98) and distal CMAP duration (OR 0.96, 95% CI 0.91 to 0.99) were significant predictors of the poor long-term outcome. CONCLUSION Our results show that EDX data-driven clustering could differentiate a pattern of EDX features with prognostic implication in patients with CIDP. Reduced distally evoked CMAPs may not necessarily predict poor responses to treatment, and active treatment is warranted when prominent slowing of conduction is accompanied in the distal segments.
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Affiliation(s)
- Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Neuroscience Research Institute, Seoul National University Medical Research Council, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - So Hyun Ahn
- Department of Neurology, Neuroscience Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kee Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Neuroscience Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Neuroscience Research Institute, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Choi SJ, Kim B, Lee HJ, Kim SJ, Kim SM, Sung JJ. Rebound of relapses after discontinuation of rituximab in a patient with MOG-IgG1 positive highly relapsing optic neuritis: a case report. BMC Neurol 2018; 18:216. [PMID: 30577778 PMCID: PMC6302456 DOI: 10.1186/s12883-018-1222-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 12/09/2018] [Indexed: 11/29/2022] Open
Abstract
Background Myelin oligodendrocyte glycoprotein immunoglobulin G1 (MOG-IgG1)-associated disease is suggested as a separate disease entity distinct from multiple sclerosis and neuromyelitis optica spectrum disorder. Nonetheless, the optimal treatment regimen for preventing relapses in MOG-IgG1-associated disease remains unclear. Case presentation We describe the case of a 45-year-old man with MOG-IgG1-positive highly relapsing optic neuritis who had experienced 5 attacks over 21 months and had monocular blindness despite prednisolone and azathioprine therapy. He began treatment with rituximab, which reduced the rate of relapse markedly. Following discontinuation of rituximab, however, the patient experienced two successive optic neuritis attacks 2 and 4 months after B-lymphocyte restoration. Conclusions Highly relapsing MOG-IgG1-associated disease can be prevented with rituximab even when the MOG-IgG1 titers are relatively stationary. Discontinuation of rituximab and restoration of B-lymphocytes may be associated with the rebound of disease activity.
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Affiliation(s)
- Seok-Jin Choi
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Boram Kim
- Department of Neurology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Haeng-Jin Lee
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, 101, Daehak-Ro Jongno-Gu, Seoul, 03080, Republic of Korea
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Park KH, Kang DW, Lee KW, Sung JJ. Atypical initial manifestation of facioscapulohumeral muscular dystrophy mimicking neuralgic amyotrophy. Neurol India 2018; 64:173-4. [PMID: 26755015 DOI: 10.4103/0028-3886.173646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Ahn JH, Kim DJ, Sung JJ, Hong YH, Ahn SW, Park JJ, Yoon BN. Reversible reddish skin color change in a patient with compressive radial neuropathy. BMC Neurol 2018; 18:120. [PMID: 30129424 PMCID: PMC6102845 DOI: 10.1186/s12883-018-1128-y] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The motor and sensory symptoms caused by compressive radial neuropathy are well-known, but the involvement of the autonomic nervous system or the dermatologic symptoms are less well known. We report an unusual case of compressive radial neuropathy with reversible reddish skin color change. CASE PRESENTATION A 42-year-old man was referred for left wrist drop, finger drop and a tingling sensation over the lateral dorsum of the left hand. Based on clinical information, neurologic examinations and electrophysiologic studies, he was diagnosed with compressive radial neuropathy. In addition, a reddish skin color change was observed at the area of radial sensory distribution. After two weeks of observation without specific treatment, the skin color had recovered along with a marked improvement in weakness and aberrant sensation. CONCLUSIONS Compressive radial neuropathy with a reversible reddish skin color change is unusual and is considered to be due to vasomotor dysfunction of the radial autonomic nerve. Compressive radial neuropathy is presented with not only motor and sensory symptoms but also autonomic symptoms; therefore, careful examination and inspection are needed at diagnosis.
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Affiliation(s)
- Jong Hyeon Ahn
- Department of Neurology, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea
| | - Dae Joong Kim
- Department of Anatomy, Inha University College of Medicine, Incheon, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, South Korea
| | - Jeong Jin Park
- Department of Neurology, Konkuk University Medical Center, Seoul, South Korea
| | - Byung-Nam Yoon
- Department of Neurology, Seoul Paik Hospital, Inje University College of Medicine, Mareunnae-ro 9, Jung-gu, Seoul, 04551, Republic of Korea.
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Jeon GS, Shim YM, Lee DY, Kim JS, Kang M, Ahn SH, Shin JY, Geum D, Hong YH, Sung JJ. Pathological Modification of TDP-43 in Amyotrophic Lateral Sclerosis with SOD1 Mutations. Mol Neurobiol 2018; 56:2007-2021. [PMID: 29982983 PMCID: PMC6394608 DOI: 10.1007/s12035-018-1218-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [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: 04/17/2018] [Accepted: 06/29/2018] [Indexed: 12/12/2022]
Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal, adult-onset, progressive neurodegenerative disorder with no known cure. Cu/Zn-superoxide dismutase (SOD1) was the first identified protein associated with familial ALS (fALS). Recently, TAR DNA-binding protein 43 (TDP-43) has been found to be a principal component of ubiquitinated cytoplasmic inclusions in neurons and glia in ALS. However, it remains unclear whether these ALS-linked proteins partly have a shared pathogenesis. Here, we determine the association between mutant SOD1 and the modification of TDP-43 and the relationship of pathologic TDP-43 to neuronal cytotoxicity in SOD1 ALS. In this work, using animal model, human tissue, and cell models, we provide the evidence that the association between the TDP-43 modification and the pathogenesis of SOD1 fALS. We demonstrated an age-dependent increase in TDP-43 C-terminal fragments and phosphorylation in motor neurons and glia of SOD1 mice and SOD1G85S ALS patient. Cytoplasmic TDP-43 was also observed in iPSC-derived motor neurons from SOD1G17S ALS patient. Moreover, we observed that mutant SOD1 interacts with TDP-43 in co-immunoprecipitation assays with G93A hSOD1-transfected cell lines. Mutant SOD1 overexpression led to an increase in TDP-43 modification in the detergent-insoluble fraction in the spinal cord of SOD1 mice and fALS patient. Additionally, we showed cellular apoptosis in response to the interaction of mutant SOD1 and fragment forms of TDP-43. These findings suggest that mutant SOD1 could affect the solubility/insolubility of TDP-43 through physical interactions and the resulting pathological modifications of TDP-43 may be involved in motor neuron death in SOD1 fALS.
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Affiliation(s)
- Gye Sun Jeon
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea.,Biomedical Research Institute, Seoul National University Hospital, Seoul, South Korea
| | - Yu-Mi Shim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Do-Yeon Lee
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Jun-Soon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - MinJin Kang
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - So Hyun Ahn
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea
| | - Dongho Geum
- Department of Biomedical Sciences, Korea University College of Medicine, Seoul, South Korea
| | - Yoon Ho Hong
- Department of Neurology, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, South Korea. .,Neuroscience Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
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Park KH, Waters P, Woodhall M, Lang B, Smith T, Sung JJ, Kim KK, Lim YM, Kim JE, Kim BJ, Park JS, Lim JG, Kim DS, Kwon O, Sohn EH, Bae JS, Yoon BN, Kim NH, Ahn SW, Oh J, Park HJ, Shin KJ, Hong YH. Correction: Myasthenia gravis seronegative for acetylcholine receptor antibodies in South Korea: Autoantibody profiles and clinical features. PLoS One 2018; 13:e0200225. [PMID: 29958297 PMCID: PMC6025849 DOI: 10.1371/journal.pone.0200225] [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] Open
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