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Acampora R, de Falco A, Lanfranchi F, Montella S, Scala R, Lieto M, Durante L, Bruno R. Delayed onset Bickerstaff brainstem encephalitis overlapping Miller-Fisher Syndrome during SARS-CoV-2 infection. Neurol Sci 2023; 44:4179-4182. [PMID: 37889381 DOI: 10.1007/s10072-023-07142-8] [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: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
Bickerstaff brainstem encephalitis (BBE) is a neuroimmunologic disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance, mostly subsequent to an infection. BBE is considered to be a variant of Miller-Fisher syndrome (MFS), which also exhibits external ophthalmoplegia and ataxia but not presenting consciousness alterations. Therefore, these two medical conditions are included in the clinical spectrum of the "Fisher-Bickerstaff syndrome" ( Shahrizaila and Yuki in J Neurol Neurosurg Psychiatry 84(5):576-583) [1]. With regard to the etiopathogenesis, increasing evidence worldwide suggests that SARS-CoV-2 infection-enhanced immune response is involved in a wide range of neurological complications such as Guillain-Barré syndrome (GBS), MFS, acute necrotizing encephalitis (ANE), myelitis, acute disseminated encephalomyelitis (ADEM), and, although very rarely, BBE either (Hosseini et al. in Rev Neurosci 32:671-691) [2]. We report a case of a patient affected by delayed onset BBE overlapping MFS during a mild SARS-CoV-2 infection. To the best of our knowledge, similar cases have never been reported.
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Affiliation(s)
- R Acampora
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy.
| | - A de Falco
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - F Lanfranchi
- Department of Health Sciences (DISSAL), University of Genoa, 16132, Genoa, Italy
| | - S Montella
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - R Scala
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - M Lieto
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - L Durante
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - R Bruno
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
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Lieto M, Riso V, Galatolo D, De Michele G, Rossi S, Barghigiani M, Cocozza S, Pontillo G, Trovato R, Saccà F, Salvatore E, Tessa A, Filla A, Santorelli FM, De Michele G, Silvestri G. The complex phenotype of spinocerebellar ataxia type 48 in eight unrelated Italian families. Eur J Neurol 2019; 27:498-505. [PMID: 31571321 DOI: 10.1111/ene.14094] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [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: 06/26/2019] [Accepted: 09/27/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE Heterozygous mutations in the STUB1 gene have recently been associated with an autosomal dominant form of spinocerebellar ataxia (SCA) associated with cerebellar cognitive-affective syndrome (CCAS), named SCA48. METHODS Molecular screening was performed in a cohort of 235 unrelated patients with adult-onset, autosomal dominant (17) or sporadic (218) cerebellar ataxia, negative for pathological trinucleotide expansions in the common SCAs, FRDA and FXTAS loci, by using targeted multigene panels or whole-exome sequencing. Bioinformatics analyses, detailed neurological phenotyping and family segregation studies corroborated the pathogenicity of the novel STUB1 mutations. Clinico-diagnostic findings were reviewed to define the phenotypic spectrum. RESULTS Eight heterozygous STUB1 mutations were identified, six of which were novel in 11 patients from eight index families, giving an estimated overall frequency of 3.4% (8/235) for SCA48 in our study cohort, rising to 23.5% (4/17) when considering only familial cases. All our SCA48 patients had cerebellar ataxia and dysarthria associated with cerebellar atrophy on brain magnetic resonance imaging; of note, many cases were also associated with parkinsonism, chorea and dystonia. CCAS also occurred frequently, whereas definite signs of pyramidal tract dysfunction and peripheral nervous system involvement were absent. One SCA48 patient presented with hypogonadism, associated with other autoimmune endocrine dysfunctions. CONCLUSIONS Our results support SCA48 as a significant cause of adult-onset SCA. Besides CCAS, our SCA48 patients often showed movement disorders and other clinical manifestations previously described in SCAR16, linked to biallelic variants in the same gene, thus suggesting a continuous clinical spectrum and significant overlap amongst recessive and dominantly inherited mutations in STUB1.
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Affiliation(s)
- M Lieto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - V Riso
- Area of Neuroscience, Institute of Neurology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | - D Galatolo
- IRCCS Fondazione Stella Maris, Pisa, Italy
| | - G De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - S Rossi
- Area of Neuroscience, Institute of Neurology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
| | | | - S Cocozza
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - G Pontillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - R Trovato
- IRCCS Fondazione Stella Maris, Pisa, Italy
| | - F Saccà
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - E Salvatore
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - A Tessa
- IRCCS Fondazione Stella Maris, Pisa, Italy
| | - A Filla
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | | | - G De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - G Silvestri
- Area of Neuroscience, Institute of Neurology, Fondazione Policlinico Universitario A.Gemelli IRCCS, Rome, Italy
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Lieto M, Roca A, Antenora A, Peluso S, Bellofatto M, Bruzzese D, De Michele G, Filla A. Longitudinal study of a cohort of MSA-C patients in south Italy: Survival and clinical features. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.855] [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: 10/18/2022]
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Lieto M, Wood M, Rinaldi C. Unravelling the role of androgen receptor splice variants in the mechanisms of pathogenesis of spinal and bulbar muscular atrophy. Neuromuscul Disord 2017. [DOI: 10.1016/s0960-8966(17)30309-7] [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: 10/19/2022]
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Criscuolo C, Carbone R, Lieto M, Peluso S, Guacci A, Filla A, Quarantelli M, Lanzillo R, Brescia Morra V, De Michele G. SPG5 and multiple sclerosis: clinical and genetic overlap? Acta Neurol Scand 2016; 133:410-4. [PMID: 26370385 DOI: 10.1111/ane.12476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Autosomal recessive (AR) spastic paraplegia type 5 (SPG5) is due to mutations in the CYP7B1 gene, encoding for the cytochrome P450-7B1, responsible for oxysterols 7α-hydroxylation. Oxysterol/cholestenoic acids pool plays a role in motor neuron survival and immune response. SPG5 is characterized by white matter abnormalities at brain resonance imaging (MRI). In view of clinical presentation and MRI findings, multiple sclerosis (MS) is a possible differential diagnosis of SPG5. This study aimed to evaluate the frequency of CYP7B1 mutations in patients with MS. METHODS One hundred and seventeen MS patients with clinical spastic paraplegia or possible AR transmission were selected for the mutational screening. RESULTS Forty-three patients had primary progressive, 26 relapsing remitting, 26 secondary progressive, and 22 relapsing progressive MS clinical course. No CYP7B1 homozygous mutations were identified. Two novel variants and one pathogenic mutation were found at heterozygous state. CONCLUSIONS The two novel variants cosegregated with pyramidal signs and autoimmune diseases suggesting that they might be susceptibility factors. Reduced cytochrome P450-7B1 enzymatic activity could alter the balance among neurotoxic and neuroprotective oxysterols promoting motor neuron degeneration and/or immune response.
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Affiliation(s)
- C. Criscuolo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - R. Carbone
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - M. Lieto
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - S. Peluso
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - A. Guacci
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - A. Filla
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - M. Quarantelli
- Biostructure and Bioimaging Institute; National Research Council; Naples Italy
| | - R. Lanzillo
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - V. Brescia Morra
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
| | - G. De Michele
- Department of Neurosciences, Reproductive Sciences and Odontostomatology; ‘Federico II’ University of Naples; Naples Italy
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De Rosa A, Pellegrino T, Pappatà S, Lieto M, Bonifati V, Palma V, Topa A, Santoro L, Bilo L, Cuocolo A, De Michele G. Non-motor symptoms and cardiac innervation in SYNJ1-related parkinsonism. Parkinsonism Relat Disord 2015; 23:102-5. [PMID: 26725142 DOI: 10.1016/j.parkreldis.2015.12.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 07/20/2015] [Revised: 11/17/2015] [Accepted: 12/07/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION PARK20 is a rare autosomal recessive parkinsonism related to the SYNJ1 gene and characterized by early-onset of disease and atypical signs such as supranuclear vertical gaze palsy, dementia, dystonia, and generalized tonic-clonic seizures. OBJECTIVE Non-motor features and cardiac sympathetic innervation were assessed in two siblings affected by parkinsonism who harboured the homozygous Arg258Gln mutation in the SYNJ1 gene. METHODS The Non-Motor Symptoms, the SCOPA-AUT, the Mayo Sleep Questionnaires and polysomnography were used to investigate non-motor signs (NMS), autonomic dysfunction and REM Behavioural Disorder (RBD). Cognitive functions were examined by an extensive battery of neuropsychological tests. In addition, motor and sensory nerve conduction studies and evoked laser potentials were performed. Cardiac sympathetic innervation was assessed in the two patients by (123)I-metaiodobenzylguanidine (MIBG) scintigraphy, computing early and late heart-to-mediastinum (H/M) ratios and myocardial washout rates (WR). RESULTS Among the non-motor symptoms and autonomic signs, case 1 had cold intolerance, drooling and dysphagia, while case 2 had pain and urinary dysfunction. Both cases showed mood and behavioural disorders. RBD were not found, whereas the neuropsychological assessment revealed a progressive cognitive impairment. Neurophysiological studies revealed no abnormalities. Indexes of cardiac sympathetic innervation in the two patients did not differ from those of control subjects. CONCLUSIONS Our findings expand the phenotypic profile of SYNJ1-related parkinsonism. Preserved cardiac sympathetic function and absence of RBD suggest that PARK20 should be explained by a pathogenic mechanism different from Lewy Body pathology, or that the latter is not as widespread as idiopathic Parkinson's disease.
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Affiliation(s)
- A De Rosa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy.
| | - T Pellegrino
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - S Pappatà
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - M Lieto
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - V Bonifati
- Department of Clinical Genetics, Erasmus MC, Rotterdam, The Netherlands
| | - V Palma
- Department of Neurophysiology, San Gennaro Hospital, Naples, Italy
| | - A Topa
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - L Santoro
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - L Bilo
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - A Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - G De Michele
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy; Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
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Lieto M, Saccà F, Costabile T, Antenora A, Abate F, Liguori A, De Michele G, Filla A. Cognitive assessment in multiple system atrophy cerebellar type. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.218] [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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Criscuolo C, Guacci A, Carbone R, Lieto M, Salsano E, Nanetti L, De Michele G, Filla A. Polyneuropathy, hearing loss, ataxia, retinitis pigmentosa and cataracts (PHARC) screening in an Italian population. Eur J Neurol 2013; 20:e60. [DOI: 10.1111/ene.12056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Accepted: 11/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- C. Criscuolo
- Department of Neurological Sciences; Federico II University; Naples Italy
| | - A. Guacci
- Department of Neurological Sciences; Federico II University; Naples Italy
| | - R. Carbone
- Department of Neurological Sciences; Federico II University; Naples Italy
| | - M. Lieto
- Department of Neurological Sciences; Federico II University; Naples Italy
| | - E. Salsano
- Department of Clinical Neurosciences; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - L. Nanetti
- Unit of Genetics of Neurodegenerative and Metabolic Diseases; Fondazione IRCCS Istituto Neurologico Carlo Besta; Milan Italy
| | - G. De Michele
- Department of Neurological Sciences; Federico II University; Naples Italy
| | - A. Filla
- Department of Neurological Sciences; Federico II University; Naples Italy
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