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Ducatel P, Michaud M, Viala K, Leblond V, Charlotte F, Roos-Weil D, Benoit C, Debs R, Maisonobe T. Neurolymphomatosis: involvement of peripheral nervous system revealing hematologic malignancy, a report of nine cases. J Peripher Nerv Syst 2023. [PMID: 36861226 DOI: 10.1111/jns.12541] [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: 10/09/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND AND AIM Neurolymphomatosis is defined as an infiltration of the peripheral nervous system (PNS) by malignant lymphoma cells. It is a rare entity and diagnosis is complicated especially when PNS involvement is the initial and leading symptom. To improve knowledge of the disorder and shorten the time to diagnosis, we report a series of nine patients without a history of hematologic malignancy, who were diagnosed with neurolymphomatosis after evaluation and workup of peripheral neuropathy. METHODS The patients were included from the Department of Clinical Neurophysiology at Pitié Salpêtrière and Nancy Hospitals over a period of 15 years. Diagnosis of neurolymphomatosis was confirmed by histopathologic examination for each patient. We characterized their clinical, electrophysiological, biological, imaging, and histopathologic features. RESULTS The neuropathy was characterized by pain (78%), proximal involvement (44%) or of all four limbs (67%), asymmetrical or with multifocal distribution (78%), abundant fibrillation (78%), a tendency to worsen rapidly, and significant associated weight loss (67%). Neurolymphomatosis was diagnosed principally on nerve biopsy (89%) identifying infiltration of lymphoid cells, atypical cells (78%), a monoclonal population (78%), and supported by fluorodeoxyglucose-positron emission tomography, spine or plexus MRI, cerebrospinal fluid analysis, and blood lymphocyte immunophenotyping. Six patients had systemic disease and three impairment limited to the PNS. In the latter case, progression could be unpredictable and may be diffuse and explosive, sometimes occurring years after a seemingly indolent course. INTERPRETATION This study provides better knowledge and understanding of neurolymphomatosis when neuropathy is the initial presentation.
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Affiliation(s)
- Pauline Ducatel
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Maud Michaud
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Karine Viala
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Véronique Leblond
- Département d'Hématologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Frédéric Charlotte
- Département d'Anatomopathologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Damien Roos-Weil
- Département d'Hématologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Charline Benoit
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Rabab Debs
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.,Département de Neuropathologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Masingue M, Fernández-Eulate G, Debs R, Tard C, Labeyrie C, Leonard-Louis S, Dhaenens CM, Masson MA, Latour P, Stojkovic T. Strategy for genetic analysis in hereditary neuropathy. Rev Neurol (Paris) 2023; 179:10-29. [PMID: 36566124 DOI: 10.1016/j.neurol.2022.11.007] [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: 10/31/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022]
Abstract
Inherited neuropathies are a heterogeneous group of slowly progressive disorders affecting either motor, sensory, and/or autonomic nerves. Peripheral neuropathy may be the major component of a disease such as Charcot-Marie-Tooth disease or a feature of a more complex multisystemic disease involving the central nervous system and other organs. The goal of this review is to provide the clinical clues orientating the genetic diagnosis in a patient with inherited peripheral neuropathy. This review focuses on primary inherited neuropathies, amyloidosis, inherited metabolic diseases, while detailing clinical, neurophysiological and potential treatment of these diseases.
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Affiliation(s)
- M Masingue
- Centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
| | - G Fernández-Eulate
- Centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - R Debs
- Service de neurophysiologie, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - C Tard
- CHU de Lille, clinique neurologique, centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, 59037 Lille cedex, France
| | - C Labeyrie
- Service de neurologie, hôpital Kremlin-Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - S Leonard-Louis
- Centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - C-M Dhaenens
- Université de Lille, Inserm, CHU de Lille, U1172-LilNCog-Lille Neuroscience & Cognition, 59000 Lille, France
| | - M A Masson
- Inserm U1127, Paris Brain Institute, ICM, Sorbonne Université, CNRS UMR 7225, hôpital Pitié-Salpêtrière, Paris, France
| | - P Latour
- Service de biochimie biologie moléculaire, CHU de Lyon, centre de biologie et pathologie Est, 69677 Bron cedex, France
| | - T Stojkovic
- Centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, hôpital Pitié-Salpêtrière, AP-HP, Paris, France
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3
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Birzu C, Farina A, Pegat A, Devic P, Lenglet T, Viala K, Debs R, Fargeot G, Picca A, Le Guennec L, Mongin M, Villette B, Joubert B, Maisonobe T, Psimaras D. P11.66.A Immune checkpoint inhibitors related peripheral nerve disorders: clinical and electrophysiological particularities. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The immune-checkpoint inhibitors (ICIs) announced a new era in cancer treatment allowing long-term survival in advanced cancers. However, immune related adverse events impose treatment limitations being one of the main challenges when dealing with ICI treated patients. Neurologic toxicities have unique presentations and can progress rapidly, requiring prompt recognition. Among them, ICI-related peripheral nerve disorders are highly heterogeneous, profoundly debilitating, and insufficiently explored.
Material and Methods
We reviewed the clinical and electrodiagnostic features of a retrospective cohort of patients hospitalized in our centre for ICI related neuropathies. We applied the EFNS 2021 electrodiagnostic criteria for neuropathies and we researched the outcome according to the treatment received.
Results
We included 16 patients: 4 men and 12 women, median age 61 years (31-72) treated by anti-PD1 monotherapy (10) or antiCTLA4-antiPD1 combination (6). Median delay from ICIs initiation to neuropathy symptoms was 58,5 days (4 cycles), it seemed lower in combination group (median 33,5 days vs 81,5 days in monotherapy patients p=0,02). Half of patients presented with concurrent non-neurological irAE. CSF was inflammatory in 56% of cases, pleocytosis was seen in 57% of these. Cranial nerve involvement was rare (3/16) the most frequent phenotype was demyelinating polyneuropathy fulfilling EFNS 2021 EMG criteria in 10 cases. The other 6 presented with non-length dependent sensory neuropathy, (3) dysautonomic neuropathy (1) or sensory motor neuropathy with incomplete EFNS 2021 EMG criteria (2). ICI treatment was stopped, and steroids were the first line of treatment for all patients. However, 12/16 patients received additional iv immunoglobulin. Supplementary immunomodulation (cyclophosphamide, tocilizumab) was required in 2 cases. 75% of patients improved within a median of 4.5 months, median decrease in mRS was 2 points. Noteworthy, the rechallenge by antiPD1 monotherapy was proposed in 4 patients with a single neuropathy relapse.
Conclusion
Our series expand the knowledge on the clinical and electrophysiological phenotype of ICI related neuropathies improving their recognition in clinical practice. Moreover, our findings argue for the benefit of adding iv immunoglobulin to steroids as a first line treatment for different phenotypes of ICI related neuropathies.
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Affiliation(s)
- C Birzu
- Institut du Cerveau, ICM, AP-HP, Inserm, UMR S 1127, Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, , Paris , France
- Service de Neurologie 2-Mazarin Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, , Paris , France
| | - A Farina
- Centre Léon Bérard, 28 Rue Laënnec, Université Claude Bernard Lyon I , Lyon , France
| | - A Pegat
- Service de Neurologie fonctionnelle et Epileptologie, CHU Pierre Wertheimer, 69 Bdv Pinel, 69677 Bron-Cedex , Lyon , France
| | - P Devic
- Service de Neurologie fonctionnelle et Epileptologie, CHU Pierre Wertheimer, 69 Bdv Pinel, 69677 Bron-Cedex, , Lyon , France
| | - T Lenglet
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - K Viala
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - R Debs
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - G Fargeot
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - A Picca
- Institut du Cerveau, ICM, AP-HP, Inserm, UMR S 1127, Sorbonne Université, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, , Paris , France
- Service de Neurologie 2-Mazarin Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix , Paris , France
| | - L Le Guennec
- Sorbonne Université, AP-HP Hôpital de la Pitié-Salpêtrière, département de neurologie, unité de Médecine Intensive Réanimation à orientation neurologique , Paris , France
| | - M Mongin
- Service de Neurologie Hôpital Avicenne, 93000 Bobigny , Bobigny , France
| | - B Villette
- Service Dermatologie, Hôpital Avicenne, 93000 , Bobigny , France
| | - B Joubert
- Centre français de référence des syndromes neurologiques paranéoplasiques et des encéphalites auto-immunes, Hospices civils de Lyon; Équipe Synaptopathies et auto-anticorps (SynatAc)nstitut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, , Lyon , France
| | - T Maisonobe
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
| | - D Psimaras
- Service de Neurologie 2-Mazarin Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix , Paris , France
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière , Paris , France
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Foirest C, Bihan K, Tankéré F, Junot H, Demeret S, Debs R, Maillart E, Lebrun-Frenay C, Vigouroux A, Caudron M, Canouï E, Lamas G, Weiss N, Pourcher V. Peripheral facial palsy following COVID-19 vaccination: a practical approach to use the clinical situation as a guide. Acta Otorhinolaryngol Ital 2022; 42:300-303. [PMID: 35880371 PMCID: PMC9330747 DOI: 10.14639/0392-100x-n2131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/16/2022] [Indexed: 11/23/2022]
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Huin V, Coarelli G, Guemy C, Boluda S, Debs R, Mochel F, Stojkovic T, Grabli D, Maisonobe T, Gaymard B, Lenglet T, Tard C, Davion JB, Sablonnière B, Monin ML, Ewenczyk C, Viala K, Charles P, Le Ber I, Reilly MM, Houlden H, Cortese A, Seilhean D, Brice A, Durr A. Motor neuron pathology in CANVAS due to RFC1 expansions. Brain 2021; 145:2121-2132. [DOI: 10.1093/brain/awab449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/03/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
CANVAS caused by RFC1 biallelic expansions is a major cause of inherited sensory neuronopathy. Detection of RFC1 expansion is challenging and CANVAS can be associated with atypical features.
We clinically and genetically characterized 50 patients, selected based on the presence of sensory neuronopathy confirmed by EMG. We screened RFC1 expansion by PCR, repeat-primed PCR, and Southern blotting of long-range PCR products, a newly developed method. Neuropathological characterization was performed on the brain and spinal cord of one patient.
Most patients (88%) carried a biallelic (AAGGG)n expansion in RFC1. In addition to the core CANVAS phenotype (sensory neuronopathy, cerebellar syndrome, and vestibular impairment), we observed chronic cough (97%), oculomotor signs (85%), motor neuron involvement (55%), dysautonomia (50%), and parkinsonism (10%). Motor neuron involvement was found for 24 of 38 patients (63.1%). First motor neuron signs, such as brisk reflexes, extensor plantar responses, and/or spasticity, were present in 29% of patients, second motor neuron signs, such as fasciculations, wasting, weakness, or a neurogenic pattern on EMG in 18%, and both in 16%. Mixed motor and sensory neuronopathy was observed in 19% of patients. Among six non-RFC1 patients, one carried a heterozygous AAGGG expansion and a pathogenic variant in GRM1. Neuropathological examination of one RFC1 patient with an enriched phenotype, including parkinsonism, dysautonomia, and cognitive decline, showed posterior column and lumbar posterior root atrophy. Degeneration of the vestibulospinal and spinocerebellar tracts was mild. We observed marked astrocytic gliosis and axonal swelling of the synapse between first and second motor neurons in the anterior horn at the lumbar level. The cerebellum showed mild depletion of Purkinje cells, with empty baskets, torpedoes, and astrogliosis characterized by a disorganization of the Bergmann's radial glia. We found neuronal loss in the vagal nucleus. The pars compacta of the substantia nigra was depleted, with widespread Lewy bodies in the locus coeruleus, substantia nigra, hippocampus, entorhinal cortex, and amygdala.
We propose new guidelines for the screening of RFC1 expansion, considering different expansion motifs. Here, we developed a new method to more easily detect pathogenic RFC1 expansions. We report frequent motor neuron involvement and different neuronopathy subtypes. Parkinsonism was more prevalent in this cohort than in the general population, 10% versus the expected 1% (p < 0.001). We describe, for the first time, the spinal cord pathology in CANVAS, showing the alteration of posterior columns and roots, astrocytic gliosis and axonal swelling, suggesting motor neuron synaptic dysfunction.
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Affiliation(s)
- Vincent Huin
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Giulia Coarelli
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Clément Guemy
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
| | - Susana Boluda
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- Laboratoire Neuropathologie Raymond Escourolle, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Rabab Debs
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurology, Sorbonne University, Paris, France
| | - Fanny Mochel
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Tanya Stojkovic
- Institut de Myologie, Centre de Référence de Pathologie Neuromusculaire Paris-Est, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - David Grabli
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurology, Sorbonne University, Paris, France
| | - Thierry Maisonobe
- Institut de Myologie, Centre de Référence de Pathologie Neuromusculaire Paris-Est, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Bertrand Gaymard
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurophysiology, Sorbonne University, Paris, France
| | - Timothée Lenglet
- AP-HP, Pitié Salpêtrière University Hospital, Department of Neurophysiology, Sorbonne University, Paris, France
| | - Céline Tard
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
- Centre de Référence des Maladies Neuromusculaires, CHU Lille, F-59000 Lille, France
| | - Jean-Baptiste Davion
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
- Centre de Référence des Maladies Neuromusculaires, CHU Lille, F-59000 Lille, France
| | - Bernard Sablonnière
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
| | | | - Claire Ewenczyk
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Karine Viala
- Institut de Myologie, Centre de Référence de Pathologie Neuromusculaire Paris-Est, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Perrine Charles
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
| | - Isabelle Le Ber
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, National Reference Center for “Rare and Young Dementia”, IM2A, Pitié-Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Mary M Reilly
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Henry Houlden
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Andrea Cortese
- Department of Neuromuscular Disease, UCL Queen Square Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, UK
| | - Danielle Seilhean
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- Laboratoire Neuropathologie Raymond Escourolle, AP-HP, Pitié Salpêtrière University Hospital, Sorbonne University, Paris, France
| | - Alexis Brice
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
| | - Alexandra Durr
- Sorbonne Université, Paris Brain Institute, APHP, INSERM, CNRS, Paris, France
- AP-HP, Pitié Salpêtrière University Hospital, Genetics Department, Sorbonne University, Paris, France
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Kermorvant H, Debs R, Maisonobe T, Huin V, Stojkovic T, Lenglet T. Cramp-fasciculation syndrome phenotype of cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) due to RFC1 repeat expansion. Clin Neurophysiol 2021; 134:34-36. [PMID: 34968871 DOI: 10.1016/j.clinph.2021.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 11/27/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Hugo Kermorvant
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière Hospital, Department of Neurology, Paris ALS Center, 75013 Paris, France.
| | - Rabab Debs
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière Hospital, Department of Neurophysiology, 75013 Paris, France
| | - Thierry Maisonobe
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière Hospital, Department of Neurophysiology, 75013 Paris, France
| | - Vincent Huin
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog (JPARC) - Lille Neuroscience & Cognition, F-59000 Lille, France
| | - Tanya Stojkovic
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière Hospital, Centre de Référence des Maladies Neuromusculaires, Nord/Est/Ile-de-France, Inserm UMR_S 974, 75013 Paris, France
| | - Timothée Lenglet
- Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière Hospital, Department of Neurology, Paris ALS Center, 75013 Paris, France; Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière Hospital, Department of Neurophysiology, 75013 Paris, France.
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7
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Pisella LI, Fernandes S, Solé G, Stojkovic T, Tard C, Chanson JB, Bouhour F, Salort-Campana E, Beaudonnet G, Debergé L, Duval F, Grapperon AM, Masingue M, Nadaj-Pakleza A, Péréon Y, Audic F, Behin A, Friedman D, Magot A, Noury JB, Souvannanorath S, Wahbi K, Antoine JC, Bigaut K, Camdessanché JP, Cintas P, Debs R, Espil-Taris C, Kremer L, Kuntzer T, Laforêt P, Laugel V, Mallaret M, Michaud M, Nollet S, Svahn J, Vicart S, Villar-Quiles RN, Desguerre I, Adams D, Segovia-Kueny S, Merret G, Hammouda E, Molon A, Attarian S. A multicenter cross-sectional French study of the impact of COVID-19 on neuromuscular diseases. Orphanet J Rare Dis 2021; 16:450. [PMID: 34702344 PMCID: PMC8547719 DOI: 10.1186/s13023-021-02090-y] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/17/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Due to their health condition, patients with neuromuscular diseases (NMD) are at greater risk of developing serious complications with COVID-19. The objective of this study was to analyze the prevalence of COVID-19 among NMD patients and the risk factors for its impact and severity during the first wave of the pandemic. Clinical data were collected from NMD-COVID-19 patients, between March 25, 2020 and May 11, 2020 in an anonymous survey carried out by expert physicians from the French Health Care Network Filnemus. RESULTS Physicians reported 84 patients, including: 34 with myasthenia gravis, 27 with myopathy and 23 with neuropathy. COVID-19 had no effect on NMD for 48 (58%) patients and 48 (58%) patients developed low COVID-19 severity. COVID-19 caused the death of 9 (11%) NMD patients. Diabetic patients were at greater risk of dying. Patients with diabetes, hypertension or severe forms of NMD had a higher risk of developing a moderate or severe form of COVID-19. In our cohort, corticosteroids and other immunosuppressants were not significantly associated with higher COVID-19 severity for acquired NMD. CONCLUSION During this period, a small percentage of French NMD patients was affected by COVID-19 compared to the general French population and COVID-19 had a limited short-term effect on them. Diabetes, hypertension and a severe degree of NMD were identified as risk factors of unfavorable outcome following COVID-19. Conversely, in our cohort of patients with acquired NMD, corticosteroids or other immunosuppressants did not appear to be risk factors for more severe COVID-19.
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Affiliation(s)
| | - Sara Fernandes
- Department of Epidemiology and Health Economics, AP-HM, Marseille, France
| | - Guilhem Solé
- Department of Neurology and Neuromuscular Disorders, Reference Center for Neuromuscular Disorders AOC, University Hospitals of Bordeaux (Pellegrin University Hospital), place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Tanya Stojkovic
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - Céline Tard
- CHU de Lille, Inserm U1171, Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Lille, France
| | - Jean-Baptiste Chanson
- Neurology Department, Reference Center for Neuromuscular Diseases 'Nord-Est-Ile de France', University Hospitals of Strasbourg, Strasbourg, France
| | - Françoise Bouhour
- ENMG Unit, Reference Center for Neuromuscular Diseases, University Hospitals of Lyon (Neurologic Hospital Pierre Wertheimer), Lyon, France
| | - Emmanuelle Salort-Campana
- Filnemus, AP-HM, Marseille, France
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, Aix-Marseille University, ERN-Center, Marseille, France
| | - Guillemette Beaudonnet
- Clinical Neurophysiology Unit, Reference Center for Neuromuscular Disease, University Hospital of Bicetre, Le Kremlin Bicêtre, France
| | - Louise Debergé
- Department of Neurology and Neuromuscular Disorders, Reference Center for Neuromuscular Disorders AOC, University Hospitals of Bordeaux (Pellegrin University Hospital), place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Fanny Duval
- Department of Neurology and Neuromuscular Disorders, Reference Center for Neuromuscular Disorders AOC, University Hospitals of Bordeaux (Pellegrin University Hospital), place Amélie-Raba-Léon, 33076, Bordeaux, France
| | - Aude-Marie Grapperon
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, Aix-Marseille University, ERN-Center, Marseille, France
| | - Marion Masingue
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - Aleksandra Nadaj-Pakleza
- Neurology Department, Reference Center for Neuromuscular Diseases 'Nord-Est-Ile de France', University Hospitals of Strasbourg, Strasbourg, France
| | - Yann Péréon
- Reference Center for Neuromuscular Diseases, Filnemus, ERN Euro-NMD, CHU Nantes, Nantes, France
| | - Frédérique Audic
- Reference Center for Neuromuscular Diseases, Neuropediatric Unit Timone University Hospital, Marseille, France
| | - Anthony Behin
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - Diane Friedman
- Neurology Department, Nord/Est/Île-de-France Neuromuscular Reference Center, Raymond-Poincaré Teaching Hospital, AP-HP, Garches, France
| | - Armelle Magot
- Reference Center for Neuromuscular Diseases, Filnemus, ERN Euro-NMD, CHU Nantes, Nantes, France
| | - Jean-Baptiste Noury
- Reference Center for Neuromuscular Diseases AOC, University Hospital of Brest, Brest, France
| | - Sarah Souvannanorath
- Reference Center for Neuromuscular Diseases, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - Karim Wahbi
- AP-HP, Cochin Hospital, Cardiology Department, FILNEMUS, Reference Center for Neuromuscular Diseases Nord/Est/Île-de-France, Paris-Descartes, Sorbonne Paris Cité University, 75006, Paris, France
- INSERM Unit 970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Jean-Christophe Antoine
- Department of Neurology, Reference Center for Neuromuscular Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Kévin Bigaut
- Neurology Department, Reference Center for Neuromuscular Diseases 'Nord-Est-Ile de France', University Hospitals of Strasbourg, Strasbourg, France
| | - Jean-Philippe Camdessanché
- Department of Neurology, Reference Center for Neuromuscular Diseases, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Pascal Cintas
- Department of Neurology, Reference Center for Neuromuscular Diseases, University Hospitals of Toulouse (Purpan Hospital), Toulouse, France
| | - Rabab Debs
- Clinical Neurophysiology Department, Hôpital Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Caroline Espil-Taris
- Department of Pediatric Neurology, Neuromuscular Center, CHU Bordeaux, Bordeaux, France
| | - Laurent Kremer
- Neurology Department, Reference Center for Neuromuscular Diseases 'Nord-Est-Ile de France', University Hospitals of Strasbourg, Strasbourg, France
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pascal Laforêt
- Neurology Department, Nord/Est/Île-de-France Neuromuscular Reference Center, Raymond-Poincaré Teaching Hospital, AP-HP, Garches, France
- INSERM U1179, END-ICAP, Versailles-Saint-Quentin-en-Yvelines University, Université Paris Saclay, Montigny-le-Bretonneux, France
| | - Vincent Laugel
- Department of Pediatrics, Strasbourg University Hospital, Strasbourg Cedex, France
| | - Martial Mallaret
- Department of Neurology, Competence Center for Neuromuscular Diseases, University Hospital Centre Grenoble Alpes, CS 10217, 38043, Grenoble Cedex 9, France
| | - Maud Michaud
- Department of Neurology, Nancy University Hospital, Nancy, France
| | - Sylvain Nollet
- Clinical Neurology-Electrophysiology Department, University Hospital (CHRU) Besançon, Besançon, France
| | - Juliette Svahn
- ENMG Unit, Reference Center for Neuromuscular Diseases, University Hospitals of Lyon (Neurologic Hospital Pierre Wertheimer), Lyon, France
| | - Savine Vicart
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - Rocio Nur Villar-Quiles
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Sorbonne Université, AP-HP, Hôpital Pitié-Salpêtrière, Inserm UMR_S 974, Paris, France
| | - Isabelle Desguerre
- Reference Center for Neuromuscular Disorders Nord/Est/Île-de-France, Pediatric Neurology Department, Necker-Enfants-Malades Hospital, AP-HP, Paris, France
| | - David Adams
- Department of Neurology, University Hospital of Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | | | | | - Shahram Attarian
- Filnemus, AP-HM, Marseille, France.
- Reference Center for Neuromuscular Diseases and ALS, Timone University Hospital, Aix-Marseille University, ERN-Center, Marseille, France.
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8
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Benoit C, Svahn J, Debs R, Vandendries C, Lenglet T, Zyss J, Maisonobe T, Viala K. Focal chronic inflammatory demyelinating polyradiculoneuropathy: Onset, course, and distinct features. J Peripher Nerv Syst 2021; 26:193-201. [PMID: 33660880 DOI: 10.1111/jns.12438] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Focal chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is defined as involving the brachial or lumbosacral plexus, or one or more peripheral nerves in one upper or one lower limb (monomelic distribution). However, other auto-immune neuropathies such as Lewis-Sumner syndrome (LSS) and multifocal motor neuropathy (MMN) can also have a focal onset. From a retrospective cohort of 30 focal CIDP patients with a monomelic onset dating back at least 2 years, we distinguished patients with plexus involvement (focal demyelinating plexus neuropathy [F-PN], n = 18) from those with sensory or sensorimotor (F-SMN, n = 7), or purely motor (F-MN, n = 5) impairment located in one or several peripheral nerves. Few (39%) F-PN patients had motor nerve conduction abnormalities, but the majority showed proximal conduction abnormalities in somatosensory evoked potentials (80%), and all had focal hypertrophy and/or increased short tau inversion recovery image signal intensity on plexus MRI. Impairment remained monomelic in most (94%) F-PN patients, whereas abnormalities developed in other limbs in 57% of F-SMN, and 40% of F-MN patients (P = .015). The prognosis of F-PN patients was significantly better: none had an ONLS score > 2 at the final follow-up visit, vs 43% of F-SMN patients and 40% of F-MN patients (P = .026). Our findings from a large cohort of focal CIDP patients confirm the existence of different entities that are typically categorized under this one term: on the one hand, patients with a focal plexus neuropathy and on the other, patients with monomelic sensori-motor or motor involvement of peripheral nerves. These two last subgroups appeared to be more likely to evolve to LSS or MMN phenotype, when F-PN patients have a more distinctive long-term, focal, benign course.
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Affiliation(s)
- Charline Benoit
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Juliette Svahn
- Service de neurologie, Hôpital Pierre Wertheimer, Bron, France
| | - Rabab Debs
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | | | - Timothée Lenglet
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Julie Zyss
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Thierry Maisonobe
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
| | - Karine Viala
- Département de neurophysiologie clinique, Hôpital de la Pitié-Salpêtrière, APHP Paris VI Université, Paris, France
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9
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Breza M, Hirst J, Chelban V, Banneau G, Tissier L, Kol B, Bourinaris T, Said SA, Péréon Y, Heinzmann A, Debs R, Juntas-Morales R, Martinez VG, Camdessanche JP, Scherer-Gagou C, Zola JM, Athanasiou-Fragkouli A, Efthymiou S, Vavougios G, Velonakis G, Stamelou M, Tzartos J, Potagas C, Zambelis T, Mariotti C, Blackstone C, Vandrovcova J, Mavridis T, Kartanou C, Stefanis L, Wood N, Karadima G, LeGuern E, Koutsis G, Houlden H, Stevanin G. Expanding the Spectrum of AP5Z1-Related Hereditary Spastic Paraplegia (HSP-SPG48): A Multicenter Study on a Rare Disease. Mov Disord 2021; 36:1034-1038. [PMID: 33543803 DOI: 10.1002/mds.28487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/08/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2023] Open
Affiliation(s)
- Marianthi Breza
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Jennifer Hirst
- Cambridge Institute for Medical Research, University of Cambridge, Cambridge, United Kingdom
| | - Viorica Chelban
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom.,Department of Neurology and Neurosurgery, Institute of Emergency Medicine, Chisinau, Republic of Moldova
| | - Guillaume Banneau
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.,Département de Génétique Médicale, Institut Fédératif de Biologie, Toulouse, France
| | - Laurène Tissier
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Bophara Kol
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Thomas Bourinaris
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Samia A Said
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Yann Péréon
- Department of Clinical Neurophysiology, Reference centre for NMD, CHU Nantes, Place Alexis-Ricordeau, Nantes, France
| | - Anna Heinzmann
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Rabab Debs
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Raul Juntas-Morales
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Victoria G Martinez
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean P Camdessanche
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Clarisse Scherer-Gagou
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Jean-Médard Zola
- Département de Neurologie, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | | | - Stephanie Efthymiou
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom
| | | | - Georgios Velonakis
- 2nd Department of Radiology, National and Kapodistrian University of Athens, Medical School, Attikon Hospital, Athens, Greece
| | - Maria Stamelou
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Parkinson's Disease and Movement Disorders Department, Hygeia Hospital, Athens, Greece.,School of Medicine, European University of Cyprus, Nicosia, Cyprus
| | - John Tzartos
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantin Potagas
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Zambelis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Caterina Mariotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Instituto Neurologico Carlo Besta, Milan, Italy
| | - Craig Blackstone
- Cell Biology Section, Neurogenetics Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland, USA
| | - Jana Vandrovcova
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom
| | - Theodoros Mavridis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Chrisoula Kartanou
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Leonidas Stefanis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicholas Wood
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom.,Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Georgia Karadima
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Eric LeGuern
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.,Sorbonne Université, Institut du Cerveau, INSERM, CNRS, CHU Pitié-Salpêtrière, Paris, France
| | - Georgios Koutsis
- 1st Department of Neurology, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Henry Houlden
- Department of Neuromuscular Disease, Institute of Neurology, University College London, London, United Kingdom.,Neurogenetics Laboratory, National Hospital for Neurology and Neurosurgery, London, United Kingdom
| | - Giovanni Stevanin
- Département de génétique, Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.,Sorbonne Université, Institut du Cerveau, INSERM, CNRS, CHU Pitié-Salpêtrière, Paris, France.,PSL Research University, EPHE, Neurogenetics Team, Paris, France
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10
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Ruaud L, Keren B, Debs R, Mignot C, Mochel F. Demyelinating motor neuropathy associated with a homozygous GPT2 pathogenic variant. Muscle Nerve 2021; 63:E41-E44. [PMID: 33501685 DOI: 10.1002/mus.27183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 01/07/2021] [Accepted: 01/24/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Lyse Ruaud
- INSERM UMR 1141, Neurodiderot, University of Paris, Paris, France.,Department of Genetics, APHP, Robert-Debré Hospital, Paris, France
| | - Boris Keren
- Department of Genetics, APHP, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Rabab Debs
- Department of Clinical Neurophysiology, APHP, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France
| | - Cyril Mignot
- Department of Genetics, APHP, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,Centre de Référence Déficiences Intellectuelles de Causes Rares, Pitié-Salpêtrière University Hospital, Paris, France
| | - Fanny Mochel
- Department of Genetics, APHP, Sorbonne Université, Pitié-Salpêtrière University Hospital, Paris, France.,INSERM U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
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11
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Querin G, Lenglet T, Debs R, Stojkovic T, Behin A, Salachas F, Le Forestier N, Amador MDM, Bruneteau G, Laforêt P, Blancho S, Marchand-Pauvert V, Bede P, Hogrel JY, Pradat PF. Development of new outcome measures for adult SMA type III and IV: a multimodal longitudinal study. J Neurol 2021; 268:1792-1802. [PMID: 33388927 DOI: 10.1007/s00415-020-10332-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/06/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was the comprehensive characterisation of longitudinal clinical, electrophysiological and neuroimaging measures in type III and IV adult spinal muscular atrophy (SMA) with a view to propose objective monitoring markers for future clinical trials. METHODS Fourteen type III or IV SMA patients underwent standardised assessments including muscle strength testing, functional evaluation (SMAFRS and MFM), MUNIX (abductor pollicis brevis, APB; abductor digiti minimi, ADM; deltoid; tibialis anterior, TA; trapezius) and quantitative cervical spinal cord MRI to appraise segmental grey and white matter atrophy. Patients underwent a follow-up assessment with the same protocol 24 months later. Longitudinal comparisons were conducted using the Wilcoxon-test for matched data. Responsiveness was estimated using standardized response means (SRM) and a composite score was generated based on the three most significant variables. RESULTS Significant functional decline was observed based on SMAFRS (p = 0.019), pinch and knee flexion strength (p = 0.030 and 0.027), MUNIX and MUSIX value in the ADM (p = 0.0006 and 0.043) and in TA muscle (p = 0.025). No significant differences were observed based on cervical MRI measures. A significant reduction was detected in the composite score (p = 0.0005, SRM = -1.52), which was the most responsive variable and required a smaller number of patients than single variables in the estimation of sample size for clinical trials. CONCLUSIONS Quantitative strength testing, SMAFRS and MUNIX readily capture disease progression in adult SMA patients. Composite multimodal scores increase predictive value and may reduce sample size requirements in clinical trials.
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Affiliation(s)
- Giorgia Querin
- Centre de Référence Maladies Neuromusculaires Paris-Est, APHP, Hôpital Pitié-Salpêtrière, Service de Neuromyologie, Paris, France
- Laboratoire D'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
- Institut de Myologie, I-Motion Adultes Plateforme, Paris, France
| | - Timothée Lenglet
- Département de Neurophysiologie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
- APHP, Centre Référant SLA, Hôpital Pitié-Salpêtrière, Paris, France
| | - Rabab Debs
- Département de Neurophysiologie, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Tanya Stojkovic
- Centre de Référence Maladies Neuromusculaires Paris-Est, APHP, Hôpital Pitié-Salpêtrière, Service de Neuromyologie, Paris, France
| | - Anthony Behin
- Centre de Référence Maladies Neuromusculaires Paris-Est, APHP, Hôpital Pitié-Salpêtrière, Service de Neuromyologie, Paris, France
| | | | - Nadine Le Forestier
- APHP, Centre Référant SLA, Hôpital Pitié-Salpêtrière, Paris, France
- Département de Recherche en Éthique, EA 1610: Etudes Des Sciences Et Techniques, Université Paris Sud/Paris Saclay, Paris, France
| | | | - Gaëlle Bruneteau
- APHP, Centre Référant SLA, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Laforêt
- Neurology Department, Nord/Est/Ile de France Neuromuscular Center, Raymond-Poincaré Hospital, Garches, France
- INSERM U1179, END-ICAP, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Sophie Blancho
- Institut Pour La Recherche Sur La Moelle Epinière Et L'Encéphale (IRME), Paris, France
| | | | - Peter Bede
- Laboratoire D'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France
- APHP, Centre Référant SLA, Hôpital Pitié-Salpêtrière, Paris, France
- Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College, Dublin, Ireland
| | - Jean-Yves Hogrel
- Institute of Myology, Neuromuscular Investigation Center, Paris, France
| | - Pierre-François Pradat
- Laboratoire D'Imagerie Biomédicale, Sorbonne Université, CNRS, INSERM, Paris, France.
- APHP, Centre Référant SLA, Hôpital Pitié-Salpêtrière, Paris, France.
- Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, Altnagelvin Hospital, Derry/Londonderry, C-TRIC, UK.
- Département de Neurologie, 47 Boulevard de l'sHôpital, 75634, Paris cedex 13, France.
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12
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Abstract
The manifestations of borreliosis in the peripheral nervous system (PNS) remain poorly described. As the symptoms of neuroborreliosis can be reversed with timely introduction of antibiotics, early identification could avoid unnecessary axonal loss. Our aim was to describe the characteristics of confirmed neuroborreliosis cases involving the PNS diagnosed between 2007 and 2017 in our neuromuscular disease center in a nonendemic area (La Pitié-Salpêtrière Hospital, Paris, France).Neuroborreliosis was defined as follows: compatible neurological symptoms without other cause of neuropathy; cerebrospinal fluid and serum analysis (positive serological tests with ELISA, confirmed by Western Blot); and improvement of symptoms with adapted antibiotherapy. All the patients consulting in our center between 2007 and 2017 underwent electrophysiological study.Sixteen confirmed cases of neuroborreliosis involving the PNS were included: 10 cases of meningoradiculoneuritis, 4 of axonal neuropathy, and 2 of demyelinating neuropathy (one acute and one chronic). Only 4 (25%) patients reported tick bites. Meningoradiculoneuritis was characterized by lymphocytic meningitis, intense pain, cranial nerve palsy, and contrast enhancement of nerve roots on imagery. The patients with axonal neuropathy presented sensory symptoms with intense pain but no motor deficit and meningitis was rare. Nerve biopsy of 1 patient revealed lymphocytic vasculitis. Electrophysiological testing showed sensory or sensorimotor axonal neuropathy (3 subacute and 1 chronic) of the lower limbs, with asymmetrical neuropathy in 1 patients, symmetrical neuropathy in one and monomelic sensory mononeuritis multiplex in another. We also found 1 case of acute demyelinating neuropathy, treated with antibiotherapy and immunoglobulins, and 1 chronic demyelinating neuropathy. Overall, diaphragmatic paralysis was frequent (18.6%). Antibiotherapy (mostly ceftriaxone 3-4 weeks) resulted in symptom resolution.This series gives an updated overview of the peripheral complications of neuroborreliosis to help identify this disease so that timely treatment could avoid axonal loss.
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Affiliation(s)
- Anne-Laure Kaminsky
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Nancy, Nancy
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Timothée Lenglet
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Dimitri Psimaras
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Rabab Debs
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Karine Viala
- Département de Neurophysiologie Clinique, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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13
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Hesters A, Amador MDM, Debs R, Le Forestier N, Lenglet T, Pradat PF, Salachas F, Faure M, Jimenez MAG, Gonzalez-Bermejo J, Morelot C, Bruneteau G. Predictive factors for prognosis after gastrostomy placement in routine non-invasive ventilation users ALS patients. Sci Rep 2020; 10:15117. [PMID: 32934263 PMCID: PMC7492246 DOI: 10.1038/s41598-020-70422-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/23/2020] [Indexed: 12/11/2022] Open
Abstract
Due to the expanding use of non-invasive ventilation (NIV) in amyotrophic lateral sclerosis (ALS), the question of enteral nutrition is increasingly raised in NIV users ALS patients. Here, we aimed to determine the prognostic factors for survival after gastrostomy placement in routine NIV users, taking into consideration ventilator dependence. Ninety-two routine NIV users ALS patients, who underwent gastrostomy insertion for severe dysphagia and/or weight loss, were included. We used a Cox proportional hazards model to identify factors affecting survival and compared time from gastrostomy to death and 30-day mortality rate between dependent (daily use ≥ 16 h) and non-dependent NIV users. The hazard of death after gastrostomy was significantly affected by 3 factors: age at onset (HR 1.047, p = 0.006), body mass index < 20 kg/m2 at the time of gastrostomy placement (HR 2.012, p = 0.016) and recurrent accumulation of airway secretions (HR 2.614, p = 0.001). Mean time from gastrostomy to death was significantly shorter in the dependent than in the non-dependent NIV users group (133 vs. 250 days, p = 0.04). The 30-day mortality rate was significantly higher in dependent NIV users (21.4% vs. 2.8%, p = 0.03). Pre-operative ventilator dependence and airway secretion accumulation are associated with worse prognosis and should be key decision-making criteria when considering gastrostomy tube placement in NIV users ALS patients.
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Affiliation(s)
- Adèle Hesters
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Maria Del Mar Amador
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Rabab Debs
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Nadine Le Forestier
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.,Département de Recherche en Ethique, Université Paris Sud/Paris Saclay EA 1610 : Etude des sciences et techniques, Pr Emmanuel Hirsch, Paris, France
| | - Timothée Lenglet
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Pierre-François Pradat
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France.,Laboratoire D'Imagerie Biomédicale, CNRS, INSERM, Sorbonne Université, Paris, France.,Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Londonderry, UK
| | - François Salachas
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France
| | - Morgane Faure
- Service de Pneumologie, Médecine Intensive Et Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Jesus Gonzalez-Bermejo
- Unité Fonctionnelle SSR Respiratoire, APHP, Hôpital Pitié-Salpêtrière, 75013, Paris, France.,UMRS 1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Universités - Inserm, Paris, France
| | - Capucine Morelot
- Service de Pneumologie, Médecine Intensive Et Réanimation, APHP, Hôpital Pitié-Salpêtrière, Paris, France.,UMRS 1158, Neurophysiologie Respiratoire Expérimentale Et Clinique, Sorbonne Universités - Inserm, Paris, France
| | - Gaëlle Bruneteau
- Département de Neurologie, Centre de Référence SLA, Centre de Recherche en Myologie, UMRS974, APHP, Hôpital Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75013, Paris, France. .,Institut National de La Santé Et de La Recherche Médicale, Association Institut de Myologie, Centre de Recherche en Myologie, UMRS974, Sorbonne Université, Paris, France.
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Querin G, Lenglet T, Debs R, Stojkovic T, Béhin A, Hogrel JY, Pradat PF. Développement de nouveaux marqueurs chez les patients SMA type III et IV. Rev Neurol (Paris) 2020. [DOI: 10.1016/j.neurol.2020.01.098] [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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15
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Pegat A, Boisseau W, Maisonobe T, Debs R, Lenglet T, Psimaras D, Azoulay-Cayla A, Fournier E, Viala K. Motor chronic inflammatory demyelinating polyneuropathy (CIDP) in 17 patients: Clinical characteristics, electrophysiological study, and response to treatment. J Peripher Nerv Syst 2020; 25:162-170. [PMID: 32364302 DOI: 10.1111/jns.12380] [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: 10/26/2019] [Revised: 04/29/2020] [Accepted: 04/29/2020] [Indexed: 12/14/2022]
Abstract
Motor chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare and poorly described subtype of CIDP. We aimed to study their clinical and electrophysiological characteristics and response to treatment. From a prospective database of CIDP patients, we included patients with definite or probable CIDP with motor signs and without sensory signs/symptoms at diagnosis. Patients were considered to have pure motor CIDP (PM-CIDP) if sensory conductions were normal or to have motor predominant CIDP (MPred-CIDP) if ≥2 sensory nerve action potential amplitudes were abnormal. Among the 700 patients with CIDP, 17 (2%) were included (PM-CIDP n = 7, MPred-CIDP n = 10); 71% were male, median age at onset was 48 years (range: 13-76 years), 47% had an associated inflammatory or infectious disease or neoplasia. At the more severe disease stage, 94% of patients had upper and lower limb weakness, with distal and proximal weakness in 4 limbs for 56% of them. Three-quarters (75%) responded to intravenous immunoglobulins (IVIg) and four of five patients to corticosteroids including three of three patients with MPred-CIDP. The most frequent conduction abnormalities were conduction blocks (CB, 82%) and F-wave abnormalities (88%). During follow up, 4 of 10 MPred-CIDP patients developed mild sensory symptoms; none with PM-CIDP did so. Patients with PM-CIDP had poorer outcome (median ONLS: 4; range: 22-5) compared to MPred-CIDP (2, range: 0-4; P = .03) at last follow up. This study found a progressive clinical course in the majority of patients with motor CIDP as well as frequent associated diseases, CB, and F-wave abnormalities. Corticosteroids might be considered as a therapeutic option in resistant IVIg patients with MPred-CIDP.
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Affiliation(s)
- Antoine Pegat
- Service de neurologie C pathologies neuromusculaires, service d'explorations fonctionnelles neurologiques, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France.,Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - William Boisseau
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Rabab Debs
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Timothée Lenglet
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Dimitri Psimaras
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.,Service de Neurologie 2-Mazarin, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France.,Université Pierre et Marie Curie Paris 6, Centre de Recherche de l'Institut du Cerveau et de la Moelle Epinière (CRICM), UMRS 975, Inserm U 975, CNRS, UMR 7225, Paris, France
| | - Arièle Azoulay-Cayla
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Emmanuel Fournier
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
| | - Karine Viala
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, Assistance publique-Hôpitaux de Paris, Paris, France
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16
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Gendreau S, Berzero G, Tafani C, Raynouard I, Ricard D, Malfuson JV, Viala K, Debs R, Houillier C, Diamanti L, Marchioni E, Lenglet T, Ouzegdouh M, Bihan K, Gilardin L, Psimaras D. Demyelinating polyradiculoneuritis in patients with multiple myeloma: the other side of bortezomib-induced neurotoxicity. Acta Oncol 2020; 59:484-489. [PMID: 32122210 DOI: 10.1080/0284186x.2020.1723163] [Citation(s) in RCA: 1] [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] [Indexed: 10/24/2022]
Affiliation(s)
- Segolene Gendreau
- Département de Médecine Interne et d’Immunologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Giulia Berzero
- Service de Neurologie 2-Mazarin, AP-HP, Groupe Hospitalier Pitié-Salpetrière, Paris, France
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Camille Tafani
- Service de neurologie, Hôpital d’Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
| | - Igor Raynouard
- Service de Neurologie 2-Mazarin, AP-HP, Groupe Hospitalier Pitié-Salpetrière, Paris, France
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
| | - Damien Ricard
- Service de neurologie, Hôpital d’Instruction des Armées Percy, Service de Santé des Armées, Clamart, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
- Ecole du Val-de-Grâce, Service de Santé des Armées, F-75005, Paris, France
- Université Paris-Saclay, ENS Paris-Saclay, CNRS, Centre Borelli, F-94235, Cachan, France
- Université de Paris, CNRS, Centre Borelli, F-75005 Paris, France
| | - Jean-Valère Malfuson
- Ecole du Val-de-Grâce, Service de Santé des Armées, F-75005, Paris, France
- Service d’Hématologie, Service de Santé des Armées, Hôpital d’Instruction des Armées Percy, Clamart, France
| | - Karine Viala
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris
| | - Rabab Debs
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris
| | - Caroline Houillier
- Service de Neurologie 2-Mazarin, AP-HP, Groupe Hospitalier Pitié-Salpetrière, Paris, France
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- Service d’Hématologie, Institut Curie, Site Saint Cloud, France
| | - Luca Diamanti
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Timothée Lenglet
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris
| | - Maya Ouzegdouh
- Département d’Hématologie, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Kevin Bihan
- Regional Pharmacovigilance Center, Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Laurent Gilardin
- Département de Médecine Interne et d’Immunologie Clinique, Groupe Hospitalier Pitié-Salpêtrière, AP-HP, Paris, France
| | - Dimitri Psimaras
- Service de Neurologie 2-Mazarin, AP-HP, Groupe Hospitalier Pitié-Salpetrière, Paris, France
- Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle épinière (ICM), Paris, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments, Hôpitaux Universitaires Pitié-Salpetrière-Charles Foix et Hôpital Percy, Paris, France
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17
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Marchand‐Pauvert V, Peyre I, Lackmy‐Vallee A, Querin G, Bede P, Lacomblez L, Debs R, Pradat P. Absence of hyperexcitability of spinal motoneurons in patients with amyotrophic lateral sclerosis. J Physiol 2019; 597:5445-5467. [DOI: 10.1113/jp278117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 09/06/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
| | - Iseline Peyre
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
| | | | - Giorgia Querin
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
| | - Peter Bede
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
- Computational Neuroimaging Group Trinity College Dublin Dublin Ireland
| | | | - Rabab Debs
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
| | - Pierre‐François Pradat
- Sorbonne Université Inserm, CNRS, Laboratoire d'Imagerie Biomédicale LIB Paris France
- Neurologie, AP‐HP Hôpital Pitié‐Salpêtrière Paris France
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18
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Fargeot G, Maisonobe T, Psimaras D, Debs R, Lenglet T, Adams D, Vandendries C, Labeyrie C, Viala K. Comparison of Lewis-Sumner syndrome with chronic inflammatory demyelinating polyradiculoneuropathy patients in a tertiary care centre. Eur J Neurol 2019; 27:522-528. [PMID: 31574194 DOI: 10.1111/ene.14101] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 02/16/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Whether the Lewis-Sumner syndrome (L-SS) is a distinct entity from other types of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP-ot) remains controversial. METHOD The clinical/electrophysiological characteristics and long-term outcomes of 45 L-SS and 35 CIDP-ot patients were retrospectively compared. RESULTS The CIDP-ot group was composed of 11 patients with a typical CIDP, 17 with a pure sensory form, four with a distal form and three with a pure motor form. In the L-SS group, asymmetric (P < 0.001) and monomelic involvement (P = 0.04) of the upper limbs (P < 0.001) was significantly more frequent; paucisymptomatic forms (Overall Neuropathy Limitations Scale ≤ 1) were less frequent (P < 0.001); electroneuromyography showed that conduction block in intermediate nerve segments was the main demyelinating feature, with frequent F-wave abnormalities on nerves without conduction block (44%). Long-term prognosis was globally poorer in the L-SS group with more frequent aggravation during treatment (P = 0.02), less frequent treatment withdrawal (P = 0.03) and longer time to achieve successful withdrawal (39 vs. 15 months). CONCLUSIONS Our study suggests that L-SS patients have a less favourable therapeutic response rate and long-term outcomes. Rapid differentiation of L-SS from other forms of CIDP is important in order to anticipate a more complicated disease course management, with from one side the inefficacy or even harmfulness of corticosteroids and from the other side a difficult weaning procedure. A prospective study is necessary to confirm these results.
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Affiliation(s)
- G Fargeot
- CRMR Neuropathies Périphériques Rares, INSERM U1195, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - T Maisonobe
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - D Psimaras
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - R Debs
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - T Lenglet
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, APHP, Paris, France
| | - D Adams
- CRMR Neuropathies Périphériques Rares, INSERM U1195, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - C Vandendries
- Service d'imagerie, Fondation Ophtalmologique Adolphe de Rothschild, APHP, Paris, France
| | - C Labeyrie
- CRMR Neuropathies Périphériques Rares, INSERM U1195, Hôpital Bicêtre, APHP, Le Kremlin Bicêtre, France
| | - K Viala
- Département de Neurophysiologie Clinique, Hôpital Pitié Salpêtrière, APHP, Paris, France
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19
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Renaud M, Moreira MC, Ben Monga B, Rodriguez D, Debs R, Charles P, Chaouch M, Ferrat F, Laurencin C, Vercueil L, Mallaret M, M'Zahem A, Pacha LA, Tazir M, Tilikete C, Ollagnon E, Ochsner F, Kuntzer T, Jung HH, Beis JM, Netter JC, Djamshidian A, Bower M, Bottani A, Walsh R, Murphy S, Reiley T, Bieth É, Roelens F, Poll-The BT, Lourenço CM, Jardim LB, Straussberg R, Landrieu P, Roze E, Thobois S, Pouget J, Guissart C, Goizet C, Dürr A, Tranchant C, Koenig M, Anheim M. Clinical, Biomarker, and Molecular Delineations and Genotype-Phenotype Correlations of Ataxia With Oculomotor Apraxia Type 1. JAMA Neurol 2019; 75:495-502. [PMID: 29356829 DOI: 10.1001/jamaneurol.2017.4373] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Importance Ataxia with oculomotor apraxia type 1 (AOA1) is an autosomal recessive cerebellar ataxia due to mutations in the aprataxin gene (APTX) that is characterized by early-onset cerebellar ataxia, oculomotor apraxia, axonal motor neuropathy, and eventual decrease of albumin serum levels. Objectives To improve the clinical, biomarker, and molecular delineation of AOA1 and provide genotype-phenotype correlations. Design, Setting, and Participants This retrospective analysis included the clinical, biological (especially regarding biomarkers of the disease), electrophysiologic, imaging, and molecular data of all patients consecutively diagnosed with AOA1 in a single genetics laboratory from January 1, 2002, through December 31, 2014. Data were analyzed from January 1, 2015, through January 31, 2016. Main Outcomes and Measures The clinical, biological, and molecular spectrum of AOA1 and genotype-phenotype correlations. Results The diagnosis of AOA1 was confirmed in 80 patients (46 men [58%] and 34 women [42%]; mean [SD] age at onset, 7.7 [7.4] years) from 51 families, including 57 new (with 8 new mutations) and 23 previously described patients. Elevated levels of α-fetoprotein (AFP) were found in 33 patients (41%); hypoalbuminemia, in 50 (63%). Median AFP level was higher in patients with AOA1 (6.0 ng/mL; range, 1.1-17.0 ng/mL) than in patients without ataxia (3.4 ng/mL; range, 0.8-17.2 ng/mL; P < .01). Decreased albumin levels (ρ = -0.532) and elevated AFP levels (ρ = 0.637) were correlated with disease duration. The p.Trp279* mutation, initially reported as restricted to the Portuguese founder haplotype, was discovered in 53 patients with AOA1 (66%) with broad white racial origins. Oculomotor apraxia was found in 49 patients (61%); polyneuropathy, in 74 (93%); and cerebellar atrophy, in 78 (98%). Oculomotor apraxia correlated with the severity of ataxia and mutation type, being more frequent with deletion or truncating mutations (83%) than with presence of at least 1 missense variant (17%; P < .01). Mean (SD) age at onset was higher for patients with at least 1 missense mutation (17.7 [11.4] vs 5.2 [2.6] years; P < .001). Conclusions and Relevance The AFP level, slightly elevated in a substantial fraction of patients, may constitute a new biomarker for AOA1. Oculomotor apraxia may be an optional finding in AOA1 and correlates with more severe disease. The p.Trp279* mutation is the most frequent APTX mutation in the white population. APTX missense mutations may be associated with a milder phenotype.
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Affiliation(s)
- Mathilde Renaud
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Maria-Céu Moreira
- Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France
| | - Bondo Ben Monga
- Faculté de Médecine et Ecole de Santé Publique, Université de Lubumbashi, Lubumbashi, République Démocratique du Congo
| | - Diana Rodriguez
- Service de Neuropédiatrie, Hôpital d'Enfants Armand-Trousseau, Paris, France.,Centre de Référence de Neurogénétique, Hôpital Armand-Trousseau, Hôpitaux Universitaires Est Parisien, Assistance Publique-Hôpitaux de Paris, Paris, France.,Groupe de Recherch Clinique ConCer-LD, Sorbonne Universités, l'Université Pierre-et-Marie-Curie, Université Paris 06, Paris, France.,Neuroprotection du Cerveau en Développement, INSERM U1141, Paris, France
| | - Rabab Debs
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Perrine Charles
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Malika Chaouch
- Service de Neurologie, Etablissement Hospitalier Spécialisé, Algers, Algeria
| | - Farida Ferrat
- Service de Neurologie, Etablissement Hospitalier Spécialisé de Ben Aknoun, Algers, Algeria
| | - Chloé Laurencin
- Service de Neurologie C, Hopital Neurologique, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS, Institut des Sciences Cognitives, UMR 5229, Bron, France
| | - Laurent Vercueil
- Exploration Fonctionnelle du Système Nerveux, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble, France.,INSERM U836, Grenoble Institut des Neurosciences, Bâtiment Edmond J. Safra, Chemin Fortuné Ferrini, La Tronche, France
| | - Martial Mallaret
- Exploration Fonctionnelle du Système Nerveux, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, Centre Hospitalier Universitaire (CHU) Grenoble, Grenoble, France
| | | | | | - Meriem Tazir
- Service de Neurologie, CHU Mustapha, Algers, Algeria
| | - Caroline Tilikete
- Service de Neuro-ophtalmologie, Hôpital Neurologique, CHU Lyon, Bron, France
| | | | | | | | - Hans H Jung
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Jean-Marie Beis
- Institut Régional de Médecine Physique et de Réadaptation, Centre de Lay-Saint-Christophe, France
| | | | - Atbin Djamshidian
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Mattew Bower
- Department of Neurology, University of Minnesota Health, Minneapolis, Minnesota
| | - Armand Bottani
- Service de Génétique, Hôpitaux Universitaires de Genève, Genève, Suisse
| | - Richard Walsh
- Academic Unit of Neurology, Trinity College Dublin, Dublin, Ireland.,National Ataxia Clinic, Adelaide and Meath Hospital Dublin, National Children's Hospital, Dublin, Ireland
| | - Sinead Murphy
- National Ataxia Clinic, Adelaide and Meath Hospital Dublin, National Children's Hospital, Dublin, Ireland
| | - Thomas Reiley
- Department of Public Health and Environment, Greeley, Colorado
| | - Éric Bieth
- Service de Génétique Médicale, Hopital Purpan, Toulouse, France
| | | | - Bwee Tien Poll-The
- Pediatric Neurology, Emma Children's Hospital, University of Amsterdam, Amsterdam, the Netherlands
| | - Charles Marques Lourenço
- Neurogenetics Unit, School of Medicine of Ribeirao Preto, University of São Paulo, São Paulo, Brazil
| | - Laura Bannach Jardim
- Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Rachel Straussberg
- Neurogenetics Clinic, Department of Child Neurology, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler School of Medicine Tel Aviv University, Ramat Aviv, Israel
| | - Pierre Landrieu
- Service de Neurologie Pédiatrique, Hôpital Bicêtre, Paris, France
| | - Emmanuel Roze
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Stéphane Thobois
- Service de Neurologie C, Hopital Neurologique, Hospices Civils de Lyon, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.,CNRS, Institut des Sciences Cognitives, UMR 5229, Bron, France
| | - Jean Pouget
- Service de Neurologie, Hôpital de la Timone, Marseille, France
| | - Claire Guissart
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Cyril Goizet
- Service de Génétique Médicale, CHU Bordeaux, Bordeaux, France.,INSERM U1211, Laboratoire Maladies Rares Génétique et Métabolisme, Université de Bordeaux, Bordeaux, France
| | - Alexandra Dürr
- Département de Génétique, Hôpital de La Pitié-Salpétrière, Paris, France
| | - Christine Tranchant
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Michel Koenig
- Laboratoire de Génétique de Maladies Rares EA7402, Institut Universitaire de Recherche Clinique, Université de Montpellier, CHU Montpellier, Montpellier, France
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.,Institut de Génétique et de Biologie Moléculaire et Cellulaire, Institut National de la Santé et de la Recherche Medicale (INSERM)-U964, Centre National de la Recherche Scientifique (CNRS)-Unité Mixte de Recherché (UMR) 7104, Université de Strasbourg, Illkirch, France.,Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France
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Cousyn L, Law-Ye B, Pyatigorskaya N, Debs R, Froissart R, Piraud M, Federico A, Salvatore S, Cerase A, Macário MC, Durães J, Kim SH, Adachi H, Audoin B, Ayrignac X, Da Y, Henderson R, La Piana R, Laule C, Nakamagoe K, Raininko R, Schols L, Sirrs SM, Viader F, Jastrzębski K, Leclercq D, Nadjar Y. Brain MRI features and scoring of leukodystrophy in adult-onset Krabbe disease. Neurology 2019; 93:e647-e652. [DOI: 10.1212/wnl.0000000000007943] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/21/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo perform a systematic analysis and scoring of brain MRI white matter hyperintensities (WMH) in adult-onset Krabbe disease.MethodsWe retrospectively collected basic clinical data and the first available brain MRI from patients with confirmed Krabbe disease with first clinical manifestations beyond 10 years of age. Data were obtained from our reference center for lysosomal diseases (n = 6) and from contacted authors of published articles describing patients with adult-onset Krabbe disease (n = 15). T2-weighted fluid-attenuated inversion recovery images of each patient were analyzed and scored using a radiologic score of WMH in a single center.ResultsThe corticospinal tract was always affected by WMH (100% of patients), however, with some distinctions along the tract: the precentral gyrus (100%), corona radiata (95%), and posterior internal capsule (81%) were highly abnormal, whereas the mesencephalon (57%), pons (52%), and medulla oblongata (5%) were less affected. WMH were also frequently present in the posterior lateral periventricular white matter (95%), optic radiations (86%), postcentral gyrus (71%), medial lemniscus (62%), and corpus callosum, especially in the isthmus (71%), whereas the genu was always normal. A few patients did not have the classical MRI pattern but extensive hyperintensities (n = 3), or patchy distribution of hyperintensities mimicking an acquired etiology (n = 2), or very subtle hyperintensities of the corticospinal tract (n = 1).ConclusionsWe specified the main locations of WMH, which were observed in the earliest stages of the disease and were also present in patients with atypical MRI pattern, highlighting the importance of radiologic features to guide the diagnosis.
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21
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Marelli C, Lamari F, Rainteau D, Lafourcade A, Banneau G, Humbert L, Monin ML, Petit E, Debs R, Castelnovo G, Ollagnon E, Lavie J, Pilliod J, Coupry I, Babin PJ, Guissart C, Benyounes I, Ullmann U, Lesca G, Thauvin-Robinet C, Labauge P, Odent S, Ewenczyk C, Wolf C, Stevanin G, Hajage D, Durr A, Goizet C, Mochel F. Plasma oxysterols: biomarkers for diagnosis and treatment in spastic paraplegia type 5. Brain 2019; 141:72-84. [PMID: 29228183 DOI: 10.1093/brain/awx297] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [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: 07/03/2017] [Accepted: 09/25/2017] [Indexed: 12/14/2022] Open
Abstract
The hereditary spastic paraplegias are an expanding and heterogeneous group of disorders characterized by spasticity in the lower limbs. Plasma biomarkers are needed to guide the genetic testing of spastic paraplegia. Spastic paraplegia type 5 (SPG5) is an autosomal recessive spastic paraplegia due to mutations in CYP7B1, which encodes a cytochrome P450 7α-hydroxylase implicated in cholesterol and bile acids metabolism. We developed a method based on ultra-performance liquid chromatography electrospray tandem mass spectrometry to validate two plasma 25-hydroxycholesterol (25-OHC) and 27-hydroxycholesterol (27-OHC) as diagnostic biomarkers in a cohort of 21 patients with SPG5. For 14 patients, SPG5 was initially suspected on the basis of genetic analysis, and then confirmed by increased plasma 25-OHC, 27-OHC and their ratio to total cholesterol. For seven patients, the diagnosis was initially based on elevated plasma oxysterol levels and confirmed by the identification of two causal CYP7B1 mutations. The receiver operating characteristic curves analysis showed that 25-OHC, 27-OHC and their ratio to total cholesterol discriminated between SPG5 patients and healthy controls with 100% sensitivity and specificity. Taking advantage of the robustness of these plasma oxysterols, we then conducted a phase II therapeutic trial in 12 patients and tested whether candidate molecules (atorvastatin, chenodeoxycholic acid and resveratrol) can lower plasma oxysterols and improve bile acids profile. The trial consisted of a three-period, three-treatment crossover study and the six different sequences of three treatments were randomized. Using a linear mixed effect regression model with a random intercept, we observed that atorvastatin decreased moderately plasma 27-OHC (∼30%, P < 0.001) but did not change 27-OHC to total cholesterol ratio or 25-OHC levels. We also found an abnormal bile acids profile in SPG5 patients, with significantly decreased total serum bile acids associated with a relative decrease of ursodeoxycholic and lithocholic acids compared to deoxycholic acid. Treatment with chenodeoxycholic acid restored bile acids profile in SPG5 patients. Therefore, the combination of atorvastatin and chenodeoxycholic acid may be worth considering for the treatment of SPG5 patients but the neurological benefit of these metabolic interventions remains to be evaluated in phase III therapeutic trials using clinical, imaging and/or electrophysiological outcome measures with sufficient effect sizes. Overall, our study indicates that plasma 25-OHC and 27-OHC are robust diagnostic biomarkers of SPG5 and shall be used as first-line investigations in any patient with unexplained spastic paraplegia.
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Affiliation(s)
- Cecilia Marelli
- Gui de Chauliac University Hospital, Department of Neurology, Montpellier, France.,Gui de Chauliac University Hospital, Expert Center for Neurogenetic Diseases and Adult Mitochondrial and Metabolic Diseases, Montpellier, France
| | - Foudil Lamari
- APHP, La Pitié-Salpêtrière University Hospital, Department of Biochemistry, Paris, France.,University Pierre and Marie Curie, Neurometabolic Research Group, Paris, France.,APHP, La Pitié-Salpêtrière University Hospital, Reference Center for Adult Neurometabolic Diseases, Paris, France
| | - Dominique Rainteau
- APHP, Hôpital Saint Antoine, Département PM2 Plateforme de Métabolomique, Peptidomique et dosage de Médicaments, Paris, France
| | - Alexandre Lafourcade
- APHP, Hôpital La Pitié-Salpêtrière, Département de Biostatistiques, Santé publique et Information médicale, Centre de Pharmacoépidémiologie (Cephepi), F-75013, Paris, France
| | - Guillaume Banneau
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Functional Unit of Molecular and Cellular Neurogenetics, Paris, France
| | - Lydie Humbert
- APHP, Hôpital Saint Antoine, Département PM2 Plateforme de Métabolomique, Peptidomique et dosage de Médicaments, Paris, France
| | - Marie-Lorraine Monin
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Elodie Petit
- Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Rabab Debs
- APHP, La Pitié-Salpêtrière University Hospital, Department of Neurology, Paris, France
| | | | - Elisabeth Ollagnon
- La Croix-Rousse University Hospital, Department of Genetics, Lyon, France
| | - Julie Lavie
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Julie Pilliod
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Isabelle Coupry
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Patrick J Babin
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France
| | - Claire Guissart
- Institut Universitaire de Recherche Clinique, Laboratoire de Génétique Moléculaire, Montpellier, France
| | - Imen Benyounes
- APHP, La Pitié-Salpêtrière University Hospital, Department of Biochemistry, Paris, France
| | - Urielle Ullmann
- Institut de Pathologie et Génétique, Centre de Génétique Humaine, Gosselies, Belgium
| | - Gaetan Lesca
- Lyon University Hospital, Department of Medical Genetics, Lyon, France
| | | | - Pierre Labauge
- Gui de Chauliac University Hospital, Department of Neurology, Montpellier, France.,Gui de Chauliac University Hospital, Reference Center for Adult Leukodystrophy, Montpellier, France
| | - Sylvie Odent
- Rennes University Hospital, Department of Clinical Genetics, Rennes, France
| | - Claire Ewenczyk
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
| | - Claude Wolf
- APHP, Hôpital Saint Antoine, Département PM2 Plateforme de Métabolomique, Peptidomique et dosage de Médicaments, Paris, France
| | - Giovanni Stevanin
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,Ecole Pratique des Hautes Etudes, PSL Research University, Neurogenetic lab, Paris, France
| | - David Hajage
- APHP, Hôpital La Pitié-Salpêtrière, Département de Biostatistiques, Santé publique et Information médicale, Centre de Pharmacoépidémiologie (Cephepi), F-75013, Paris, France.,Paris Diderot University, Sorbonne Paris Cité, UMR 1123 ECEVE, Paris, France
| | - Alexandra Durr
- APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France.,APHP, La Pitié-Salpêtrière University Hospital, Neurogenetic Reference Center, Paris, France
| | - Cyril Goizet
- Laboratoire MRGM, INSERM U1211, Univ Bordeaux, Bordeaux, France.,Bordeaux University Hospital, Department of Medical Genetics, Bordeaux, France.,Bordeaux University Hospital, Neurogenetic Reference Center, Bordeaux, France
| | - Fanny Mochel
- APHP, La Pitié-Salpêtrière University Hospital, Reference Center for Adult Neurometabolic Diseases, Paris, France.,APHP, La Pitié-Salpêtrière University Hospital, Department of Genetics, Paris, France.,Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06 UMR S 1127, Institut du Cerveau et de la Moelle épinière, ICM, Paris, France
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22
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Querin G, El Mendili MM, Lenglet T, Behin A, Stojkovic T, Salachas F, Devos D, Le Forestier N, Del Mar Amador M, Debs R, Lacomblez L, Meininger V, Bruneteau G, Cohen-Adad J, Lehéricy S, Laforêt P, Blancho S, Benali H, Catala M, Li M, Marchand-Pauvert V, Hogrel JY, Bede P, Pradat PF. The spinal and cerebral profile of adult spinal-muscular atrophy: A multimodal imaging study. Neuroimage Clin 2018; 21:101618. [PMID: 30522974 PMCID: PMC6413472 DOI: 10.1016/j.nicl.2018.101618] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 11/17/2018] [Accepted: 11/26/2018] [Indexed: 12/13/2022]
Abstract
Spinal muscular atrophy (SMA) type III and IV are autosomal recessive, slowly progressive lower motor neuron syndromes. Nevertheless, wider cerebral involvement has been consistently reported in mouse models. The objective of this study is the characterisation of spinal and cerebral pathology in adult forms of SMA using multimodal quantitative imaging. Methods Twenty-five type III and IV adult SMA patients and 25 age-matched healthy controls were enrolled in a spinal cord and brain imaging study. Structural measures of grey and white matter involvement and diffusion parameters of white matter integrity were evaluated at each cervical spinal level. Whole-brain and region-of-interest analyses were also conducted in the brain to explore cortical thickness, grey matter density and tract-based white matter alterations. Results In the spinal cord, considerable grey matter atrophy was detected between C2-C6 vertebral levels. In the brain, increased grey matter density was detected in motor and extra-motor regions of SMA patients. No white matter pathology was identified neither at brain and spinal level. Conclusions Adult forms of SMA are associated with selective grey matter degeneration in the spinal cord with preserved white matter integrity. The observed increased grey matter density in the motor cortex may represent adaptive reorganisation. (SMA) type 3 and 4 is a lower motor neuron syndrome. Nevertheless, wider involvement of the nervous system might be possible. 25 adults type 3 and 4 SMA patients were studied using brain and cervical spinal cord neuroimaging techniques. Grey matter atrophy was observed in the spinal cord. No white matter degeneration was present at brain and spinal level. Increased grey matter density was detected in cerebral motor regions and explained as compensatory mechanism.
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Affiliation(s)
- Giorgia Querin
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France
| | - Mohamed-Mounir El Mendili
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; Icahn School of Medicine at Mount Sinai, Department of Neurology, New York, USA
| | - Timothée Lenglet
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; APHP, Hôpital Pitié-Salpêtriere, Service d'Explorations Fonctionnelles, Paris, France
| | - Anthony Behin
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Tanya Stojkovic
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - François Salachas
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - David Devos
- Department of Neurology, ALS Centre, Lille University, INSERM UMRS_1171, University Hospital Centre, LICEND COEN Centre, Lille, France; Department of Medical Pharmacology, Lille University, INSERM UMRS_1171, University Hospital Centre, LICEND COEN Centre, Lille, France
| | - Nadine Le Forestier
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Département de recherche en éthique, EA 1610: Etudes des sciences et techniques, Université Paris Sud/Paris Saclay, Paris, France
| | - Maria Del Mar Amador
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Rabab Debs
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Lucette Lacomblez
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Vincent Meininger
- Hôpital des Peupliers, Ramsay Générale de Santé, F-75013 Paris, France
| | - Gaëlle Bruneteau
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada; Functional Neuroimaging Unit, CRIUGM, Université de Montréal, Montreal, QC, Canada
| | - Stéphane Lehéricy
- APHP, Hôpital Pitié-Salpêtriere, Service de Neuroradiologie, Paris, France; Sorbonne Université, UMR-S975, Inserm U975, CNRS UMR7225, Centre de recherche de l'Institut du Cerveau et de la Moelle épinière - CRICM, Centre de Neuroimagerie de Recherche - CENIR, Paris, France
| | - Pascal Laforêt
- Neurology Department, Nord/Est/Ile de France neuromuscular center, Raymond-Poincaré Hospital, Garches, France; INSERM U1179, END-ICAP, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux
| | - Sophie Blancho
- Institut pour la Recherche sur la Moelle Epinière et l'Encéphale (IRME), Paris, France
| | - Habib Benali
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; Concordia University, PERFORM Centre, Electrical & Computer Engineering Division, Canada
| | - Martin Catala
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Sorbonne Université, CNRS UMR7622, INSERM ERL 1156, IBPS, Paris, France
| | - Menghan Li
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France
| | | | - Jean-Yves Hogrel
- Institute of Myology, Neuromuscular Investigation Center, Paris, France
| | - Peter Bede
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Pierre-François Pradat
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Derry, Londonderry, United Kingdom.
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23
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Roux T, Debs R, Maisonobe T, Lenglet T, Delorme C, Louapre C, Leblond V, Viala K. Rituximab in chronic inflammatory demyelinating polyradiculoneuropathy with associated diseases. J Peripher Nerv Syst 2018; 23:235-240. [PMID: 30203907 DOI: 10.1111/jns.12287] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 07/06/2018] [Revised: 09/03/2018] [Accepted: 09/06/2018] [Indexed: 11/29/2022]
Abstract
We aimed to analyse the response to rituximab in a cohort of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients with associated disorders. We conducted a clinical and electrophysiological retrospective monocentric study in 28 CIDP patients. Response to rituximab was defined as (a) a five-point increase in the Medical Research Council sum score or a one-point decrease in the Overall Neuropathy Limitations Scale score, compared to the score at the first rituximab infusion, or (b) the discontinuation of, or reduced need for, the last treatments before rituximab initiation. Twenty-one patients (75%) were responders to rituximab. The median time before response was 6 months (1-10 months). Only two patients needed to be treated again during a median follow-up of 2.0 years (0.75-9 years). Interestingly, the response rate was good in patients with associated autoimmune disease (5/8) and similar to the response rate observed in patients with a haematological disease (16/20) (P = 0.63). A shorter disease duration was associated with a better clinical response to rituximab (odds ratio 0.81, P = 0.025) and the response rate was better (P = 0.05) in common forms (83.3%) than in sensory forms (42.9%). No major adverse events were recorded. Rituximab is efficacious in CIDP patients with haematological or autoimmune disease. It improves clinical response and decreases dependence on first-line treatments.
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Affiliation(s)
- Thomas Roux
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Rabab Debs
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France.,Medical School, Pierre et Marie Curie University-Paris VI, Paris, France
| | - Thierry Maisonobe
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France.,Medical School, Pierre et Marie Curie University-Paris VI, Paris, France
| | - Timothée Lenglet
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France.,Medical School, Pierre et Marie Curie University-Paris VI, Paris, France
| | - Cécile Delorme
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France.,Medical School, Pierre et Marie Curie University-Paris VI, Paris, France
| | - Céline Louapre
- Department of Neurology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Leblond
- Department of Haematology, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Karine Viala
- Department of Clinical Neurophysiology, APHP, Pitié-Salpêtrière Hospital, Paris, France.,Medical School, Pierre et Marie Curie University-Paris VI, Paris, France
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24
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Querin G, Lenglet T, Debs R, Stojkovic T, Behin A, Salachas F, Le Forestier N, Amador MDM, Lacomblez L, Meininger V, Bruneteau G, Laforêt P, Blancho S, Marchand-Pauvert V, Bede P, Hogrel JY, Pradat PF. The motor unit number index (MUNIX) profile of patients with adult spinal muscular atrophy. Clin Neurophysiol 2018; 129:2333-2340. [PMID: 30248623 DOI: 10.1016/j.clinph.2018.08.025] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 06/22/2018] [Revised: 07/27/2018] [Accepted: 08/27/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Objective of this study is the comprehensive characterisation of motor unit (MU) loss in type III and IV Spinal Muscular Atrophy (SMA) using motor unit number index (MUNIX), and evaluation of compensatory mechanisms based on MU size indices (MUSIX). METHODS Nineteen type III and IV SMA patients and 16 gender- and age-matched healthy controls were recruited. Neuromuscular performance was evaluated by muscle strength testing and functional scales. Compound motor action potential (CMAP), MUNIX and MUSIX were studied in the abductor pollicis brevis (APB), abductor digiti minimi (ADM), deltoid, tibialis anterior and trapezius muscles. A composite MUNIX score was also calculated. RESULTS SMA patients exhibited significantly reduced MUNIX values (p < 0.05) in all muscles, while MUSIX was increased, suggesting active re-innervation. Significant correlations were identified between MUNIX/MUSIX and muscle strength. Similarly, composite MUNIX scores correlated with disability scores. Interestingly, in SMA patients MUNIX was much lower in the ADM than in the ABP, a pattern which is distinctly different from that observed in Amyotrophic Lateral Sclerosis. CONCLUSIONS MUNIX is a sensitive measure of MU loss in adult forms of SMA and correlates with disability. SIGNIFICANCE MUNIX evaluation is a promising candidate biomarker for longitudinal studies and pharmacological trials in adult SMA patients.
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Affiliation(s)
- Giorgia Querin
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Timothée Lenglet
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; APHP, Hôpital Pitié-Salpêtriere, Service d'Explorations Fonctionnelles, Paris, France
| | - Rabab Debs
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; APHP, Hôpital Pitié-Salpêtriere, Service d'Explorations Fonctionnelles, Paris, France
| | - Tanya Stojkovic
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anthony Behin
- APHP, Centre de Référence Maladies Neuromusculaires Paris-Est, Institut de Myologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - François Salachas
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Nadine Le Forestier
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Département de recherche en éthique, EA 1610: Etudes des sciences et techniques, Université Paris Sud/Paris Saclay, Paris, France
| | - Maria Del Mar Amador
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Lucette Lacomblez
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Vincent Meininger
- Hôpital des Peupliers, Ramsay Générale de Santé, F-75013 Paris, France
| | - Gaelle Bruneteau
- APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France
| | - Pascal Laforêt
- Neurology Department, Nord/Est/Ile de France Neuromuscular Center, Raymond-Poincaré Hospital, Garches, France; INSERM U1179, END-ICAP, Versailles Saint-Quentin-en-Yvelines University, Montigny-le-Bretonneux, France
| | - Sophie Blancho
- Institut pour la Recherche sur la Moelle Epinière et l'Encéphale (IRME), Paris, France
| | | | - Peter Bede
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Computational Neuroimaging Group, Academic Unit of Neurology, Trinity College Dublin, Ireland
| | - Jean-Yves Hogrel
- Institute of Myology, Neuromuscular Investigation Center, Paris, France; Institut pour la Recherche sur la Moelle Epinière et l'Encéphale (IRME), Paris, France
| | - Pierre-François Pradat
- Sorbonne Université, CNRS, INSERM, Laboratoire d'Imagerie Biomédicale, Paris, France; APHP, Département de Neurologie, Hôpital Pitié-Salpêtrière, Centre référent SLA, Paris, France; Northern Ireland Centre for Stratified Medicine, Biomedical Sciences Research Institute Ulster University, C-TRIC, Altnagelvin Hospital, Derry/Londonderry, United Kingdom.
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Amador MDM, Masingue M, Debs R, Lamari F, Perlbarg V, Roze E, Degos B, Mochel F. Treatment with chenodeoxycholic acid in cerebrotendinous xanthomatosis: clinical, neurophysiological, and quantitative brain structural outcomes. J Inherit Metab Dis 2018; 41:799-807. [PMID: 29560583 DOI: 10.1007/s10545-018-0162-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [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] [Received: 10/10/2017] [Revised: 02/11/2018] [Accepted: 02/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cerebrotendinous xanthomatosis (CTX) is a rare neurodegenerative disease related to sterols metabolism. It affects both central and peripheral nervous systems but treatment with chenodeoxycholic acid (CDCA) has been reported to stabilize clinical scores and improve nerve conduction parameters. Few quantitative brain structural studies have been conducted to assess the effect of CDCA in CTX. METHODS AND RESULTS We collected retrospectively clinical, neurophysiological, and quantitative brain structural data in a cohort of 14 patients with CTX treated by CDCA over a mean period of 5 years. Plasma cholestanol levels normalized under treatment with CDCA within a few months. We observed a significant clinical improvement in patients up to 25 years old, whose treatment was initiated less than 15 years after the onset of neurological symptoms. Conversely, patients whose treatment was initiated more than 25 years after neurological disease onset continued their clinical deterioration. Eleven patients presented with a length-dependent peripheral neuropathy, whose electrophysiological parameters improved significantly under CDCA. Volumetric analyses in a subset of patients showed no overt volume loss under CDCA. Moreover, diffusion weighted imaging showed improved fiber integrity of the ponto-cerebellar and the internal capsule with CDCA. CDCA was well tolerated in all patients with CTX. CONCLUSION CDCA may reverse the pathophysiological process in patients with CTX, especially if treatment is initiated early in the disease process. Besides tendon xanthoma, this study stresses the need to consider plasma cholestanol measurement in any patient with infantile chronic diarrhea and/or jaundice, juvenile cataract, learning disability and/or autism spectrum disorder, pyramidal signs, cerebellar syndrome or peripheral neuropathy.
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Affiliation(s)
- Maria Del Mar Amador
- Assistance Publique-Hôpitaux de Paris, Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Marion Masingue
- Assistance Publique-Hôpitaux de Paris, Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Rabab Debs
- Assistance Publique-Hôpitaux de Paris, Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Assistance Publique-Hôpitaux de Paris, Département de Neurophysiologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Foudil Lamari
- Assistance Publique-Hôpitaux de Paris, Laboratoire de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Centre de Référence Neurométabolique Adulte, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Université Pierre et Marie Curie, Groupe de Recherche Clinique Neurométabolique, Paris, France
| | - Vincent Perlbarg
- Sorbonne Universités, UPMC-Paris 6, UMR S 1127 and Inserm U 1127, and CNRS UMR 7225, and ICM, F-75013, Paris, France
- Laboratoire d'imagerie biomédicale (LIB), F-75013, Paris, France
- Bioinformatics and Biostatistics Core Facility, iCONICS, IHU-A-ICM, ICM, F-75013, Paris, France
| | - Emmanuel Roze
- Assistance Publique-Hôpitaux de Paris, Département de Neurologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Centre de Référence Neurométabolique Adulte, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
- Sorbonne Universités, UPMC-Paris 6, UMR S 1127 and Inserm U 1127, and CNRS UMR 7225, and ICM, F-75013, Paris, France
| | - Bertrand Degos
- CNRS-UMR 7241/INSERM U1050, CIRB, Collège de France, UPMC, Paris, France
- Assistance Publique-Hôpitaux de Paris, Service de Neurologie, Hôpital Universitaire d'Avicenne, Bobigny, France
| | - Fanny Mochel
- Centre de Référence Neurométabolique Adulte, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
- Université Pierre et Marie Curie, Groupe de Recherche Clinique Neurométabolique, Paris, France.
- Sorbonne Universités, UPMC-Paris 6, UMR S 1127 and Inserm U 1127, and CNRS UMR 7225, and ICM, F-75013, Paris, France.
- Assistance Publique-Hôpitaux de Paris, Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
- Reference Center for Neurometabolic Diseases, Department of Genetics, La Pitié-Salpêtrière University Hospital, 47 Boulevard de l'Hôpital, 75013, Paris, France.
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Cousyn L, Law B, Leclercq D, Pyatigorskaya N, Debs R, Nadjar Y. Phénotypes radiologiques de la leucodystrophie dans la maladie de Krabbe débutant à l’âge adulte : étude d’une cohorte multicentrique internationale de 21 cas. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.01.261] [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: 11/15/2022]
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Vialatte De Pémille C, Maisonobe T, Lenglet T, Debs R. Caractérisations cliniques et électrophysiologiques des atteintes motrices pures isolées et non dégénératives de la main. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.01.153] [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: 11/15/2022]
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Mongin M, Debs R, Le Forestier N, Lenglet T, Salachas F, Degos B. Traitement de la spasticité des masséters par injections de toxine botulique chez des patients atteints de sclérose latérale amyotrophique. Rev Neurol (Paris) 2018. [DOI: 10.1016/j.neurol.2018.01.121] [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: 10/17/2022]
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Masingue M, Debs R, Maillart E, Delvaux V, Lubetzki C, Vidal JS, Papeix C. Fatigue evaluation in fingolimod treated patients: An observational study. Mult Scler Relat Disord 2017; 14:8-11. [PMID: 28619437 DOI: 10.1016/j.msard.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/15/2016] [Revised: 03/10/2017] [Accepted: 03/12/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Fatigue is one of the most disabling symptoms in Multiple Sclerosis (MS) patients and is associated with a low quality of life. Fingolimod (Fg), a sphingosine 1-phosphate receptor modulator, is the first oral MS disease modifying treatment. Little is known about its effect on fatigue. To assess the impact of Fg on fatigue within the first 6 months of treatment in MS patients, we conducted a prospective, open label study, in real life setting. METHODS Change of Modified Fatigue Impact Scale (MFIS) between Fg treatment start and at 6 months was used as a first outcome. Secondary outcomes were changes of MFIS subscales, Fatigue severity scale (FSS) and Visual Analogic Scale of Fatigue (VAS-F) scores, RESULTS: 54 completed the study at M6. No significant change was noted in global MFIS (and neither in sub analysis of MFIS), FSS or VAS-F at M6. Patients with high level of fatigue (MFIS or ≥38) had a higher EDSS score than patients with lower level of fatigue (MFIS <38), (mean 3.3, [SD 1.6] versus 1.6 [SD1.1], p=0.0002) but showed no significant difference in MFIS evolution at M6. There was no significant statistical difference in fatigue parameters evolution at M6 within patients Nz+ or Nz-. CONCLUSION There is no significant impact of Fg on fatigue after 6 months of treatment.
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Affiliation(s)
- Marion Masingue
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Rabab Debs
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France.
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | | | - Catherine Lubetzki
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France; Sorbonne Universités UPMC Univ Paris 06, 75013, France
| | - Jean-Sébastien Vidal
- Paul Broca Hospital, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, Equipe d'Accueil 4468, Paris, France
| | - Caroline Papeix
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
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Medjebar S, Louapre C, Debs R, Peczynski C, Maillart E. Étude pilote comparant le score MSFC à l’application DAM : une solution d’auto-évaluation pour les patients atteints de SEP. Rev Neurol (Paris) 2017. [DOI: 10.1016/j.neurol.2017.01.211] [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: 11/24/2022]
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Debs R, Reach P, Cret C, Demeret S, Saheb S, Maisonobe T, Viala K. A new treatment regimen with high-dose and fractioned immunoglobulin in a special subgroup of severe and dependent CIDP patients. Int J Neurosci 2016; 127:864-872. [PMID: 27918219 DOI: 10.1080/00207454.2016.1269328] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyneuropathy (CIDP) is treated with intravenous immunoglobulins (IVIg), corticosteroids or plasma exchange (PE). IVIg dosage is not universal and markers for treatment management are needed. METHODS We report the response to high-dose and fractioned IVIg in a subgroup of definite CIDP patients, resistant to corticosteroids and PE, responders to IVIg but with an efficacy window <15 d. RESULTS Four patients were included with similar predominantly clinical motor form and conduction abnormalities. Treatment management consisted of fractioning IVIg and increasing the monthly cumulated dose (mean: 3 g/kg/month). Serum IgG concentration was measured and correlated to the clinical state. Monitoring of serum IgG helped to guide IVIg administration dosage and frequency. A mean of 10 months was required to improve symptoms; therapy was then switched to subcutaneous (SC) route (maintenance dose: 3.5 g/kg/month). The mean Overall Neuropathy Limitations Scale was improved from 11 to 3.2 and the mean Medical Research Council scale from 26 to 90. CONCLUSION It is important to distinguish patients with short IVIg efficacy window from those with classical resistance since the former may benefit from fractioning and increasing the IVIg dose. The monitoring of serum IgG level and its correlation to the clinical response could be of help in monitoring each individual's dosage.
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Affiliation(s)
- Rabab Debs
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Pauline Reach
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Corina Cret
- b Neurology Department , Centre Hospitalier de Meaux , Meaux , France
| | - Sophie Demeret
- c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Samir Saheb
- d Centre Clinique d'Hémobiothérapie, service d'Hématologie , Groupe Hospitalier Pitié-Salpêtrière , AP-HP , Paris , France
| | - Thierry Maisonobe
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
| | - Karine Viala
- a Département de Neurophysiologie , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France.,c Service de neurologie 1, Centre diagnostique et thérapeutique des neuropathies périphériques , Groupe Hospitalier Pitié-Salpêtriére , AP-HP , Paris , France
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Richard A, Corvol JC, Debs R, Reach P, Tahiri K, Carpentier W, Gueguen J, Guillemot V, Labeyrie C, Adams D, Viala K, Cohen Aubart F. Transcriptome Analysis of Peripheral Blood in Chronic Inflammatory Demyelinating Polyradiculoneuropathy Patients Identifies TNFR1 and TLR Pathways in the IVIg Response. Medicine (Baltimore) 2016; 95:e3370. [PMID: 27175635 PMCID: PMC4902477 DOI: 10.1097/md.0000000000003370] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We have studied the response to intravenous immunoglobulins (IVIg) by a transcriptomic approach in 11 chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients (CIDP duration = 6 [0.83-6.5] years). RNA was extracted from cells in whole blood collected before and 3 weeks after IVIg treatment, and hybridized on Illumina chips. After RNA quality controls, gene expression was analyzed using statistical tests fitted for microarrays (R software, limma package), and a pathway analysis was performed using DAVID software. We identified 52 genes with expression that varied significantly after IVIg (fold change [FC] > 1.2, P < 0.001, false discovery rate [FDR] <0.05). Among these 52 genes, 7 were related to immunity, 3 were related to the tumor necrosis factor (TNF)-α receptor 1 (TNFR1) pathway (inhibitor of caspase-activated DNase (ICAD): FC = 1.8, P = 1.7E-7, FDR = 0.004; p21 protein-activated kinase 2 [PAK2]: FC = 1.66, P = 2.6E-5, FDR = 0.03; TNF-α-induced protein 8-like protein 1 [TNFAIP8L1]: P = 1.00E-05, FDR = 0.026), and 2 were related to Toll-like receptors (TLRs), especially TLRs 7 and 9, and were implicated in autoimmunity. These genes were UNC93B1 (FC = 1.6, P = 2E-5, FDR = 0.03), which transports TLRs 7 and 9 to the endolysosomes, and RNF216 (FC = 1.5, P = 1E-05, FDR = 0.03), which promotes TLR 9 degradation. Pathway analysis showed that the TNFR1 pathway was significantly lessened by IVIg (enrichment score = 24, Fischer exact test = 0.003). TNF-α gene expression was higher in responder patients than in nonresponders; however, it decreased after IVIg in responders (P = 0.04), but remained stable in nonresponders. Our data suggest the actions of IVIg on the TNFR1 pathway and an original mechanism involving innate immunity through TLRs in CIDP pathophysiology and the response to IVIg. We conclude that responder patients have stronger inflammatory activity that is lessened by IVIg.
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Affiliation(s)
- Alexandra Richard
- From the Sorbonne Universités (AR, J-CC, KT), UPMC Univ Paris 06, INSERM UMRS_1127, CIC_1422, CNRS UMR_7225, AP-HP, and ICM, Hôpital Pitié-Salpêtrière, Département des maladies du système nerveux; Hôpital Pitié Salpêtrière (RD, PR, KV), Département de Neurophysiologie Clinique; Plateforme Post-génomique P3S (WC), UPMC, Site Pitié Salpêtrière; IHU-A-ICM Bioinformatics/Biostatistics Core Facility (JG, VG), Paris; Hôpital de Bicêtre (CL, DA), Centre de Référence des Neuropathies Amyloïdes et autres Neuropathies Périphériques Rares, Le Kremlin-Bicêtre; and AP-HP, Hôpital Pitié Salpêtrière, Service de Médecine Interne, Institut E3M, Centre National de Référence Maladies auto-immunes Systémiques Rares, et Université Paris VI Pierre et Marie Curie, Sorbonnes Université, Paris, France (FCA)
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Pavy-Le Traon A, Piedvache A, Perez-Lloret S, Calandra-Buonaura G, Cochen-De Cock V, Colosimo C, Cortelli P, Debs R, Duerr S, Fanciulli A, Foubert-Samier A, Gerdelat A, Gurevich T, Krismer F, Poewe W, Tison F, Tranchant C, Wenning G, Rascol O, Meissner WG. New insights into orthostatic hypotension in multiple system atrophy: a European multicentre cohort study. J Neurol Neurosurg Psychiatry 2016; 87:554-61. [PMID: 25977316 DOI: 10.1136/jnnp-2014-309999] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [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: 12/07/2014] [Accepted: 04/21/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Orthostatic hypotension (OH) is a key feature of multiple system atrophy (MSA), a fatal progressive neurodegenerative disorder associated with autonomic failure, parkinsonism and ataxia. This study aims (1) to determine the clinical spectrum of OH in a large European cohort of patients with MSA and (2) to investigate whether a prolonged postural challenge increases the sensitivity to detect OH in MSA. METHODS Assessment of OH during a 10 min orthostatic test in 349 patients with MSA from seven centres of the European MSA-Study Group (age: 63.6 ± 8.8 years; disease duration: 4.2 ± 2.6 years). Assessment of a possible relationship between OH and MSA subtype (P with predominant parkinsonism or C with predominant cerebellar ataxia), Unified MSA Rating Scale (UMSARS) scores and drug intake. RESULTS 187 patients (54%) had moderate (> 20 mm Hg (systolic blood pressure (SBP)) and/or > 10 mm Hg (diastolic blood pressure (DBP)) or severe OH (> 30 mm Hg (SBP) and/or > 15 mm Hg (DBP)) within 3 min and 250 patients (72%) within 10 min. OH magnitude was significantly associated with disease severity (UMSARS I, II and IV), orthostatic symptoms (UMSARS I) and supine hypertension. OH severity was not associated with MSA subtype. Drug intake did not differ according to OH magnitude except for antihypertensive drugs being less frequently, and antihypotensive drugs more frequently, prescribed in severe OH. CONCLUSIONS This is the largest study of OH in patients with MSA. Our data suggest that the sensitivity to pick up OH increases substantially by a prolonged 10 min orthostatic challenge. These results will help to improve OH management and the design of future clinical trials.
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Affiliation(s)
- A Pavy-Le Traon
- Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France Unité INSERM U 1048 Eq 8, Toulouse, France
| | - A Piedvache
- Faculty of Mathematics, Paul Sabatier University, Toulouse, France
| | - S Perez-Lloret
- Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France Faculty of Medical Sciences, UCA-BIOMED-CONICET, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - G Calandra-Buonaura
- DIBINEM Alma Mater Studiorum-Università di Bologna, Bologna, Italy IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - V Cochen-De Cock
- Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France EuroMov, Laboratoire Movement to Health (M2H), Pôle Sommeil et Neurologie Clinique Beau Soleil, University of Montpellier, Montpellier, France
| | - C Colosimo
- Dipartimento di Neurologia e Psichiatria, Sapienza Università di Roma, Roma, Italy
| | - P Cortelli
- DIBINEM Alma Mater Studiorum-Università di Bologna, Bologna, Italy IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Debs
- Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France
| | - S Duerr
- Department of Neurology, Medical University, Innsbruck, Austria
| | - A Fanciulli
- Department of Neurology, Medical University, Innsbruck, Austria
| | - A Foubert-Samier
- Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - A Gerdelat
- Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France
| | - T Gurevich
- Movement Disorders Unit, Department of Neurology, Sourasky Medical Center, Tel-Aviv University, Tel Aviv, Israel
| | - F Krismer
- Department of Neurology, Medical University, Innsbruck, Austria
| | - W Poewe
- Division of Neurobiology, Medical University, Innsbruck, Austria
| | - F Tison
- Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
| | - C Tranchant
- Neurology department, University Hospital Hautepierre, Strasbourg, France
| | - G Wenning
- Department of Neurology, Medical University, Innsbruck, Austria Division of Neurobiology, Medical University, Innsbruck, Austria
| | - O Rascol
- Neurology Department, French Reference Center for MSA, University Hospital of Toulouse, Toulouse, France Department of Clinical Pharmacology, Clinical Investigation Center CIC 1436, University Hospital of Toulouse, University of Toulouse 3 and INSERM, Toulouse, France
| | - W G Meissner
- Centre de référence atrophie multisystématisée, CHU de Bordeaux, Bordeaux, France Service de Neurologie, CHU de Bordeaux, Bordeaux, France Université de Bordeaux, Institut des Maladies Neurodégénératives, UMR 5293, Bordeaux, France
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Debs R, Maillart E, Fahed R, Papeix C, Duyckaerts C, Stadelmann C, Galanaud D, Lubetzki C. Extensive brain demyelinating lesions under natalizumab: The role of anti-natalizumab antibodies. Neurology 2015; 85:1630-2. [DOI: 10.1212/wnl.0000000000002084] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Accepted: 07/09/2015] [Indexed: 11/15/2022] Open
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Masingue M, Debs R, Maillart E, Lubetzki C, Papeix C. Effet sur la fatigue du traitement par fingolimod dans les 6 premiers mois chez des patients suivis pour une sclérose en plaques rémittente. Rev Neurol (Paris) 2015. [DOI: 10.1016/j.neurol.2015.01.171] [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: 11/24/2022]
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Richard A, Corvol JC, Debs R, Reach P, Adams D, Cohen F, Viala K. L’analyse transcriptome suggère l’implication des voies TNFR1 et TLRs dans la réponse des polyneuropathies démyélinisantes inflammatoires chroniques aux IgIV. Rev Neurol (Paris) 2015. [DOI: 10.1016/j.neurol.2015.01.472] [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: 10/23/2022]
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Rosenberg S, Périn B, Michel V, Debs R, Navarro V, Convers P. EEG in adults in the laboratory or at the patient's bedside. Neurophysiol Clin 2015; 45:19-37. [DOI: 10.1016/j.neucli.2014.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 12/25/2022] Open
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Roux T, Courtillot C, Debs R, Touraine P, Lubetzki C, Papeix C. Fecundity in women with multiple sclerosis: an observational mono-centric study. J Neurol 2015; 262:957-60. [PMID: 25673128 DOI: 10.1007/s00415-015-7663-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/29/2015] [Accepted: 01/30/2015] [Indexed: 12/13/2022]
Abstract
Multiple sclerosis (MS) is a neurological disease mostly affecting women of childbearing age. When counseling MS patients, many questions arise on the reciprocal influence of MS and pregnancy. However, little is known on the impact of MS and its treatments on the time to pregnancy. The objective was to evaluate fecundity (pregnancy and time to pregnancy) in a French cohort of MS women. One hundred and fifteen women with MS were included consecutively in this observational retrospective study. Pregnancy and time to pregnancy were collected using self-questionnaires. Among the 115 patients, 216 pregnancies (from 84 women) were reported. Mean time to pregnancy, which was available for 124 of these pregnancies, was 8.57 months when pregnancy occurred before MS onset, and 7.53 months after MS onset. Among the 95 patients who had a parental project, 2.27 spontaneous pregnancies per woman were recorded. The mean number of children per woman with MS was 1.37. Spontaneous pregnancies per woman and time to pregnancy were not different from the general French population. However, despite a normal fecundity, the mean number of children per woman with MS (1.37) was lower than in the general French population (1.99).
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Affiliation(s)
- Thomas Roux
- AP-HP, Neurology Department, Pitié-Salpêtrière Hospital, 43-87 Boulevard de l'Hôpital, 75013, Paris, France
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Debs R, Froissart R, Aubourg P, Papeix C, Douillard C, Degos B, Fontaine B, Audoin B, Lacour A, Said G, Vanier MT, Sedel F. Krabbe disease in adults: phenotypic and genotypic update from a series of 11 cases and a review. J Inherit Metab Dis 2013. [PMID: 23197103 DOI: 10.1007/s10545-012-9560-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [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: 11/24/2022]
Abstract
Krabbe disease usually presents as a severe leukodystrophy in early infancy and childhood. From a series of 11 patients and 30 cases previously reported in the literature we describe the clinical, radiological, electrophysiological and genetic features of adult Krabbe disease. Patients diagnosed after the age of 16 years were included in this study. They were further divided into three groups depending on age at symptoms onset: (1) childhood onset cases (n = 7); (2) adolescence onset cases (n = 6) and adult onset cases (n = 28). Overall, 96 % of patients in the adult-onset group presented with signs of pyramidal tracts dysfunction. Spastic paraparesis or tetraparesis became prominent in all cases. A peripheral neuropathy was present in 59 % of cases and was most often demyelinating (80 %). Other clinical signs encompassed dysarthria (31 %), cerebellar ataxia (27 %), pes cavus (27 %), deep sensory signs (23 %), tongue atrophy (15 %), optic neuropathy (12 %), cognitive decline (12 %). Cerebrospinal fluid protein concentration was moderately increased in 54 % of patients. Patients in the adolescent- and childhood-onset groups had similar presentations but were more likely to display optic neuropathy (33 % and 57 %) and cerebellar ataxia (50 % and 57 %). In the adult-onset group, the disease progressed slowly over more than 10 years, but a rapid course was observed in two patients. Abnormalities of brain MRI was similar in the three groups and included high signals of cortico-spinal tracts (94 % of cases), hyper-intensities of optic radiations (89 %) and hyper-intensities or atrophy of the posterior part of the corpus callosum (60 %). No clear genotype-phenotype relationship could be demonstrated.
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Affiliation(s)
- Rabab Debs
- Department of Neurology, Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris and University Pierre&Marie Curie, Paris, France
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Cochen De Cock V, Debs R, Oudiette D, Leu S, Radgi F, Tiberge M, Yu H, Bayard S, Roze E, Vidailhet M, Dauvilliers Y, Rascol O, Arnulf I. Amélioration du mouvement et de la parole pendant les troubles du comportement en sommeil paradoxal au cours de l’atrophie multi systématisée. Rev Neurol (Paris) 2012. [DOI: 10.1016/s0035-3787(12)70039-5] [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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41
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Debs R, Depienne C, Rastetter A, Bellanger A, Degos B, Galanaud D, Keren B, Lyon-Caen O, Brice A, Sedel F. Biotin-Responsive Basal Ganglia Disease in Ethnic Europeans With Novel SLC19A3 Mutations. ACTA ACUST UNITED AC 2010; 67:126-30. [DOI: 10.1001/archneurol.2009.293] [Citation(s) in RCA: 85] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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42
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Perez Lloret S, Nègre-Pagès L, Cochen V, Debs R, Damier P, Destée A, Tison F, Rascol O. Hallucinations et rêves animés dans la maladie de Parkinson : données préliminaires de l’étude PARKMIP/COPARK. Rev Epidemiol Sante Publique 2009. [DOI: 10.1016/j.respe.2009.02.164] [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: 10/20/2022] Open
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Nègre-Pagès L, Cochen V, Debs R, Damier P, Destée A, Tison F, Rascol O. Prévalence et facteurs associés aux hallucinations dans la maladie de Parkinson : données préliminaires de l’étude COPARK dans la Région Midi-Pyrénées (PARKMIP). Rev Neurol (Paris) 2009. [DOI: 10.1016/s0035-3787(09)70003-7] [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: 11/30/2022]
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Debs R, Acket B, Cognard C. U - 3 Ataxie-tremblement liée à l’X fragile chez 2 frères : apport de l’IRM au diagnostic. Rev Neurol (Paris) 2007. [DOI: 10.1016/s0035-3787(07)90616-5] [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: 12/01/2022]
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Haddad F, Debs R, Tohme A, Helou J, Ghayad E. [Werner's syndrome]. Ann Dermatol Venereol 1998; 125:24-6. [PMID: 9747202] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Werner's syndrome associates early aging in young adults, small height, cataract, glucose intolerance, hypogonadism, skin ulcers, vascular calcifications and osteoporosis. CASE REPORT We report a new case of Werner's syndrome in a 34-year-old man with suggestive alterations of the skin and endocrine anomalies in addition to hypospadias, urethral stenosis, bilateral mega-ureter and chronic renal failure. DISCUSSION The diagnosis of Werner's syndrome in our patient was unquestionable because of the clinical presentation and the familial context. However, the urology anomalies have not been reported in this syndrome. A simple coincidence cannot be excluded.
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Affiliation(s)
- F Haddad
- Service de Médecine Interne, Hôtel-Dieu de France, Liban
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Sawa T, Miyazaki H, Pittet JF, Widdicombe JH, Gropper MA, Hashimoto S, Conrad DJ, Folkesson HG, Debs R, Forsayeth JR, Fox B, Wiener-Kronish JP. Intraluminal water increases expression of plasmid DNA in rat lung. Hum Gene Ther 1996; 7:933-41. [PMID: 8727507 DOI: 10.1089/hum.1996.7.8-933] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [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] [Indexed: 02/01/2023] Open
Abstract
Effective gene delivery to specific organs is a major goal for human gene therapy. The lung's structure allows instillation of agents into the airspaces, directly adjacent to the lung epithelium. We hypothesized that the airspace instillation of hypotonic solutions would increase the permeability of the lung epithelium and increase DNA uptake. This hypothesis was tested by instilling plasmid DNA (p4241) encoding the luciferase gene in isotonic and hypotonic solutions. The highest luciferase expression in the lung was achieved after the instillation of this plasmid DNA in distilled water. Aerosolization of water just before the instillation of the plasmid DNA also enhanced the expression level of luciferase in the lung. In addition, an intralobar instillation of the plasmid DNA in water significantly increased the luciferase expression, suggesting that the instillation of the plasmid over a smaller surface area increased expression. Levels of expression could be measured for 3 days. Water increases the permeability of lung epithelial cells transiently and/or enhances gene expression and can be used to achieve gene expression in the lung airspaces for short intervals without toxicity.
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Affiliation(s)
- T Sawa
- Department of Anesthesia and Medicine, University of California, San Francisco 94143, USA
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Abstract
Systemic gene transfer provides new opportunities for the analysis of gene function and gene regulation in vivo, as well as for human gene therapy. We used the chloramphenicol acetyltransferase reporter gene to examine several parameters important for the development of efficient, cationic liposome-mediated, intravenous (IV) gene transfer in mice. We then demonstrated that this approach can produce high level expression of biologically important genes. Specifically, we assessed the relationship of expression vector design to the level of systemic gene expression produced, and compared transfection levels produced by intravenously injecting DNA alone versus DNA-liposome complexes. We found that both the position of the heterologous intron, and the promoter element used in the expression plasmid, significantly affected the level of systemic gene expression produced. Although intravenous injection of plasmid DNA alone transfected every tissue analyzed, liposome-mediated delivery was much more efficient. We also established that repeated i.v. injection of DNA-liposome complexes produced high level systemic transfection. The second injection of DNA-liposome complexes produced levels of gene expression at least as high as those following a single i.v. injection. Thus, unlike some viral vectors, a neutralizing host-immune response does not limit re-expression, following reinjection of DNA-liposome complexes. Finally, we showed that the expression vectors which produced the highest levels of chloramphenicol acetyltransferase reporter gene expression could also produce high level expression of two colony stimulating factor genes in mice. Specifically, i.v. injection of liposomes complexed to expression vectors into which we had inserted either the murine granulocyte-macrophage-colony stimulating factor cDNA or the human granulocyte-CSF cDNA, produced circulating levels of the corresponding colony stimulating factor gene product comparable to levels which have been shown previously to be both biologically and therapeutically significant.
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Affiliation(s)
- Y Liu
- California Pacific Medical Research Institute, San Francisco, California 94115, USA
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Philip R, Liggitt D, Philip M, Dazin P, Debs R. In vivo gene delivery. Efficient transfection of T lymphocytes in adult mice. J Biol Chem 1993; 268:16087-90. [PMID: 8344890] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We have demonstrated that a single intraperitoneal injection of cationic liposomes complexed to a chloramphenicol acetyltransferase (CAT) gene expression plasmid can transfect the majority of splenic Thy 1.2+ T lymphocytes, as well as significant numbers of bone marrow-derived hematopoietic cells, in adult mice. CAT activity was detected in the spleen for at least 2 weeks, and there was no evidence of treatment-related toxicity. Some degree of tissue-specific transgene expression was achieved by varying the cationic lipid used.
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Affiliation(s)
- R Philip
- Cancer Research Institute, University of California, San Francisco 94143-0128
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Abstract
Direct gene transfer into adult animals resulting in generalized or tissue-specific expression would facilitate rapid analysis of transgene effects and allow precise in vivo manipulation of biologic processes at the molecular level. A single intravenous injection of expression plasmid:cationic liposome complexes into adult mice efficiently transfected virtually all tissues. In addition to vascular endothelial cells, most of the extravascular parenchymal cells present in many tissues including the lung, spleen, lymph nodes, and bone marrow expressed the transgene without any apparent treatment-related toxicity. The transgene was still expressed in large numbers of cells in multiple tissues for at least 9 weeks after a single injection. Expression could be targeted to specific tissues and cell types, depending on the promoter element used.
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Affiliation(s)
- N Zhu
- Cancer Research Institute, University of California, San Francisco 94143-0128
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