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Motte J, Sgodzai M, Schneider-Gold C, Steckel N, Mika T, Hegelmaier T, Borie D, Haghikia A, Mougiakakos D, Schroers R, Gold R. Treatment of concomitant myasthenia gravis and Lambert-Eaton myasthenic syndrome with autologous CD19-targeted CAR T cells. Neuron 2024:S0896-6273(24)00275-7. [PMID: 38697115 DOI: 10.1016/j.neuron.2024.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/13/2024] [Accepted: 04/11/2024] [Indexed: 05/04/2024]
Abstract
Myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) are autoimmune disorders affecting neuromuscular transmission. Their combined occurrence is rare, and treatment remains challenging. Two women diagnosed with concomitant MG/LEMS experienced severe, increasing disease activity despite multiple immunotherapies. Anti-CD19 chimeric antigen receptor (CAR) T cells have shown promise for treating autoimmune diseases. This report details the safe application of anti-CD19 CAR T cells for treating concomitant MG/LEMS. After CAR T cell therapy, both patients experienced rapid clinical recovery and regained full mobility. Deep B cell depletion and normalization of acetylcholine receptor and voltage-gated calcium channel N-type autoantibody levels paralleled major neurological responses. Within 2 months, both patients returned to everyday life, from wheelchair dependency to bicycling and mountain hiking, and remain stable at 6 and 4 months post-CAR T cell infusion, respectively. This report highlights the potential for anti-CD19 CAR T cells to achieve profound clinical effects in the treatment of neuroimmunological diseases.
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Affiliation(s)
- Jeremias Motte
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, 44791 Bochum, Germany
| | | | - Nina Steckel
- Department of Hematology and Oncology, Ruhr-University Bochum, Knappschaftskrankenhaus, 44892 Bochum, Germany
| | - Thomas Mika
- Department of Hematology and Oncology, Ruhr-University Bochum, Knappschaftskrankenhaus, 44892 Bochum, Germany
| | - Tobias Hegelmaier
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | | | - Aiden Haghikia
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Dimitrios Mougiakakos
- Department of Hematology and Oncology, Otto-von-Guericke University, 39120 Magdeburg, Germany
| | - Roland Schroers
- Department of Hematology and Oncology, Ruhr-University Bochum, Knappschaftskrankenhaus, 44892 Bochum, Germany.
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, 44791 Bochum, Germany.
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Gold R, Schmidt S, Deisenhammer F, Motte J, Richter N, Taipale K, Salmen HC, Bohland C, Schirduan K. Real-world evidence and patient preference for subcutaneous versus intravenous natalizumab in the treatment of relapsing-remitting multiple sclerosis - initial results from the observational SISTER study. Ther Adv Neurol Disord 2024; 17:17562864241241382. [PMID: 38616781 PMCID: PMC11015759 DOI: 10.1177/17562864241241382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/04/2024] [Indexed: 04/16/2024] Open
Abstract
Background The consideration of patient preference for a certain drug route of administration (RoA) plays an important role in promoting patient adherence in chronic diseases. Natalizumab is an established treatment for relapsing-remitting multiple sclerosis (RRMS) and can be administered as intravenous (IV) infusion or subcutaneous (SC) injection developed to enable a shorter and easier administration versus IV RoA. Study objectives Primary objective is to compare patients' preference for RoA and satisfaction with SC versus IV natalizumab at baseline and subsequent visits up to 12 months. Secondary objectives include drug utilization, clinical outcomes, safety, and treatment satisfaction in a usual care setting. Design and methods SISTER (Subcutaneous: Non-Interventional Study for Tysabri Patient Preference - Experience from Real World) is an ongoing, prospective, observational study where natalizumab is utilized according to local label. RRMS patients are included in three natalizumab cohorts: Patients switching from current IV to SC administration (switcher) and patients newly starting natalizumab on either SC or IV route (starter SC/IV). This interim analysis includes 262 patients (184 switchers, 39 SC starters, and 39 IV starters), median observation period was 9 months. Results 80.8% IV starters and 93.9% SC starters reported at baseline that they prefer the assigned RoA. Although initial satisfaction with chosen RoA was maintained over time from baseline through Month 12 in all three cohorts, the wish for change of the current RoA after 6 and 12 months was more frequently expressed among IV starters than in either SC cohort. Consistently, six patients (23.1%) starting with IV changed their RoA from IV to SC route.Mean global treatment satisfaction according to TSQM-II score at baseline remained high in the switcher group and increased through Month 12 in both IV and SC starter cohorts. Conclusion Based on current data, there is a trend toward patients' preference for the natalizumab SC route over the IV route, which provides valuable insights into patients' preference for natalizumab RoA in routine care and complements available data from clinical studies with real-world data on SC natalizumab. Trial registration This observational (non-interventional) study was registered in the local German PEI register for non-interventional studies (NIS-No. 611) and in the international CTgov register (NCT05304520).
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Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Gudrunstr. 56, Bochum 44791, Germany
| | | | | | - Jeremias Motte
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Nils Richter
- Gemeinschaftspraxis für Neurologie, Düsseldorf, Germany
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Gold R, Motte J. Drug-induced lymphopenia: Are all fumarates the same? Mult Scler 2024:13524585241242011. [PMID: 38605492 DOI: 10.1177/13524585241242011] [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] [Indexed: 04/13/2024]
Affiliation(s)
- Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Schmitz F, Klimas R, Spenner M, Schumacher A, Hieke A, Greiner T, Enax-Krumova E, Sgodzai M, Fels M, Brünger J, Huckemann S, Stude P, Tegenthoff M, Gold R, Philipps J, Fisse AL, Grüter T, Pitarokoili K, Motte J, Sturm D. Morphological Differentiation of Corneal Inflammatory Cells: Proposal of Pragmatic Protocol. Cornea 2024:00003226-990000000-00534. [PMID: 38588437 DOI: 10.1097/ico.0000000000003543] [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] [Received: 10/20/2023] [Accepted: 02/18/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Corneal confocal microscopy is a noninvasive imaging technique to analyze corneal nerve fibers and corneal inflammatory cells (CICs). The amount of CICs is a potential biomarker of disease activity in chronic autoinflammatory diseases. To date, there are no standardized criteria for the morphological characterization of CICs. The aim was to establish a protocol for a standardized morphological classification of CICs based on a literature search and to test this protocol for applicability and reliability. METHODS A systematic review of the literature about definitions of CICs was conducted. Existing morphological descriptions were translated into a structured algorithm and applied by raters. Subsequently, the protocol was optimized by reducing and defining the criteria of the cell types. The optimized algorithm was applied by 4 raters. The interrater reliability was calculated using Fleiss kappa (K). RESULTS A systematic review of the literature revealed no uniform morphological criteria for the differentiation of the individual cell types in CICs. Our first protocol achieved only a low level of agreement between 3 raters (K = 0.09; 1062 rated cells). Our revised protocol was able to achieve a higher interrater reliability with 3 (K = 0.64; 471 rated cells) and 4 (K = 0.61; 628 rated cells) raters. CONCLUSIONS The indirect use of criteria from the literature leads to a high error rate. By clearly defining the individual cell types and standardizing the protocol, reproducible results were obtained, allowing the introduction of this protocol for the future evaluation of CICs in the corneal confocal microscopy.
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Affiliation(s)
- Fynn Schmitz
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Marie Spenner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Tineke Greiner
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Elena Enax-Krumova
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Miriam Fels
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Philipp Stude
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Martin Tegenthoff
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Sturm
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
- Department of Neurology, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany; and
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Fisse AL, Schäfer E, Hieke A, Schröder M, Klimas R, Brünger J, Huckemann S, Grüter T, Sgodzai M, Schneider-Gold C, Gold R, Nguyen HP, Pitarokoili K, Motte J, Arning L. Association of the neonatal Fc receptor promoter variable number of tandem repeat polymorphism with immunoglobulin response in patients with chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16205. [PMID: 38205888 DOI: 10.1111/ene.16205] [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: 09/14/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND PURPOSE Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease with humoral and cellular autoimmunity causing demyelination of peripheral nerves, commonly treated with intravenous immunoglobulins (IVIg). The neonatal Fc receptor (FcRn), encoded by the FCGRT gene, prevents the degradation of immunoglobulin G (IgG) by recycling circulating IgG. A variable number of tandem repeat (VNTR) polymorphism in the promoter region of the FCGRT gene is associated with different expression levels of mRNA and protein. Thus, patients with genotypes associated with relatively low FcRn expression may show a poorer treatment response to IVIg due to increased IVIg degradation. METHODS VNTR genotypes were analyzed in 144 patients with CIDP. Patients' clinical data, including neurological scores and treatment data, were collected as part of the Immune-Mediated Neuropathies Biobank registry. RESULTS Most patients (n = 124, 86%) were VNTR 3/3 homozygotes, and 20 patients (14%) were VNTR 2/3 heterozygotes. Both VNTR 3/3 and VNTR 2/3 genotype groups showed no difference in clinical disability and immunoglobulin dosage. However, patients with a VNTR 2 allele were more likely to receive subcutaneous immunoglobulins (SCIg) than patients homozygous for the VNTR 3 allele (25% vs. 9.7%, p = 0.02) and were more likely to receive second-line therapy (75% vs. 54%, p = 0.05). CONCLUSIONS The VNTR 2/3 genotype is associated with the administration of SCIg, possibly reflecting a greater benefit from SCIg due to more constant immunoglobulin levels without lower IVIg levels between the treatment circles. Also, the greater need for second-line treatment in VNTR 2/3 patients could be an indirect sign of a lower response to immunoglobulins.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Emelie Schäfer
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Maximilian Schröder
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Larissa Arning
- Department of Human Genetics, Ruhr University Bochum, Bochum, Germany
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Preisner F, Pitarokoili K, Lueling B, Motte J, Fisse AL, Grüter T, Godel T, Schwarz D, Heiland S, Gold R, Bendszus M, Kronlage M. Quantitative magnetic resonance neurography in chronic inflammatory demyelinating polyradiculoneuropathy: A longitudinal study over 6 years. Ann Clin Transl Neurol 2024; 11:593-606. [PMID: 38111964 DOI: 10.1002/acn3.51978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 12/03/2023] [Accepted: 12/05/2023] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVE To evaluate magnetic resonance neurography (MRN) for the longitudinal assessment of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS Prospective examination of twelve CIDP patients by neurological assessment, MRN, and nerve conduction studies in 2016 and 6 years later in 2022. Imaging parameters were compared with matched healthy controls and correlated with clinical and electrophysiological markers. The MRN protocol included T2-weighted imaging, diffusion tensor imaging (DTI), T2 relaxometry, and magnetization transfer imaging (MTI). RESULTS Nerve cross-sectional area (CSA) was increased in CIDP patients compared to controls (plexus: p = 0.003; sciatic nerve: p < 0.001). Over 6 years, nerve CSA decreased in CIDP patients, most pronounced at the lumbosacral plexus (p = 0.015). Longitudinally, changes in CSA correlated with changes in the inflammatory neuropathy cause and treatment validated overall disability sum score (INCAT/ODSS) (p = 0.006). High initial nerve CSA was inversely correlated with changes in the INCAT/ODSS over 6 years (p < 0.05). The DTI parameter fractional anisotropy (FA) showed robust correlations with electrodiagnostic testing both cross-sectionally and longitudinally (p < 0.05). MTI as a newly added imaging technique revealed a significantly reduced magnetization transfer ratio (MTR) in CIDP patients (p < 0.01), suggesting underlying changes in macromolecular tissue composition, and correlated significantly with electrophysiological parameters of demyelination (p < 0.05). INTERPRETATION This study provides evidence that changes in nerve CSA and FA reflect the clinical and electrophysiological course of CIDP patients. Initial nerve hypertrophy might predict a rather benign course or better therapy response.
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Affiliation(s)
- Fabian Preisner
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Benjamin Lueling
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Tim Godel
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Sabine Heiland
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr University of Bochum, 44791, Bochum, Germany
| | - Martin Bendszus
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
| | - Moritz Kronlage
- Department of Neuroradiology, Neurological Clinic, Heidelberg University Hospital, 69120, Heidelberg, Germany
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Katz M, Mork H, Baghdasaryan N, Hesse L, Wille K, Treichel J, Motte J, Klimas R, Sturm D, Schellinger PD, Hettlich HJ, Philipps J. High-resolution nerve ultrasound and corneal confocal microscopy in taxane-induced polyneuropathy. Eur J Neurol 2024; 31:e16141. [PMID: 37969021 DOI: 10.1111/ene.16141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND AND PURPOSE The role of high-resolution nerve ultrasound (HRUS) and corneal confocal microscopy (CCM) in the early detection of taxane-induced polyneuropathy (TIPN) is unclear. The present prospective longitudinal controlled observational pilot study estimates the role of HRUS and CCM in the early diagnosis of TIPN in breast cancer patients. METHODS Fifteen breast cancer patients receiving paclitaxel and 15 healthy age matched controls were included. Visits before and 3 weeks, 8 weeks and 6 months after treatment included clinical examination, the total neuropathy score, nerve conduction studies (NCS), monocular CCM including corneal nerve fibre length, density and branching and HRUS of bilateral median, ulnar, radial, tibial, peroneal and sural nerves. Patients were compared between different visits and to healthy controls. RESULTS Total neuropathy score increased from 2.2 at baseline to 5.8 (p < 0.001) at week 8. NCS showed a decreased sensory amplitude in the sural, radial, ulnar and median nerve after 6 months (p < 0.001). HRUS revealed a significant increase of cross-sectional area in the sural nerve (p = 0.004), the median nerve (p = 0.003) at the carpal tunnel and the ulnar nerve in the forearm (p = 0.006) after 6 months. CCM showed no changes at different visits. CONCLUSIONS Corneal confocal microscopy and HRUS do not detect early signs of TIPN during the paclitaxel treatment period. HRUS and NCS might detect congruent signs of an axonal, predominantly sensory polyneuropathy after 6 months. The clinical examination remains the most sensitive tool in the early detection of TIPN in breast cancer patients.
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Affiliation(s)
- Maria Katz
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Hannah Mork
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Nazik Baghdasaryan
- Clinic for Ophthalmology, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Lukas Hesse
- Clinic for Ophthalmology, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Kai Wille
- University Clinic for Haematology, Oncology, Haemostaseology and Palliative Care, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Jasmin Treichel
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Jeremias Motte
- Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Sturm
- Department of Neurology, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany
| | - Peter Dieter Schellinger
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Hans-Joachim Hettlich
- Clinic for Ophthalmology, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Ruhr-University Bochum, Minden, Germany
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Seeliger T, Gingele S, Güzeloglu YE, Heitmann L, Lüling B, Kohle F, Preßler H, Stascheit F, Motte J, Fisse AL, Grüter T, Pitarokoili K, Skripuletz T. Comparative analysis of albumin quotient and total CSF protein in immune-mediated neuropathies: a multicenter study on diagnostic implications. Front Neurol 2024; 14:1330484. [PMID: 38264088 PMCID: PMC10803547 DOI: 10.3389/fneur.2023.1330484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] Open
Abstract
Introduction Blood-cerebrospinal fluid (CSF) barrier dysfunction is pivotal for diagnosing immune-mediated neuropathies, especially in spinal nerve root inflammation. Typically, either total CSF protein or the CSF to serum albumin ratio (QAlb) is measured. Total CSF protein measurements have limitations, notably its fixed reference value regardless of age, in contrast to the age-dependent reference for QAlb. Our goal was to evaluate both markers in patients with immune-mediated neuropathies. Methods In our multicenter research, we collected retrospective CSF data from patients suffering from immune-mediated neuropathies across four German research centers. These parameters were analyzed in relation to their clinical characteristics. Results Out of 419 samples, 36 (8.6%) displayed a notable variation between total CSF protein and QAlb values. A detailed analysis revealed that patients displaying elevated QAlb but normal total CSF protein levels were significantly younger at disease onset (p = 0.01), at the time of diagnosis (p = 0.005), and when undergoing lumbar puncture (p = 0.001) compared to patients with elevated CSF protein and normal QAlb levels. These effects were especially evident for the subgroup of samples derived by female patients. Discussion Our work confirms the crucial role of QAlb in diagnosing immune-mediated neuropathies and particularly its efficacy as a marker for evaluating the blood-CSF barrier in patients with an earlier disease onset. Considering the significance of the albumin quotient, its assessment is especially advisable in younger patients of female sex to avoid missing a potential barrier dysfunction that might be falsely negative when using total protein.
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Affiliation(s)
- Tabea Seeliger
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Lena Heitmann
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Benjamin Lüling
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Felix Kohle
- Department of Neurology, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Hannah Preßler
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
- Neuroscience Clinical Research Center, Charité — Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frauke Stascheit
- Department of Neurology with Experimental Neurology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität, Berlin, Germany
- Neuroscience Clinical Research Center, Charité — Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jeremias Motte
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St Josef Hospital, Ruhr University Bochum, Bochum, Germany
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Poser PL, Sajid GS, Beyer L, Hieke A, Schumacher A, Horstkemper L, Karl AS, Grüter T, Sgodzai M, Pitarokoili K, Gerwert K, Gold R, Fisse AL, Gisevius B, Motte J. Serum neurofilament light chain does not detect self-reported treatment-related fluctuations in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16023. [PMID: 37539836 DOI: 10.1111/ene.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Serum neurofilament light chain (sNfL) is a marker for axonal degeneration. Patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) often report a fluctuation of symptoms throughout one treatment cycle with intravenous immunoglobulins (IVIG). The aim of this study was to determine whether sNfL is suitable to quantify patient-reported symptom fluctuations. METHODS Twenty-nine patients with the diagnosis of CIDP or a CIDP-variant under treatment with IVIG were recruited in this study and underwent examination before IVIG infusion, in the middle of the treatment interval, and before their next IVIG infusion. Patients were surveyed regarding symptom fluctuations at the last visit and divided into two groups: those with and without fluctuations of symptoms. At the first visit, sociodemographic and disease-specific data were collected. Clinical scores were assessed at every examination. sNfL values were compared between both groups at the different time points after conversion into Z-scores-adjusted for age and body mass index. RESULTS Patients with CIDP show elevated sNfL Z-scores (median at baseline: 2.14, IQR: 1.0). There was no significant change in sNfL Z-scores or questionnaire scores within the treatment cycle in either group. There was no significant difference in sNfL levels between the patients with and without symptom fluctuations. CONCLUSIONS CIDP patients show elevated sNfL levels. However, sNfL is not suitable to reflect patient-reported fluctuations of symptoms. This indicates that symptom fluctuations during treatment with IVIG in patients with CIDP are not caused by a neuroaxonal injury. Furthermore, repeated sNfL measurements within one treatment cycle with IVIG seem to have no benefit for symptom monitoring.
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Affiliation(s)
- Philip Lennart Poser
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Gulchan Shazadi Sajid
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Léon Beyer
- Department of Biophysics, Faculty of Biology and Biophysics, Ruhr-University Bochum, Bochum, Germany
- Center for Protein Diagnostics (Prodi), Ruhr-University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Lea Horstkemper
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna-Sophia Karl
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Klaus Gerwert
- Department of Biophysics, Faculty of Biology and Biophysics, Ruhr-University Bochum, Bochum, Germany
- Center for Protein Diagnostics (Prodi), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Barbara Gisevius
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Haghikia A, Hegelmaier T, Wolleschak D, Böttcher M, Desel C, Borie D, Motte J, Schett G, Schroers R, Gold R, Mougiakakos D. Anti-CD19 CAR T cells for refractory myasthenia gravis. Lancet Neurol 2023; 22:1104-1105. [PMID: 37977704 DOI: 10.1016/s1474-4422(23)00375-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 11/19/2023]
Affiliation(s)
- Aiden Haghikia
- Department of Neurology, Medical Faculty, Otto-von-Guericke University, Magdeburg 39120, Germany.
| | - Tobias Hegelmaier
- Department of Neurology, Medical Faculty, Otto-von-Guericke University, Magdeburg 39120, Germany
| | - Denise Wolleschak
- Department of Haematology and Oncology, Otto-von-Guericke University, Magdeburg 39120, Germany
| | - Martin Böttcher
- Department of Haematology and Oncology, Otto-von-Guericke University, Magdeburg 39120, Germany
| | - Christiane Desel
- Department of Neurology, Medical Faculty, Otto-von-Guericke University, Magdeburg 39120, Germany
| | | | - Jeremias Motte
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Georg Schett
- Department of Rheumatology, Friedrich-Alexander-University, Erlangen, Germany
| | - Roland Schroers
- Department of Haematology and Oncology, Ruhr University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Dimitrios Mougiakakos
- Department of Haematology and Oncology, Otto-von-Guericke University, Magdeburg 39120, Germany
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11
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Klimas R, Karl AS, Poser PL, Sgodzai M, Theile-Ochel S, Gisevius B, Faissner S, Nastos I, Gold R, Motte J. [Over one year of B‑cell targeted therapy with Ofatumumab s.c.: first results of a prospective, patient-centered real-world observational study]. Nervenarzt 2023; 94:923-933. [PMID: 37042954 PMCID: PMC10576000 DOI: 10.1007/s00115-023-01470-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2023] [Indexed: 04/13/2023]
Abstract
INTRODUCTION Ofatumumab (Kesimpta™) is a s.c. applicable anti-CD20 antibody, which has been used in Germany since 2021 for the treatment of relapsing multiple sclerosis (RMS). The self-application offers a high degree of independence from intravenous forms of application with highly effective immunotherapy. In this study we recorded the patient-centered experience in 99 out of 127 patients who were adjusted to the drug by us. The aim was to investigate the tolerability and acceptance from the patient's perspective. METHODS Data collection was carried out using doctor documentation, questionnaires and telephone interviews. RESULTS The cohort consists of 127 patients. The patients received 2.8 (± SD 1.7) pre-therapies. The mean duration of therapy with Ofatumumab was 9.8 months (± SD 3.5). Structured data were collected from 99 patients. 23% of patients had no side effects during initial application. 19% rated the side effects as "very mild" and 18% as "mild". In addition to chills/fever (48%), headache (46%), limb pain (45%) and "other symptoms" (19%) also occurred. For subsequent injections, 72% of patients reported no side effects. 87% of patients found handling the medication "very easy". There was one relapse event during therapy. CONCLUSION Our study shows that Ofatumumab is well accepted and tolerated by patients. There was one relapse event during the observation period. The side effects are mild and occur during initial application. No increased tendency to infection could be observed. The data suggest that Ofatumumab is also an effective and safe treatment option for patients with relapsing remitting multiple sclerosis in real-world use.
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Affiliation(s)
- Rafael Klimas
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland.
| | - Anna-Sophia Karl
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Philip Lennart Poser
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Melissa Sgodzai
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Simon Theile-Ochel
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Barbara Gisevius
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Simon Faissner
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Ilias Nastos
- Facharztpraxis für Neurologie, Bochum, Deutschland
| | - Ralf Gold
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
| | - Jeremias Motte
- Klinik für Neurologie, St. Josef-Hospital, Ruhr-Universität Bochum, Gudrunstraße 56, 44791, Bochum, Deutschland
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12
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Salmen A, Hoepner R, Fleischer V, Heldt M, Gisevius B, Motte J, Ruprecht K, Schneider R, Fisse AL, Grüter T, Lukas C, Berthele A, Giglhuber K, Flaskamp M, Mühlau M, Kirschke J, Bittner S, Groppa S, Lüssi F, Bayas A, Meuth S, Heesen C, Trebst C, Wildemann B, Then Bergh F, Antony G, Kümpfel T, Paul F, Nischwitz S, Tumani H, Zettl U, Hemmer B, Wiendl H, Zipp F, Gold R. Factors associated with depressive mood at the onset of multiple sclerosis - an analysis of 781 patients of the German NationMS cohort. Ther Adv Neurol Disord 2023; 16:17562864231197309. [PMID: 37692259 PMCID: PMC10492471 DOI: 10.1177/17562864231197309] [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: 05/11/2023] [Accepted: 08/07/2023] [Indexed: 09/12/2023] Open
Abstract
Background Depression has a major impact on the disease burden of multiple sclerosis (MS). Analyses of overlapping MS and depression risk factors [smoking, vitamin D (25-OH-VD) and Epstein-Barr virus (EBV) infection] and sex, age, disease characteristics and neuroimaging features associated with depressive symptoms in early MS are scarce. Objectives To assess an association of MS risk factors with depressive symptoms within the German NationMS cohort. Design Cross-sectional analysis within a multicenter observational study. Methods Baseline data of n = 781 adults with newly diagnosed clinically isolated syndrome or relapsing-remitting MS qualified for analysis. Global and region-specific magnetic resonance imaging (MRI)-volumetry parameters were available for n = 327 patients. Association of demographic factors, MS characteristics and risk factors [sex, age, smoking, disease course, presence of current relapse, expanded disability status scale (EDSS) score, fatigue (fatigue scale motor cognition), 25-OH-VD serum concentration, EBV nuclear antigen-1 IgG (EBNA1-IgG) serum levels] and depressive symptoms (Beck Depression Inventory-II, BDI-II) was tested as a primary outcome by multivariable linear regression. Non-parametric correlation and group comparison were performed for associations of MRI parameters and depressive symptoms. Results Mean age was 34.3 years (95% confidence interval: 33.6-35.0). The female-to-male ratio was 2.3:1. At least minimal depressive symptoms (BDI-II > 8) were present in n = 256 (32.8%), 25-OH-VD deficiency (<20 ng/ml) in n = 398 (51.0%), n = 246 (31.5%) participants were smokers. Presence of current relapse [coefficient (c) = 1.48, p = 0.016], more severe fatigue (c = 0.26, p < 0.0001), lower 25-OH-VD (c = -0.03, p = 0.034) and smoking (c = 0.35, p = 0.008) were associated with higher BDI-II scores. Sex, age, disease course, EDSS, month of visit, EBNA1-IgG levels and brain volumes at baseline were not. Conclusion Depressive symptoms need to be assessed in early MS. Patients during relapse seem especially vulnerable to depressive symptoms. Contributing factors such as fatigue, vitamin D deficiency and smoking, could specifically be targeted in future interventions and should be investigated in prospective studies.
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Affiliation(s)
- Anke Salmen
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Vinzenz Fleischer
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Milena Heldt
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Barbara Gisevius
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, MaxDelbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
- Institute for Neuroradiology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Carsten Lukas
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
- Institute for Neuroradiology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Martina Flaskamp
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Mark Mühlau
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Jan Kirschke
- Department of Neuroradiology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
| | - Stefan Bittner
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Lüssi
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Antonios Bayas
- Department of Neurology, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Sven Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Germany
| | - Cristoph Heesen
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Gisela Antony
- Central Information Office German Competence Network of Multiple Sclerosis, Philipps University Marburg, Marburg, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilian-University Munich, Munich, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Experimental and Clinical Research Center and NeuroCure Clinical Research Center, MaxDelbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Uwe Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechtsDer Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, Medical Faculty, University Hospital, Münster, Germany
| | - Frauke Zipp
- Department of Neurology, Focus Program Translational Neuroscience (FTN) and Immunotherapy (FZI), Rhine-Main Neuroscience Network (rmn), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr-University Bochum, Bochum, Germany
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Klimas R, Renk P, Sgodzai M, Blusch A, Grüter T, Motte J, Pedreiturria X, Gebel J, Gobrecht P, Fischer D, Gold R, Pitarokoili K. P-8 Small fiber involvement, neuropathic pain and macrophage-dependentaxonal pathology in the rat model of experimental autoimmune neuritis. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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14
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Bieber A, Müller K, Kools S, Hilker L, Ebner L, Kirchgässler A, Rohmann R, Kleinz T, Ortmann L, Basner L, Kühn E, Averdunk P, Schmitz F, Bulut Y, Huckemann S, Scholz L, Fisse A, Motte J, Grüter T, Kwon E, Schneider-Gold C, Gold R, Tönges L, Pitarokoili K. P-99 Nerve conduction studies in a cohort of patients with Parkinson[StQuote]s disease, multiple system atrophy and progressive supranuclear palsy. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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15
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Hieke A, Spenner M, Schmitz F, Schumacher A, Schröder M, Klimas R, Sgodzai M, Brünger J, Grüter T, Gold R, Pitarokoili K, Fisse AL, Motte J. The impact of the SARS-CoV-2-pandemic on patients with chronic inflammatory neuropathies: results from the German INHIBIT register. J Neurol 2023; 270:1815-1822. [PMID: 36550388 PMCID: PMC9778453 DOI: 10.1007/s00415-022-11527-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION SARS-CoV-2 pandemic is especially compromising for patients with autoimmune diseases with or without immunomodulatory treatment. This study aimed to investigate the longitudinal changes in the health care of patients with immune-mediated neuropathies during the COVID-19 pandemic. METHODS We performed a longitudinal study using questionnaires in a prospective cohort of patients with immune-mediated neuropathies at two timepoints of the pandemic: May-July 2021 and May-July 2022. RESULTS The cohort consisted of 73 patients (55 male), mean age 62 years, 68 patients with CIDP, 5 with other immune neuropathies. In 2021, 19.2% of the patients reported a reduced number of physician-patient-contacts, while 13.7% reported this in 2022. Nevertheless, the overall health-care situation worsened from 2021 to 2022: 15.1% reported reduced overall healthcare in 2021, 26.0% in 2022. In 2021, 29.4% of patients reported absence of physio-/occupational therapy, while 34.4% reported this in 2022. Switching immunomodulatory treatment and stretching of treatment intervals occurred more often in 2022 (38.4%) than in 2021 (27.4%). 12 COVID-19-infections occurred overall, with typical only mild symptoms. The rate of fully vaccinated patients was 61.6% and 98.6% in May-July 2021 and 2022, respectively. Only minor side-effects after vaccination were reported. CONCLUSION Despite mitigation of COVID-19 restrictions from 2021 to 2022, the health-care situation of patients worsened in this time. Reasons could be the international shortage of immunoglobulins during the pandemic and reduced physio/ergotherapy due to lingering regulatory restrictions. Vaccination rate was high in our cohort of patients compared to the general German population and CIDP did not seem to be a risk factor for severe SARS-CoV-2 infections.
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Affiliation(s)
- Alina Hieke
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Marie Spenner
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Fynn Schmitz
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Maximilian Schröder
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Rafael Klimas
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- grid.416438.cDepartment of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791 Bochum, Germany
- grid.5570.70000 0004 0490 981XImmune-Mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Wurm H, Motte J, Kämmerer F. Lateral Tongue Bite Confirmed on MRI. Dtsch Arztebl Int 2023; 120:194. [PMID: 37222040 DOI: 10.3238/arztebl.m2022.0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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17
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Blusch A, Sgodzai M, Rilke N, Motte J, König J, Pitarokoili K, Grüter T. In Vitro Myelination of Peripheral Axons in a Coculture of Rat Dorsal Root Ganglion Explants and Schwann Cells. J Vis Exp 2023. [PMID: 36847366 DOI: 10.3791/64768] [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: 02/12/2023] Open
Abstract
The process of myelination is essential to enable rapid and sufficient signal transduction in the nervous system. In the peripheral nervous system, neurons and Schwann cells engage in a complex interaction to control the myelination of axons. Disturbances of this interaction and breakdown of the myelin sheath are hallmarks of inflammatory neuropathies and occur secondarily in neurodegenerative disorders. Here, we present a coculture model of dorsal root ganglion explants and Schwann cells, which develops a robust myelination of peripheral axons to investigate the process of myelination in the peripheral nervous system, study axon-Schwann cell interactions, and evaluate the potential effects of therapeutic agents on each cell type separately. Methodologically, dorsal root ganglions of embryonic rats (E13.5) were harvested, dissociated from their surrounding tissue, and cultured as whole explants for 3 days. Schwann cells were isolated from 3-week-old adult rats, and sciatic nerves were enzymatically digested. The resulting Schwann cells were purified by magnetic-activated cell sorting and cultured under neuregulin and forskolin-enriched conditions. After 3 days of dorsal root ganglion explant culture, 30,000 Schwann cells were added to one dorsal root ganglion explant in a medium containing ascorbic acid. The first signs of myelination were detected on day 10 of coculture, through scattered signals for myelin basic protein in immunocytochemical staining. From day 14 onward, myelin sheaths were formed and propagated along the axons. Myelination can be quantified by myelin basic protein staining as a ratio of the myelination area and axon area, to account for the differences in axonal density. This model provides experimental opportunities to study various aspects of peripheral myelination in vitro, which is crucial for understanding the pathology of and possible treatment opportunities for demyelination and neurodegeneration in inflammatory and neurodegenerative diseases of the peripheral nervous system.
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Affiliation(s)
- Alina Blusch
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital;
| | - Melissa Sgodzai
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital
| | - Niklas Rilke
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital
| | - Jeremias Motte
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital
| | - Jennifer König
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital
| | | | - Thomas Grüter
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital
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18
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Motte J, Gold R. Immune checkpoint inhibitors: A potential bright spot in the treatment of progressive multifocal leukoencephalopathy in multiple sclerosis. Mult Scler 2023; 29:306-307. [PMID: 36451582 DOI: 10.1177/13524585221137275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Affiliation(s)
- Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
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19
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Huckemann S, Mueller K, Averdunk P, Kühn E, Hilker L, Kools S, Scholz L, Bulut Y, Brünger J, Fiegert S, Grüter T, Fisse AL, Motte J, Yoon MS, Gold R, Schneider-Gold C, Tönges L, Pitarokoili K. Vagal cross-sectional area correlates with parasympathetic dysfunction in Parkinson's disease. Brain Commun 2023; 5:fcad006. [PMID: 36726777 PMCID: PMC9883711 DOI: 10.1093/braincomms/fcad006] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/28/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
The aim of this prospective study was to investigate autonomic function in Parkinson's disease with a multidimensional approach including clinical evaluation tools, head-up tilt test and morphological studies of the vagus nerve. Head-up tilt test parameters including high frequency power of the heart frequency interval, the ratio of low frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval) to the high frequency and low frequency power of systolic blood pressure were used to evaluate parasympathetic, cardiac sympathetic and vasomotor sympathetic functions, respectively, in 80 patients with Parkinson's disease. We examined the cross-sectional area of the vagus nerves bilaterally using nerve ultrasound and compared mean values with a control group of healthy subjects (n = 40) as well as patients with chronic inflammatory demyelinating polyneuropathy (n = 76). The cross-sectional area of right/left vagus nerve of Parkinson's patients was significantly lower compared to the right/left vagus nerve of the control group and of chronic demyelinating polyneuropathy patients. Furthermore, the cross-sectional area of the right vagus nerve was significantly larger from the one of the left vagus nerve for all groups. Based on tilt test, 43 patients (disease duration 7 ± 5, age at evaluation 71 ± 9, Hoehn and Yahr score 2.8 ± 8) were diagnosed with autonomic dysfunction (orthostatic hypertension n = 11, chronotropic incompetence n = 31, postural orthostatic tachycardia syndrome n = 1). Patients with orthostatic hypotension showed significantly higher Unified Parkinson's Disease Rating Scale-III values than those with chronotropic incompetence. The cross-sectional area of the vagus nerve correlated inversely with heart rate in rest and supine position and positively with tilt test parameters representing parasympathetic modulation through vagal activity [high frequency power of the distance between two consecutive R waves in electrocardiogram (RR interval)] at rest. We demonstrate for the first time that morphological characteristics of the vagus nerve correlate with parameters of parasympathetic function from the spectral analysis of cardiovascular parameters in tilt test for Parkinson's patients. This correlation reveals the impact of the atrophy of vagal atrophy for autonomic function in Parkinson's disease. Nerve ultrasound of the vagus nerve could potentially be used as an adjunct to tilt table examination to diagnose autonomic dysfunction.
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Affiliation(s)
- Sophie Huckemann
- Correspondence may also be addressed to: Sophie Huckemann E-mail:
| | - Katharina Mueller
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Paulina Averdunk
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Eva Kühn
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Lovis Hilker
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Saskia Kools
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Leonard Scholz
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Yesim Bulut
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Sean Fiegert
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Augusta Clinic, Hattingen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Lars Tönges
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany,Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr University, Bochum, Germany
| | - Kalliopi Pitarokoili
- Correspondence to: Kalliopi Pitarokoili, MD, MSc Department of Neurology, Ruhr University St. Josef-Hospital, Gudrunstr. 56, 44791 Bochum, Germany E-mail:
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20
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Appeltshauser L, Junghof H, Messinger J, Linke J, Haarmann A, Ayzenberg I, Baka P, Dorst J, Fisse AL, Grüter T, Hauschildt V, Jörk A, Leypoldt F, Mäurer M, Meinl E, Michels S, Motte J, Pitarokoili K, Stettner M, Villmann C, Weihrauch M, Welte GS, Zerr I, Heinze KG, Sommer C, Doppler K. Anti-pan-neurofascin antibodies induce subclass-related complement activation and nodo-paranodal damage. Brain 2022; 146:1932-1949. [PMID: 36346134 PMCID: PMC10151189 DOI: 10.1093/brain/awac418] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/29/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
Abstract
Autoimmune neuropathy associated with antibodies against pan-neurofascin is a new subtype of nodo-paranodopathy. It is relevant because it is associated with high morbidity and mortality. Affected patients often require intensive care unit treatment for several months, and data on the reversibility and long-term prognosis are limited. The pathogenicity including IgG subclass-associated mechanisms has not been unraveled, nor been directly compared to anti-neurofascin-155 IgG4 related pathology. Understanding the underlying pathology might have a direct impact on treatment of these severely affected patients.
By a multicenter combined pro- and retrospective approach, we provide clinical data of a large cohort of patients with anti-neurofascin associated neuropathy (n = 18) including longitudinal titre and neurofilament light chain assessment via Ella® and relate clinical data to in vitro pathogenicity studies of anti-neurofascin antibodies. We assessed antibody binding characteristics and the pathogenic effects of anti-pan-neurofascin vs. neurofascin-155 antibodies on living myelinating dorsal root ganglia co-cultures. Additionally, we analyzed the IgG subclass profile and the complement binding capacity and effector functions considering the effects of intravenous immunoglobulin preparations via ELISA and cell-based assays.
In contrast to chronic, neurofascin-155 IgG4 associated neuropathy, anti-pan-neurofascin associated disease presented with a high morbidity and mortality, but as a monophasic and potentially reversible disorder. During follow-up, antibodies were no longer detectable in 8/11 patients. Anti-pan-neurofascin had direct access to the nodes of Ranvier in myelinating cultures titre-dependently, most probably inducing this severe phenotype. Antibody preincubation lead to impaired paranode formation, destruction of paranodal architecture and alterations on paranodal myelin and sensory neurons in the cultures, with more severe effects than neurofascin-155 antibodies. Besides IgG4, subclass IgG3 was detected and associated with complement binding and cytotoxic effects in vitro. As a possible correlate of axonal damage in vivo, we detected highly increased serum neurofilament light chain levels (sNF-L), correlating to serum C3a. Still, sNF-L was not identified as a marker for poor prognosis, but rather as an inter-individual and intra-individual marker for acuteness, severity, and course, with a strong decrease during recovery.
Our data provide evidence that anti-pan-neurofascin antibodies directly attack the node and induce severe and acute, but potentially reversible nodo-paranodal pathology, possibly involving complement-mediated mechanisms. Screening for autoantibodies thus is crucial to identify this subset of patients who benefit from early antibody-depleting therapy. Titre and sNF-L might serve as valuable follow-up parameters. The prospect of a favourable outcome has high relevance for physicians, patients and relatives during months of critical care.
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Affiliation(s)
- Luise Appeltshauser
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
| | - Helena Junghof
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
| | - Julia Messinger
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
| | - Janis Linke
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
- Rudolf Virchow Center for Integrative and Translational Bioimaging, Julius Maximilian University of Würzburg , 97080 Würzburg , Germany
| | - Axel Haarmann
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum , 44791 Bochum , Germany
- Department of Neurology, I.M. Sechenov First Moscow State Medical University , 119146 Moscow , Russia
| | - Panoraia Baka
- Department of Neurology, University Medical Center of the Johannes Gutenberg University , 55131 Mainz , Germany
| | - Johannes Dorst
- Department of Neurology, University Hospital Ulm; 89081 Ulm , Germany
| | - Anna L Fisse
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum , 44791 Bochum , Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum , 44791 Bochum , Germany
| | - Valerie Hauschildt
- Department of Neurology, University Medical Center Göttingen , 37075 Göttingen , Germany
| | - Alexander Jörk
- Hans Berger Department of Neurology, Jena University Hospital , 07747 Jena , Germany
| | - Frank Leypoldt
- Neuroimmunology Section, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein , Kiel/Lubeck; 24105 Kiel , Germany
- Department of Neurology, Kiel University , 24105 Kiel , Germany
| | - Mathias Mäurer
- Department of Neurology, Klinikum Würzburg Mitte gGmbH, Standort Juliusspital , 97070 Würzburg , Germany
| | - Edgar Meinl
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospital, Ludwig Maximilian University of Munich , 82152 Planegg , Germany
| | - Sebastian Michels
- Department of Neurology, University Hospital Ulm; 89081 Ulm , Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum , 44791 Bochum , Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum , 44791 Bochum , Germany
| | - Mark Stettner
- Department of Neurology, University Hospital of Essen , 45147 Essen , Germany
| | - Carmen Villmann
- Institute for Clinical Neurobiology, University Hospital Würzburg , 97080 Würzburg , Germany
| | - Marc Weihrauch
- Department of Neurology, Bundeswehrkrankenhaus Ulm , 89081 Ulm , Germany
| | - Gabriel S Welte
- Department of Neurology, KRH Klinikum Nordstadt , 30167 Hannover , Germany
| | - Inga Zerr
- Department of Neurology, University Medical Center Göttingen , 37075 Göttingen , Germany
- German Center for Neurodegenerative Diseases , 37075 Göttingen , Germany
| | - Katrin G Heinze
- Rudolf Virchow Center for Integrative and Translational Bioimaging, Julius Maximilian University of Würzburg , 97080 Würzburg , Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
| | - Kathrin Doppler
- Department of Neurology, University Hospital of Würzburg , 97080 Würzburg , Germany
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21
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Faissner S, Heitmann N, Plaza-Sirvent C, Trendelenburg P, Ceylan U, Motte J, Bessen C, Urlaub D, Watzl C, Overheu O, Reinacher-Schick A, Hellwig K, Pfaender S, Schmitz I, Gold R. Immune response in ofatumumab treated multiple sclerosis patients after SARS-CoV-2 vaccination. Front Immunol 2022; 13:980526. [PMID: 36119053 PMCID: PMC9471319 DOI: 10.3389/fimmu.2022.980526] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Objective The pandemic induced by SARS-CoV-2 has huge implications for patients with immunosuppression that is caused by disorders or specific treatments. Especially approaches targeting B cells via anti-CD20 therapy are associated with impaired humoral immune response but sustained cellular immunity. Ofatumumab is a human anti-CD20 directed antibody applied in low dosages subcutaneously, recently licensed for Multiple Sclerosis (MS). Effects of early ofatumumab treatment on alterations of immune cell composition and immune response towards SARS-CoV-2 are incompletely understood. Methods We here investigated immune cell alterations in early ofatumumab (Ofa) treated patients and effects on humoral (titer, neutralization capacity against wild type, Delta and Omicron) and cellular immune responses in Ofa treated MS patients following a third vaccination against SARS-CoV-2 compared to healthy controls. Results We show that a mean treatment duration of three months in the Ofa group led to near complete B cell depletion in line with altered composition of certain CD4+ T cell subpopulations such as enhanced frequencies of naive and a decrease of non-suppressive regulatory T cells (Tregs). Titer and neutralization capacity against SARS-CoV-2 variants was impaired while cellular immune response was sustained, characterized by a strong T helper 1 profile (Th1). Interpretation In summary, low dosage ofatumumab treatment elicits sustained depletion of B cells in line with alterations of immune cells, mainly Tregs. This is associated with impaired humoral immune response towards SARS-CoV-2 vaccination but preserved, Th1 driven cellular immunity adding crucial information regarding early effects of low dosage anti-CD20 therapy on humoral and cellular immunity.
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Affiliation(s)
- Simon Faissner
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
- *Correspondence: Simon Faissner,
| | - Neele Heitmann
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | | | - Paulina Trendelenburg
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Ulas Ceylan
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Clara Bessen
- Department of Molecular Immunology, Ruhr-University Bochum, Bochum, Germany
| | - Doris Urlaub
- Department for Immunology, Leibniz Research Centre for Working Environment and Human Factors (IfADo) Technical University (TU) Dortmund, Dortmund, Germany
| | - Carsten Watzl
- Department for Immunology, Leibniz Research Centre for Working Environment and Human Factors (IfADo) Technical University (TU) Dortmund, Dortmund, Germany
| | - Oliver Overheu
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Anke Reinacher-Schick
- Department of Hematology and Oncology with Palliative Care, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kerstin Hellwig
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
| | - Stephanie Pfaender
- Department of Molecular and Medical Virology, Ruhr-University Bochum, Bochum, Germany
| | - Ingo Schmitz
- Department of Molecular Immunology, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, Ruhr-University Bochum, St. Josef-Hospital, Bochum, Germany
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22
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Fisse AL, Motte J, Grüter T, Kohle F, Kronlage C, Stahl JH, Winter N, Seeliger T, Gingele S, Stascheit F, Hotter B, Klehmet J, Kummer K, Enax-Krumova EK, Sturm D, Skripuletz T, Schmidt J, Yoon MS, Pitarokoili K, Lehmann HC, Grimm A. Versorgungssituation von CIDP-Patienten in neun deutschen Zentren des Neuritis Netzes. Nervenarzt 2022; 94:320-326. [PMID: 35997784 PMCID: PMC10104951 DOI: 10.1007/s00115-022-01377-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2022] [Indexed: 11/26/2022]
Abstract
Zusammenfassung
Hintergrund
Die Diagnose und Behandlung von Patienten mit immunvermittelten Polyneuropathien ist aufgrund der Heterogenität der Erkrankungen herausfordernd.
Ziel der Arbeit
Ein aktueller epidemiologischer Überblick über die Versorgungssituation von Patienten mit immunvermittelten Polyneuropathien innerhalb des deutschen Neuritis-Netzwerks „Neuritis Netz“.
Material und Methoden
Es erfolgte eine Umfrage in neun deutschen neurologischen Zentren, die auf die Betreuung von Patienten mit Immunneuropathie spezialisiert sind. Wir erfassten Diagnose, Vorgehen in der Diagnostik und Nachsorge, typische Symptome bei Manifestation und im Krankheitsverlauf sowie Therapiedaten.
Ergebnisse
Die Erhebung umfasst Daten von 1529 jährlich behandelten Patienten mit Immunneuropathien, 1320 davon mit chronisch inflammatorisch demyelinisierender Polyneuropathie (CIDP). Die Diagnostik umfasste fast immer Lumbalpunktionen sowie Elektroneuro- und -myografien entsprechend den aktuellen Leitlinien. Der Einsatz von Ultraschall, Biopsie und MRT war unterschiedlich. Wichtigster klinischer Parameter zum Therapiemonitoring in allen Zentren war die motorische Funktion in den klinischen Nachuntersuchungen. Zur Erhaltungstherapie wurde bei rund 15 % der Patienten ein breites Spektrum unterschiedlicher Immunsuppressiva eingesetzt.
Diskussion
Die Studie liefert wichtige epidemiologische Daten zur aktuellen Versorgungsituation von Patienten mit Immunneuropathien in Deutschland. Die Weiterentwicklung spezifischer Empfehlungen zur Therapie und Nachverfolgung von CIDP-Patienten ist notwendig, um einen einheitlichen Standard der Patientenversorgung zu gewährleisten. Dieses wird durch die strukturierte Zusammenarbeit von Exzellenzzentren wie dem deutschen Neuritis Netz erheblich unterstützt.
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Affiliation(s)
- Anna Lena Fisse
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland.
| | - Jeremias Motte
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Thomas Grüter
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Felix Kohle
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät, Universitätsklinikum Köln, Köln, Deutschland
| | - Cornelius Kronlage
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Jan-Hendrik Stahl
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Natalie Winter
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
| | - Tabea Seeliger
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Stefan Gingele
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Frauke Stascheit
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Benjamin Hotter
- Klinik für Neurologie mit Experimenteller Neurologie, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | - Juliane Klehmet
- Klinik für Neurologie, Jüdisches Krankenhaus, Berlin, Deutschland
| | - Karsten Kummer
- Klinik für Neurologie, Neuromuskuläres Zentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Elena K Enax-Krumova
- Neurologische Universitätsklinik und Poliklinik, BG Universitätsklinikum Bergmannsheil gGmbH Bochum, Ruhr-Universität Bochum, Bochum, Deutschland
| | - Dietrich Sturm
- Klinik für Neurologie, Agaplesion Bethesda Krankenhaus Wuppertal, Wuppertal, Deutschland
| | - Thomas Skripuletz
- Klinik für Neurologie mit Klinischer Neurophysiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Jens Schmidt
- Klinik für Neurologie, Neuromuskuläres Zentrum, Universitätsmedizin Göttingen, Göttingen, Deutschland
- Abteilung Neurologie und Schmerztherapie, Immanuel Klinik Rüdersdorf, Universitätsklinikum der Medizinischen Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf bei Berlin, Deutschland
| | - Min-Suk Yoon
- Klinik für Neurologie, Evangelisches Krankenhaus Hattingen, Hattingen, Deutschland
| | - Kalliopi Pitarokoili
- Klinik für Neurologie des St. Josef-Hospitals, Katholisches Klinikum Bochum, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Medizinische Fakultät, Universitätsklinikum Köln, Köln, Deutschland
| | - Alexander Grimm
- Klinik für Neurologie mit Schwerpunkt Epileptologie, Hertie-Institut für klinische Hirnforschung, Eberhard-Karls-Universität Tübingen, Tübingen, Deutschland
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23
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Mork H, Motte J, Fisse AL, Grüter T, Brünger J, Stykova Z, Bulut Y, Athanasopoulos D, Sturm D, Tegenthoff M, Gold R, Enax-Krumova E, Pitarokoili K. Prevalence and determinants of pain in chronic inflammatory demyelinating polyneuropathy: results from the German INHIBIT registry. Eur J Neurol 2022; 29:2109-2120. [PMID: 35357725 DOI: 10.1111/ene.15341] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/04/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pain, fatigue and depression in chronic inflammatory demyelinating polyneuropathy (CIDP) are often underestimated, as the focus lies on sensorimotor dysfunction and gait instability. The aim of this study was to investigate their prevalence, characteristics and contribution to disability in a prospective cohort of 84 patients with CIDP. METHODS Pain, fatigue, depression and quality of life were measured using Pain Detect Questionnaire, Krupp's Fatigue Severity Scale, Beck Depression Inventory-II and German Short-Form-36 Health Survey. Sensorimotor deficits and disability were assessed using the Inflammatory Neuropathy Cause and Treatment overall disability score, the Rasch-built Overall Disability Scale, the Medical Research Council Sum Score and the INCAT-sensory sum-score. The interrelation between the five factors was assessed using analysis of variance and linear regression analysis. RESULTS Pain was reported in 62%, mostly of moderate and severe intensity, whereas pain characteristics indicated of neuropathic pain (NP) in 29%. Sensory dysfunction was stronger in NP-patients compared to pain-free patients (p=0.001). Pain of any type, especially NP, was associated with more pronounced fatigue symptoms (p=0.010). Depressive symptoms were more frequent in patients with pain compared to the pain-free patients (61% vs. 33%, p=0.02) and were more severe and frequent in NP-patients than in non-NP (p=0.005). Patients with pain had a worse physical quality of life than pain-free patients (p=0.001). CONCLUSION Pain, depression and fatigue are relevant disability factors in CIDP affecting quality of life. Sensory dysfunction is associated with NP. Therefore, evaluation of CIDP-related disability should include pain and sensory function for adequate monitoring of therapeutic interventions.
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Affiliation(s)
- Hannah Mork
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Zornitsa Stykova
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Yesim Bulut
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Diamantis Athanasopoulos
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Sturm
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Martin Tegenthoff
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Elena Enax-Krumova
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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24
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Brünger J, Motte J, Grüter T, Mork H, Bulut Y, Carolus A, Athanasopoulos D, Yoon MS, Gold R, Pitarokoili K, Fisse AL. Nerve Ultrasound Distinguishes Non-Inflammatory Axonal Polyneuropathy From Inflammatory Polyneuropathy With Secondary Axonal Damage. Front Neurol 2022; 12:809359. [PMID: 35153986 PMCID: PMC8831897 DOI: 10.3389/fneur.2021.809359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/24/2021] [Indexed: 12/23/2022] Open
Abstract
Introduction Chronic inflammatory demyelinating polyneuropathy (CIDP) may have a similar clinical and electrophysiological presentation to non-inflammatory axonal polyneuropathies (NIAPs) when secondary axonal damage occurs. We aimed to investigate if nerve ultrasound can help to differentiate CIDP with additional secondary axonal damage from NIAP. Methods In a retrospective analysis, the cross-sectional area (CSA) of the peripheral nerves measured by ultrasound at six suitable nerve sites was compared in 95 patients with CIDP and 82 patients with NIAP. We developed the adjusted Bochum ultrasound score (aBUS) ranging from 0 to 6 resulting from the number of sites with enlarged CSA (median, ulnar, radial, and sural nerve). Results The mean CSA of patients with CIDP was enlarged at all six nerve sites compared with the mean CSA of patients with NIAP. A total of 21 patients with CIDP did not meet 2010 electrophysiological diagnostic criteria (European Academy of Neurology/Peripheral Nerve Society Guideline, EFNS/PNS criteria) for CIDP at examination timepoint but only in further follow-up, while 25 patients with NIAP fulfilled electrophysiological EFNS/PNS criteria for CIDP as “possible” or “probable” CIDP. To increase diagnostic power, we included aBUS measured by ultrasound in patients classified as “possible” or “probable” resulting in an improved specificity of 94% and a sensitivity of 59%, compared to a specificity of the EFNS/PNS criteria alone of 60% and sensitivity of 78%. Conclusion Using nerve ultrasound and the aBUS as a complementary method to distinguish CIDP from NIAP in case of secondary axonal damage can facilitate the diagnosis of CIDP.
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Affiliation(s)
- Jil Brünger
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
- *Correspondence: Jil Brünger
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Hannah Mork
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Yesim Bulut
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Anne Carolus
- Clinic for Neurosurgery, University Medical Center Knappschaftskrankenhaus Bochum, Bochum, Germany
| | - Diamantis Athanasopoulos
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
- Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University Bochum, Bochum, Germany
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25
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Klimas R, Sgodzai M, Motte J, Mohamad N, Renk P, Blusch A, Grüter T, Pedreiturria X, Gobrecht P, Fischer D, Schneider-Gold C, Reinacher-Schick A, Tannapfel A, Yoon MS, Gold R, Pitarokoili K. Dose-dependent immunomodulatory effects of bortezomib in experimental autoimmune neuritis. Brain Commun 2021; 3:fcab238. [PMID: 34708206 PMCID: PMC8545613 DOI: 10.1093/braincomms/fcab238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/02/2021] [Accepted: 06/09/2021] [Indexed: 11/13/2022] Open
Abstract
Proteasome inhibition with bortezomib has been reported to exert an immunomodulatory action in chronic autoimmune neuropathies. However, bortezomib used for the treatment of multiple myeloma induces a painful toxic polyneuropathy at a higher concentration. Therefore, we addressed this controversial effect and evaluated the neurotoxic and immunomodulatory mode of action of bortezomib in experimental autoimmune neuritis. Bortezomib-induced neuropathy was investigated in Lewis rats using the von Frey hair test, electrophysiological, qPCR and histological analyses of the sciatic nerve as well as dorsal root ganglia outgrowth studies. The immunomodulatory potential of bortezomib was characterized in Lewis rats after experimental autoimmune neuritis induction with P253-78 peptide. Clinical, electrophysiological, histological evaluation, von Frey hair test, flow cytometric and mRNA analyses were used to unravel the underlying mechanisms. We defined the toxic concentration of 0.2 mg/kg bortezomib applied intraperitoneally at Days 0, 4, 8 and 12. This dosage induces a painful toxic neuropathy but preserves axonal regeneration in vitro. Bortezomib at a concentration of 0.05 mg/kg significantly ameliorated experimental autoimmune neuritis symptoms, improved experimental autoimmune neuritis-induced hyperalgesia and nerve conduction studies, and reduced immune cell infiltration. Furthermore, proteasome inhibition induced a transcriptional downregulation of Nfkb in the sciatic nerve, while its inhibitor Ikba (also known as Nfkbia) was upregulated. Histological analyses of bone marrow tissue revealed a compensatory increase of CD138+ plasma cells. Our data suggest that low dose bortezomib (0.05 mg/kg intraperitoneally) has an immunomodulatory effect in the context of experimental autoimmune neuritis through proteasome inhibition and downregulation of nuclear factor 'kappa-light-chain-enhancer' of activated B-cells (NFKB). Higher bortezomib concentrations (0.2 mg/kg intraperitoneally) induce sensory neuropathy; however, the regeneration potential remains unaffected. Our data empathizes that bortezomib may serve as an attractive treatment option for inflammatory neuropathies in lower concentrations.
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Affiliation(s)
- Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Nuwin Mohamad
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Pia Renk
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Alina Blusch
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Xiomara Pedreiturria
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Philipp Gobrecht
- Department of Cell Physiology, Faculty of Biology and Biotechnology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Dietmar Fischer
- Department of Cell Physiology, Faculty of Biology and Biotechnology, Ruhr-University Bochum, 44801 Bochum, Germany
| | | | - Anke Reinacher-Schick
- Department of Oncology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Andrea Tannapfel
- Institute of Pathology, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Evangelisches Krankenhaus Hattingen, 45525 Hattingen, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, 44791 Bochum, Germany
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26
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Grüter T, Motte J, Bulut Y, Kordes A, Athanasopoulos D, Fels M, Schneider-Gold C, Gold R, Fisse AL, Pitarokoili K. Axonal damage determines clinical disability in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP): A prospective cohort study of different CIDP subtypes and disease stages. Eur J Neurol 2021; 29:583-592. [PMID: 34687104 DOI: 10.1111/ene.15156] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 07/28/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Monitoring of patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is challenging in daily medical practice because the interrelationship between clinical disability, CIDP subtype, and neuronal degeneration is still elusive. The aim of this prospective cohort study was to investigate the role of different electrophysiological variables in CIDP monitoring. METHODS Comprehensive bilateral nerve conduction studies (NCS) and structured clinical examinations were performed in 95 patients with typical CIDP and CIDP variants (age at inclusion 58.6 ± 11.6 years; median [range] inflammatory neuropathy cause and treatment overall disability score (INCAT-ODSS) 3 [0-9]), at time of first diagnosis in 25 of these patients (based on data from the prospective Immune-mediated Neuropathies Biobank registry). After 12 months, 33 patients underwent follow-up examination. Typical CIDP patients and patients with CIDP variants were characterized electrophysiologically and each individual NCS variable and the overall sum score for axonal damage and demyelination were then correlated to clinical disability scores (INCAT-ODSS, modified Medical Research Council (MRS) sum score, and INCAT sensory score). RESULTS As opposed to demyelination markers, the NCS axonal damage variable correlated strongly with disability at both first diagnosis and advanced disease stages in cross-sectional and longitudinal analyses. Distal compound muscle action potential amplitudes of the upper limbs were found to have the strongest correlation with overall clinical function. Typical and atypical CIDP variants had distinct electrophysiological characteristics but, in typical CIDP, axonal degeneration markers were more strongly associated with clinical disability. CONCLUSIONS Total disability is largely determined by the degree of axonal damage, especially in typical CIDP. Although most patients have symptoms predominantly in the legs, NCS of the upper limbs are essential for the monitoring of patients with CIDP and CIDP variants.
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Affiliation(s)
- Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Yesim Bulut
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Kordes
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Diamantis Athanasopoulos
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Miriam Fels
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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27
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Fels M, Fisse AL, Schwake C, Motte J, Athanasopoulos D, Grüter T, Spenner M, Breuer T, Starz K, Heinrich D, Grond M, Keyvani K, Appeltshauser L, Doppler K, Sommer C, Ayzenberg I, Schneider-Gold C, Gold R, Pitarokoili K, Labedi A. Report of a fulminant anti-pan-neurofascin-associated neuropathy responsive to rituximab and bortezomib. J Peripher Nerv Syst 2021; 26:475-480. [PMID: 34486194 DOI: 10.1111/jns.12465] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 01/23/2023]
Abstract
Inflammatory neuropathies with pathogenic involvement of the nodes of Ranvier through autoantibodies have been increasingly characterized in the past years. The so-called anti-pan-NF-associated neuropathies caused by the simultaneous existence of anti-Neurofascin-186/-140 and -155-antibodies are extremely rare and cause life-threatening symptoms. Therapeutic strategies are needed as symptoms may be life-threatening and may not respond to standard first-line CIDP treatment. We report a case of a 52-year-old male with a rare anti-pan-neurofascin (NF) (-155, -186/-140)-associated neuropathy. The initial presentation was subacute with mild paresthesia leading to a fulminant "locked-in"-like syndrome requiring mechanical ventilation within the first eight weeks despite treatment with intravenous immunoglobulins. Nerve conduction studies revealed non-excitable nerves with acute spontaneous activity in electromyography. High titers of anti-Neurofascin-155, -186/-140-antibodies were detected in serum and cerebrospinal fluid. A combination of aggressive immunotherapy consisting of intravenous immunoglobulins, plasma exchange, rituximab and bortezomib resulted in clinical improvement with ambulation and non-detectable anti-neurofascin-antibodies within the following 3 months. The follow-up nerve conduction studies showed normalized amplitudes of the peripheral nerves with signs of reinnervation in electromyography. We conclude that an early aggressive immunotherapy consisting of a combination of rituximab and bortezomib could be considered as a therapeutic option for anti-pan-NF-associated neuropathies.
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Affiliation(s)
- Miriam Fels
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Carolin Schwake
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Diamantis Athanasopoulos
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Marie Spenner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Breuer
- Department of Internal Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Katharina Starz
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - David Heinrich
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Martin Grond
- Department of Neurology, Kreisklinikum Siegen, Siegen, Germany
| | - Kathy Keyvani
- Institute of Neuropathology, University of Duisburg-Essen, Essen, Germany
| | | | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Claudia Sommer
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Christiane Schneider-Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Adnan Labedi
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Bulut Y, Grüter T, Kordes A, Athanasopoulos D, Motte J, Fisse A, Otto S, Schneider-Gold C, Yoon M, Gold R, Pitarokoili K. FV 10. Nerve conduction studies in CIDP at first diagnosis and during disease course: a cross-sectional study in a large cohort of patients. Clin Neurophysiol 2021. [DOI: 10.1016/j.clinph.2021.02.386] [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]
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Athanasopoulos D, Motte J, Grüter T, Köse N, Yoon MS, Otto S, Schneider-Gold C, Gold R, Fisse AL, Pitarokoili K. Evaluation of the EFNS/PNS diagnostic criteria in a cohort of CIDP patients. Ann Clin Transl Neurol 2021; 8:1110-1121. [PMID: 33826247 PMCID: PMC8108415 DOI: 10.1002/acn3.51357] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/08/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022] Open
Abstract
Objective To evaluate the European Federation of Neurological Societies (EFNS)/Peripheral Nerve Society (PNS) diagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP) in a cohort of patients diagnosed and treated for CIDP in a tertiary university hospital. Methods In a monocentric retrospective study of 203 CIDP patients, diagnosed according to expert opinion, we evaluated the EFNS/PNS diagnostic criteria. Clinical course and nerve conduction studies (NCS) over 1 year from first referral were studied. Secondarily, we compared the clinical and paraclinical characteristics, including nerve ultrasound, of patients who failed with those who fulfilled the criteria in order to identify clinically relevant differences. Results At 1 year, 182 (89.7%) patients fulfilled the criteria (156/76.9% definite, 22/10.8% probable, and 4/2% possible). Twenty‐one (10.3%) patients did not because the electrodiagnostic criteria remained negative. These still showed signs of demyelination but did not reach the cut‐off values. They also presented typical, albeit less pronounced, multifocal nerve enlargement in ultrasonography. Mean disability at presentation and 1 year after was significantly lower. Most importantly, a relevant proportion of these patients also responded to therapy (6/21 = 28.6% vs. 82/182 = 45.3% of those fulfilling the criteria). Interpretation CIDP diagnosis could be established for 89.7% of patients over the course of 1 year using EFNS/PNS criteria. The remaining patients (10.3%) presented with milder disability, less accentuated demyelination, but otherwise similar characteristics and still considerable probability of treatment response. Failure to fulfill diagnostic criteria should not automatically preclude treatment. Nerve ultrasound should be considered as a complementary diagnostic tool to detect signs of inflammation in CIDP.
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Affiliation(s)
- Diamantis Athanasopoulos
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Nuray Köse
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Evangelic Hospital Hattingen, Hattingen, Germany
| | - Susanne Otto
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna L Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Motte J, Fisse AL, Köse N, Grüter T, Mork H, Athanasopoulos D, Fels M, Otto S, Siglienti I, Schneider-Gold C, Hellwig K, Yoon MS, Gold R, Pitarokoili K. Treatment response to cyclophosphamide, rituximab, and bortezomib in chronic immune-mediated sensorimotor neuropathies: a retrospective cohort study. Ther Adv Neurol Disord 2021; 14:1756286421999631. [PMID: 33747132 PMCID: PMC7940507 DOI: 10.1177/1756286421999631] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/10/2021] [Indexed: 12/13/2022] Open
Abstract
Background: Up to 20% of patients with chronic immune-mediated sensorimotor neuropathies (CIN) do not respond adequately to first-line therapies. However, studies on further treatment are scarce. Methods: We analyzed retrospectively 200 CIN patients regarding disease characteristics and response to therapy with cyclophosphamide (CYP), rituximab (RTX), and bortezomib (BTZ). Treatment response was defined as improvement or stabilization of inflammatory neuropathy cause and treatment overall disability score (INCAT-ODSS). Results: A total of 48 of 181 patients (26.5%) received therapy with CYP, RTX, or BTZ. The most frequently and first used therapy was CYP (69%). More than 40% of patients needed a second or third treatment. Overall, 71 treatments were applied in 48 patients. The combination of up to all three treatments enhanced the response-rate to 90%. Treatment within 24 months after initial diagnosis resulted in significantly higher response rate than late treatment (79% versus 50 %, p = 0.04, χ2-test, n = 46) and in lower disability in long-term follow up (INCAT-ODSS 3.8 versus 5.8, p = 0.02, t-test, n = 48). Patients with Lewis-Sumner syndrome (n = 9) and autoantibody mediated neuropathies (n = 13) had excellent response rates after treatment with RTX (90–100%). In contrast, typical chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) showed a response rate of 64% in CYP, 64% in RTX, and 75% in BTZ. Conclusion: Treatment with CYP, RTX, or BTZ was effective in this cohort of CIN refractory to first-line treatment. Our data increase evidence for an early use of these therapies. High efficacy of RTX in Lewis-Sumner syndrome in contrast to typical CIDP suggests a distinct pathophysiology.
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Affiliation(s)
- Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, Bochum, 44791, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nuray Köse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Hannah Mork
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Miriam Fels
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Susanne Otto
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ines Siglienti
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | | | - Kerstin Hellwig
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
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Fisse AL, Fiegert S, Stoykova Z, Brünger J, Athanasopoulos D, Grüter T, Motte J, Gold R, Pitarokoili K. Increased muscle echointensity correlates with clinical disability and muscle strength in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2021; 28:1698-1705. [PMID: 33404183 DOI: 10.1111/ene.14716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 10/13/2020] [Revised: 12/04/2020] [Accepted: 01/01/2021] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE We evaluated muscle echointensity as a marker for secondary axonal damage in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) using ultrasonography. Findings were correlated with clinical disability and muscular strength. METHODS Eighty patients with CIDP (40 with typical and 40 with atypical CIDP) were examined clinically, including assessment of Medical Research Council (MRC) sum score and Inflammatory Neuropathy Cause and Treatment Overall Disability Sum Score (INCAT-ODSS). Echointensity in eight proximal and distal muscles of the arms and legs was evaluated by muscle ultrasonography using the Heckmatt scale. RESULTS Alterations of echointensity occurred most frequently in the distal leg muscles, with a median (range) Heckmatt score of 1.5 (1-4). There were no differences between typical and atypical CIDP patients with regard to Heckmatt score. Alterations of echointensity correlated to disability and muscle strength. The arm score of the INCAT-ODSS correlated to Heckmatt score for the distal arm muscles (r = 0.23, p = 0.046) and the leg score of the INCAT-ODSS correlated to Heckmatt scores for the proximal (r = 0.34, p = 0.002) and distal leg muscles (r = 0.33, p = 0.004). MRC sum score, as well as individual MRC scores for arm and leg muscles, correlated to Heckmatt scores of the corresponding muscle groups (r = -0.25, p = 0.02 for MRC sum score). CONCLUSION Increased muscle echointensity, reflecting fibrosis and fatty infiltration due to secondary axonal damage, correlated to muscular strength and disability in a large cohort of CIDP patients. Alterations of echointensity occur in both typical and atypical CIDP patients and are pronounced in the distal leg muscles.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Sean Fiegert
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Zornitsa Stoykova
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Diamantis Athanasopoulos
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Ladopoulos T, Zand R, Shahjouei S, Chang JJ, Motte J, Charles James J, Katsanos AH, Kerro A, Farahmand G, Vaghefi Far A, Rahimian N, Ebrahimzadeh SA, Abedi V, Papathanasiou M, Labedi A, Schneider R, Lukas C, Tsiodras S, Tsivgoulis G, Krogias C. COVID-19: Neuroimaging Features of a Pandemic. J Neuroimaging 2021; 31:228-243. [PMID: 33421032 PMCID: PMC8014046 DOI: 10.1111/jon.12819] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is occasionally associated with manifold diseases of the central nervous system (CNS). We sought to present the neuroimaging features of such CNS involvement. In addition, we sought to identify typical neuroimaging patterns that could indicate possible COVID-19-associated neurological manifestations. METHODS In this systematic literature review, typical neuroimaging features of cerebrovascular diseases and inflammatory processes associated with COVID-19 were analyzed. Reports presenting individual patient data were included in further quantitative analysis with descriptive statistics. RESULTS We identified 115 studies reporting a total of 954 COVID-19 patients with associated neurological manifestations and neuroimaging alterations. A total of 95 (82.6%) of the identified studies were single case reports or case series, whereas 660 (69.2%) of the reported cases included individual information and were thus included in descriptive statistical analysis. Ischemia with neuroimaging patterns of large vessel occlusion event was revealed in 59.9% of ischemic stroke patients, whereas 69.2% of patients with intracerebral hemorrhage exhibited bleeding in a location that was not associated with hypertension. Callosal and/or juxtacortical location was identified in 58.7% of cerebral microbleed positive images. Features of hemorrhagic necrotizing encephalitis were detected in 28.8% of patients with meningo-/encephalitis. CONCLUSIONS Manifold CNS involvement is increasingly reported in COVID-19 patients. Typical and atypical neuroimaging features have been observed in some disease entities, so that familiarity with these imaging patterns appears reasonable and may assist clinicians in the differential diagnosis of COVID-19 CNS manifestations.
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Affiliation(s)
- Theodoros Ladopoulos
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ramin Zand
- Department of Neurology, Geisinger Medical Center, Danville, PA
| | - Shima Shahjouei
- Department of Neurology, Geisinger Medical Center, Danville, PA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC.,Department of Neurology, Georgetown University Medical Center, Washington, DC
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | | | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ali Kerro
- SCL Health Neuroscience Department, Billings, MT
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alaleh Vaghefi Far
- Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA
| | - Matilda Papathanasiou
- Second Department of Radiology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Adnan Labedi
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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Fisse AL, Motte J, Grüter T, Sgodzai M, Pitarokoili K, Gold R. Comprehensive approaches for diagnosis, monitoring and treatment of chronic inflammatory demyelinating polyneuropathy. Neurol Res Pract 2020; 2:42. [PMID: 33324942 PMCID: PMC7722337 DOI: 10.1186/s42466-020-00088-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 09/04/2020] [Indexed: 02/08/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common chronic inflammatory neuropathy. CIDP is diagnosed according to the European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) criteria, which combine clinical features with the electrophysiological evidence of demyelination. However, firstly, diagnosis is challenging, as some patients e.g. with severe early axonal damage do not fulfil the criteria. Secondly, objective and reliable tools to monitor the disease course are lacking. Thirdly, about 25% of CIDP patients do not respond to evidence-based first-line therapy. Recognition of these patients is difficult and treatment beyond first-line therapy is based on observational studies and case series only. Individualized immunomodulatory treatment does not exist due to the lack of understanding of essential aspects of the underlying pathophysiology. Novel diagnostic imaging techniques and molecular approaches can help to solve these problems but do not find enough implementation. This review gives a comprehensive overview of novel diagnostic techniques and monitoring approaches for CIDP and how these can lead to individualized treatment and better understanding of pathophysiology.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791 Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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Fisse AL, May C, Motte J, Pedreiturria X, Breuer TGK, Schneider-Gold C, Marcus K, Gold R, Yoon MS, Pitarokoili K. New Approaches to Critical Illness Polyneuromyopathy: High-Resolution Neuromuscular Ultrasound Characteristics and Cytokine Profiling. Neurocrit Care 2020; 35:139-152. [PMID: 33236290 PMCID: PMC7685687 DOI: 10.1007/s12028-020-01148-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/30/2020] [Indexed: 11/23/2022]
Abstract
Background Diagnosis of intensive care unit acquired weakness (ICUAW) is challenging. Pathogenesis of underlying critical illness polyneuromyopathy (CIPNM) remains incompletely understood. This exploratory study investigated whether longitudinal neuromuscular ultrasound examinations and cytokine analyses in correlation to classical clinical and electrophysiological assessment contribute to the understanding of CIPNM.
Methods Intensive care unit patients were examined every 7 days until discharge from hospital. Clinical status, nerve conduction studies, electromyography as well as ultrasound of peripheral nerves and tibial anterior muscle were performed. Cytokine levels were analyzed by a bead-based multiplex assay system.
Results Of 248 screened patients, 35 patients were included at median of 6 days (IQR: 8) after admission to intensive care unit. Axonal damage was the main feature of CIPNM. At the peak of CIPNM (7 days after inclusion), nerve ultrasound showed cross-sectional area increase of tibial nerve as a sign of inflammatory edema as well as hypoechoic nerves as a possible sign of inflammation. Cytokine analyses showed signs of monocyte and macrophage activation at this stage. Fourteen days after inclusion, cytokines indicated systemic immune response as well as profiles associated to neovascularization and regeneration. Conclusions Exploratory neuromuscular ultrasound and cytokine analyses showed signs of inflammation like macrophage and monocyte activation at the peak of CIPNM followed by a systemic immune response parallel to axonal damage. This underlines the role of both axonal damage and inflammation in pathogenesis of CIPNM. Electronic supplementary material The online version of this article (10.1007/s12028-020-01148-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Caroline May
- Medizinisches Proteom-Center, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Xiomara Pedreiturria
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Thomas G K Breuer
- Department of Internal Medicine I, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Christiane Schneider-Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Katrin Marcus
- Medizinisches Proteom-Center, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
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Kühn E, Averdunk P, Huckemann S, Müller K, Biesalski AS, Hof Zum Berge F, Motte J, Fisse AL, Schneider-Gold C, Gold R, Pitarokoili K, Tönges L. Correlates of polyneuropathy in Parkinson's disease. Ann Clin Transl Neurol 2020; 7:1898-1907. [PMID: 32940017 PMCID: PMC7545593 DOI: 10.1002/acn3.51182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Previous studies in Parkinson’s disease (PD) patients have demonstrated a high prevalence of polyneuropathy (PNP) and pronounced alpha‐Synuclein pathology in dermal nerve fibers already at early disease stages. The aim of this study was to analyze associations between the prevalence and severity of PNP with nonmotor and motor symptoms in PD patients. Methods Fifty PD patients were characterized comprehensively for the presence of clinical symptoms (nonmotor and motor), electrophysiologic alterations and – for the first time – using high‐resolution ultrasound of peripheral nerves. Results Sixty‐two percent of PD patients showed electrophysiological pathology of PNP. The prevalence of patient‐reported PNP symptoms was 86% and was particularly present in patients with longer disease duration, compromised scores of nonmotor and motor symptoms as well as with a negative evaluation of quality of life. Seventy‐five percent of patients showed morphologic alterations similar to axonal PNP in high‐resolution ultrasound compared to healthy controls. Interpretation The study demonstrates the high burden of peripheral nervous system disease in Parkinson's disease. It advocates further studies to delineate the underlying pathophysiological mechanisms in order to optimize treatment approaches for PD, including the associated PNP.
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Affiliation(s)
- Eva Kühn
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Paulina Averdunk
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Katharina Müller
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | | | | | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
| | | | - Lars Tönges
- Department of Neurology, St. Josef-Hospital, Ruhr-University, Bochum, Germany.,Neurodegeneration Research, Centre for Protein Diagnostics (ProDi), Ruhr-University, Bochum, Germany
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36
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Grüter T, Motte J, Fisse AL, Bulut Y, Köse N, Athanasopoulos D, Otto S, Yoon MS, Schneider-Gold C, Gold R, Pitarokoili K. Pathological spontaneous activity as a prognostic marker in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2020; 27:2595-2603. [PMID: 32794258 DOI: 10.1111/ene.14476] [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: 07/12/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND PURPOSE Monitoring of the disease course of patients with chronic inflammatory demyelinating polyneuropathy (CIDP) remains challenging because nerve conduction studies do not adequately correlate with functional disability. The prognostic value of pathological spontaneous activity (PSA) in needle electromyography (EMG) in different CIDP subgroups in a longitudinal context has, to date, not been analysed. We aimed to determine whether PSA was a prognostic marker or a marker of disease activity in a cohort of patients with CIDP. METHODS A total of 127 patients with CIDP spectrum disorder were retrospectively analysed over 57 ± 47 months regarding the occurrence of PSA (fibrillations and positive sharp waves). The presence of PSA at diagnosis, newly occurring PSA, and continuously present PSA were longitudinally correlated with clinical disability using the Inflammatory Neuropathy Cause and Treatment Overall Disability Sum Score (INCAT-ODSS) and CIDP subtype. RESULTS Pathological spontaneous activity occurred in 49.6% of all CIDP patients at first diagnosis. More frequent evidence of PSA was significantly associated with a higher INCAT-ODSS at the last follow-up. Continuous and new occurrence of PSA were associated with higher degree of disability at the last follow-up. The majority of patients with sustained evidence of PSA were characterized by an atypical phenotype, higher degree of disability, and the need for escalation of treatment. CONCLUSIONS Pathological spontaneous activity was associated with a higher degree of disability and occurred more frequently in atypical CIDP variants according to the longitudinal data of a large cohort of patients with CIDP. Our results showed that EMG examination was an adequate marker for disease progression and should be evaluated during the disease course.
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Affiliation(s)
- T Grüter
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - J Motte
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - A L Fisse
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - Y Bulut
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - N Köse
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - D Athanasopoulos
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - S Otto
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - M-S Yoon
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany.,Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - C Schneider-Gold
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - R Gold
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
| | - K Pitarokoili
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Immunmediated Neuropathies Biobank (INHIBIT), Ruhr University, Bochum, Germany
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Gamber D, Motte J, Kerasnoudis A, Yoon MS, Gold R, Pitarokoili K, Fisse AL. High-Resolution Nerve Ultrasound to Assess Nerve Echogenicity, Fascicular Count, and Cross-Sectional Area Using Semiautomated Analysis. J Neuroimaging 2020; 30:493-502. [PMID: 32521091 DOI: 10.1111/jon.12717] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND AND PURPOSE Little is known about echogenicity and fascicular structure observed in high-resolution nerve ultrasound (HRUS) in both healthy subjects and patients with peripheral nerve disease. The aim of this study was to evaluate the reliability of echogenicity, fascicle count, and fascicle size analysis, to create standard values and compare these parameters to patients with chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS Median, ulnar, radial, tibial, and fibular nerve of 79 healthy subjects and patients were scanned by one examiner using HRUS. Image analysis regarding echogenicity, fascicle count, and fascicle cross-sectional area (CSA) was performed by two independent raters semiautomatically using ImageJ. Pearson correlation coefficient r reflected interrater reliability (IR), and intraclass correlation coefficient (ICC) determined intrarater reliability (IAR). Results of healthy subjects were compared to 20 patients with CIDP by analysis of variance. RESULTS IR was very good for echogenicity (r = .9) and good for fascicle count and size of the largest fascicle (r = .64/.56). IAR was very good for all three parameters (ICC = .9/.83/.74). Healthy subjects had a wide range of values. CIDP patients were in range of healthy subjects. Clinically progressive CIDP patients (defined as an increase in Overall Disability Sum Score by ≥1 point) had a lower fraction of black than healthy controls and stable CIDP patients (P < .001). CONCLUSION Semiautomated evaluation of echogenicity, fascicle count, and fascicle CSA is reliable. Cutoff values to differentiate between healthy persons and CIDP do not exist. Echogenicity is useful for detecting clinically progressive CIDP patients and should be used in clinical context or intraindividual course.
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Affiliation(s)
- Donata Gamber
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Antonios Kerasnoudis
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Evangelisches Krankenhaus Hattingen, Hattingen, Germany
| | - Ralf Gold
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany
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Athanasopoulos D, Motte J, Fisse AL, Grueter T, Trampe N, Sturm D, Tegenthoff M, Sgodzai M, Klimas R, Querol L, Gold R, Pitarokoili K. Longitudinal study on nerve ultrasound and corneal confocal microscopy in NF155 paranodopathy. Ann Clin Transl Neurol 2020; 7:1061-1068. [PMID: 32432402 PMCID: PMC7318093 DOI: 10.1002/acn3.51061] [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: 03/18/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
We report the case of a 27‐year‐old patient with subacute anti‐neurofascin‐155 neuropathy with bifacial palsy, who showed excellent response to rituximab. We provide longitudinal data of established clinical scores, nerve conduction studies, antibody titers, and novel imaging methods (nerve ultrasonography and corneal confocal microscopy). Clinical and electrophysiological improvement followed the reduction of serum antibody titer and correlated with a reduction of corneal inflammatory cellular infiltrates whereas the increase in the cross‐sectional area of the peripheral nerves remained 12 months after first manifestation. Our findings suggest that novel techniques provide useful follow‐up parameters in paranodopathies.
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Affiliation(s)
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Thomas Grueter
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Nadine Trampe
- Department of Neurology, Katholische Kliniken Emscher-Lippe, Germany
| | - Dietrich Sturm
- Department of Neurology, Agaplesion Bethesda Hospital, Wuppertal, Germany.,Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Martin Tegenthoff
- Department of Neurology, Bergmannsheil University Hospital, Ruhr University, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
| | - Luis Querol
- Unidad de Enfermedades Neuromusculares, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University, Bochum, Germany
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Grüter T, Blusch A, Motte J, Sgodzai M, Bachir H, Klimas R, Ambrosius B, Gold R, Ellrichmann G, Pitarokoili K. Immunomodulatory and anti-oxidative effect of the direct TRPV1 receptor agonist capsaicin on Schwann cells. J Neuroinflammation 2020; 17:145. [PMID: 32375895 PMCID: PMC7201667 DOI: 10.1186/s12974-020-01821-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/17/2020] [Indexed: 12/19/2022] Open
Abstract
Background Only few studies describe the impact of nutritive factors on chronic inflammatory demyelinating polyneuropathy (CIDP), an inflammatory disease of the peripheral nervous system. The active component of chili pepper, capsaicin, is the direct agonist of the transient receptor potential channel vanilloid subfamily member 1. Its anti-inflammatory effect in the animal model experimental autoimmune neuritis (EAN) has been previously demonstrated. Methods In the present study, we describe the anti-inflammatory and anti-oxidative influence of capsaicin on Schwann cells (SCs) in an in vitro setting. Hereby, we analyze the effect of capsaicin on Schwann cells’ gene expression pattern, major histocompatibility complex class II (MHC-II) presentation, and H2O2-induced oxidative stress. Furthermore, the effect of capsaicin on myelination was examined in a SC-dorsal root ganglia (DRG) coculture by myelin basic protein staining. Finally, in order to investigate the isolated effect of capsaicin on SCs in EAN pathology, we transplant naïve and capsaicin pre-treated SCs intrathecally in EAN immunized rats and analyzed clinical presentation, electrophysiological parameters, and cytokine expression in the sciatic nerve. Results In SC monoculture, incubation with capsaicin significantly reduces interferon gamma-induced MHC-II production as well as toll-like receptor 4 and intercellular adhesion molecule 1 mRNA expression. Calcitonin gene-related peptide mRNA production is significantly upregulated after capsaicin treatment. Capsaicin reduces H2O2-induced oxidative stress in SC in a preventive, but not therapeutic setting. In a SC-DRG coculture, capsaicin does not affect myelination rate. After intrathecal transplantation of naïve and capsaicin pre-treated SCs in EAN-immunized rats, naïve, but not capsaicin pre-treated intrathecal SCs, ameliorated EAN pathology in rats. Conclusions In conclusion, we were able to demonstrate a direct immunomodulatory and anti-oxidative effect of capsaicin in a SC culture by reduced antigen presentation and expression of an anti-inflammatory profile. Furthermore, capsaicin increases the resistance of SCs against oxidative stress. A primary effect of capsaicin on myelination was not proven. These results are in concordance with previous data showing an anti-inflammatory effect of capsaicin, which might be highly relevant for CIDP patients.
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Affiliation(s)
- Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany.
| | - Alina Blusch
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Hussein Bachir
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Björn Ambrosius
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Gisa Ellrichmann
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Gudrundstr. 56, 44791, Bochum, Germany
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Brünger J, Fisse A, Motte J, Mork H, Athanasopoulos D, Kerasnoudis A, Yoon M, Gold R, Pitarokoili K. P37 High-resolution nerve ultrasound to distinguish chronic inflammatory demyelinating polyneuropathy from axonal polyneuropathies. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.043] [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: 10/24/2022]
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Grüter T, Fisse A, Motte J, Köse N, Bulut Y, Mork H, Brünger J, Athanasopoulos D, Sgodzai M, Otto S, Schneider-Gold C, Gold R, Pitarokoili K. FV6 Persistent pathological spontaneous activity in EMG is related to a worse outcome and atypical subtype in a cohort of CIDP patients. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.098] [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: 10/24/2022]
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Motte J, Fisse AL, Grüter T, Schneider R, Breuer T, Lücke T, Krueger S, Nguyen HP, Gold R, Ayzenberg I, Ellrichmann G. Novel variants in a patient with late-onset hyperprolinemia type II: diagnostic key for status epilepticus and lactic acidosis. BMC Neurol 2019; 19:345. [PMID: 31884946 PMCID: PMC6935479 DOI: 10.1186/s12883-019-1583-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/19/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hyperprolinemia type 2 (HPII) is a rare autosomal recessive disorder of the proline metabolism, that affects the ALDH4A1 gene. So far only four different pathogenic mutations are known. The manifestation is mostly in neonatal age, in early infancy or early childhood. CASE PRESENTATION The 64-years female patient had a long history of abdominal pain, and episode of an acute neuritis. Ten years later she was admitted into the neurological intensive-care-unit with acute abdominal pain, multiple generalized epileptic seizures, a vertical gaze palsy accompanied by extensive lactic acidosis in serum 26.0 mmol/l (reference: 0.55-2.2 mmol/l) and CSF 12.01 mmol/l (reference: 1.12-2.47 mmol/l). Due to repeated epileptic seizures and secondary complications a long-term sedation with a ventilation therapy over 20 days was administered. A diagnostic work-up revealed up to 400-times increased prolin-level in urine CSF and blood. Furthermore, a low vitamin-B6 serum value was found, consistent with a HPII causing secondary pyridoxine deficiency and seizures. The ALDH4A1 gene sequencing confirmed two previously unknown compound heterozygous variants (ALDH4A1 gene (NM_003748.3) Intron 1: c.62 + 1G > A - heterozygous and ALDH4A1 gene (NM_003748.3) Exon 5 c.349G > C, p.(Asp117His) - heterozygous). Under high-dose vitamin-B6 therapy no further seizures occurred. CONCLUSION We describe two novel ALDH4A1-variants in an adult patient with hyperprolinemia type II causing secondary pyridoxine deficiency and seizures. Severe and potentially life-threatening course of this treatable disease emphasizes the importance of diagnostic vigilance and thorough laboratory work-up including gene analysis even in cases with atypical late manifestation.
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Affiliation(s)
- Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Thomas Breuer
- Department of Internal Medicine, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Lücke
- University Children's Hospital, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Center for Rare Diseases Ruhr (CeSER), Ruhr-University Bochum, Bochum, Germany
| | | | - Huu Phuc Nguyen
- Center for Rare Diseases Ruhr (CeSER), Ruhr-University Bochum, Bochum, Germany.,Department of Human Genetics, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany.,Department of Neurology, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Gisa Ellrichmann
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Gudrunstrasse 56, 44791, Bochum, Germany
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Grüter T, Ott A, Meyer W, Jarius S, Kinner M, Motte J, Pitarokoili K, Gold R, Komorowski L, Ayzenberg I. Effects of IVIg treatment on autoantibody testing in neurological patients: marked reduction in sensitivity but reliable specificity. J Neurol 2019; 267:715-720. [PMID: 31728710 DOI: 10.1007/s00415-019-09614-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/10/2019] [Accepted: 10/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapy of autoimmune diseases of the central and peripheral nervous system with intravenous IgG immunoglobulin (IVIg) is well established. Since IVIg is produced from pooled human plasma, autoantibodies can be found in IVIg products and, accordingly, in patient sera after transfusion. The de novo evidence or disappearance of anti-neural autoantibodies after IVIg treatment has so far not been systematically examined. METHODS We screened 50 neurological patients before and after IVIg treatment for classical onconeural and the most common neurological surface autoantibodies as well as for ganglioside autoantibodies and 23 different antinuclear autoantibodies using immunoblot or cell-based indirect immunofluorescence assays. Furthermore, we screened 31 neurological patients with previously known seropositivity for disappearance of the corresponding antibody after treatment. RESULTS After IVIg treatment, 90% of all sera were de novo positive for antinuclear antibodies, especially for Ro-52. In contrast, 94% of all sera did not show any de novo-positive anti-neural antibodies. In the remaining three cases, titers were very low. Importantly, 12.9% of all tested sera of patients with known antibody positivity turned false negative after IVIg treatment and titers were falsely low in 37% of the remaining sera. CONCLUSIONS Here, we present for the first time results of a broad screening for clinically relevant autoantibodies before and after IVIg treatment in neurological patients. We identified a high specificity but reduced sensitivity for anti-neural antibody testing after IVIg transfusion. In contrast, antinuclear antibody testing is not reliable after IVIg treatment. These results are of high practical importance for diagnostic of neuroimmunological diseases.
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Affiliation(s)
- Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Anthonina Ott
- Institute for Experimental Immunology, Lübeck, Germany
| | | | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Kinner
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | | | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
- Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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Pitarokoili K, Bachir H, Sgodzai M, Grüter T, Haupeltshofer S, Duscha A, Pedreiturria X, Motte J, Gold R. Induction of Regulatory Properties in the Intestinal Immune System by Dimethyl Fumarate in Lewis Rat Experimental Autoimmune Neuritis. Front Immunol 2019; 10:2132. [PMID: 31552056 PMCID: PMC6746892 DOI: 10.3389/fimmu.2019.02132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 08/23/2019] [Indexed: 12/22/2022] Open
Abstract
Objective: Dimethyl fumarate (DMF) exerts immunomodulatory and neuroprotective effects in the animal model of experimental autoimmune neuritis (EAN) in the Lewis rat. DMF has been shown to modulate gut microbiota in veterinary medicine, however the effects of oral DMF on the gut-associated lymphoid tissue (GALT) remain unknown. Methods: Lewis rats were treated orally twice daily with DMF up to day 10 after immunization with immunogenic P2 peptide. Histological, flow cytometric and RT-PCR analyses of the GALT (intraepithelial layer, lamina propria, and Peyer patches) in duodenum, jejunum, and ileum were performed ex vivo. Moreover, cell transfer experiments were used to examine the protective effects of GALT regulatory T cells of the Peyer patches. Results: In the upper layers of duodenum, DMF induced a reduction of the toll-like receptor 4 (TLR4) mRNA expression. This was combined by a decrease of the pro-inflammatory lamina propria IFN-γ mRNA expression. In the ileum, we detected an immunoregulatory phenotype characterized by an increase of FoxP3 mRNA expression and of the nuclear factor (erythroid-derived-2)- like 2 (Nrf2) downstream molecule heme oxygenase-1 (HO-1) mRNA. Finally, CD4+ CD25+ regulatory T cells were increased in the Peyer patches. In vivo, the protective effect of these regulatory cells was verified by cell transfer into recipient EAN rats. Conclusions: Our results identified a novel immunomodulatory effect of DMF through the different regions and layers of the small intestine, which led to an increase of regulatory T cells, exerting a protective role in experimental neuritis.
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Affiliation(s)
- Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Hussein Bachir
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Steffen Haupeltshofer
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Alexander Duscha
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Xiomara Pedreiturria
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
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Motte J, Kneiphof J, Straßburger-Krogias K, Pitarokoili K, Fisse AL, Kappos L, Gold R. Hereditary defect of cobalamin metabolism with adolescence onset resembling multiple sclerosis: 41-year follow up in two cases. Ther Adv Neurol Disord 2019; 12:1756286419872115. [PMID: 31489032 PMCID: PMC6710698 DOI: 10.1177/1756286419872115] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022] Open
Abstract
The cblC defect is the most common inborn error of cobalamin (Cbl) metabolism. Clinical severity and presentation of the cblC defect ranges from death to mild disability. Only 71 cases of late-onset cblC defect have been described in the literature. We provide the 41-year follow up of two siblings with a late-onset cblC defect, first described after initial diagnosis in 1996. While one of the siblings showed initial symptoms resembling multiple sclerosis with a good response to corticosteroids, the other sister showed only subclinical signs of the disease. The course of the first case was characterized by a severe deterioration and intensive-care therapy after respiratory failure. After diagnoses and Cbl treatment, the patient survived and showed a pronounced improvement of the symptoms. Both sisters have an active life and gave birth to healthy children. The reason for the initial improvement after corticosteroids could not be explained by the classical metabolic pathways of Cbl. Recent studies have suggested that Cbl plays an important role as a regulator of the balance between neurotrophic and neurotoxic factors in the central and peripheral nervous system (CNS and PNS). This first long-term follow up revealed that ultra-high-dose intramuscular Hydroxocobalamin (OH-Cbl) treatment can effectively protect patients from disease progression. It underlines the importance of diagnostic vigilance and laboratory work up even in cases without typical hematologic signs of Cbl deficiency. Cbl-related diseases are often a chameleon and must always be considered in the differential of demyelinating diseases of the PNS and CNS. The case supports the theory that it is not only the classical biochemical pathways that play a key role in Cbl deficiency, especially with regard to neurological symptoms.
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Affiliation(s)
- Jeremias Motte
- Department of Neurology, Ruhr-University Bochum, St Josef- Hospital, Gudrunstrasse 56, Bochum 44791, Germany
| | - Janina Kneiphof
- Department of Neurology, Ruhr-University Bochum, Bochum, Germany
| | | | | | - Anna Lena Fisse
- Department of Neurology, Ruhr-University Bochum, Bochum, Germany
| | - Ludwig Kappos
- Neurologic Clinic and Policlinic, University Hospital Basel, Basel, Switzerland
| | - Ralf Gold
- Department of Neurology, Ruhr-University Bochum, Bochum, Germany
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46
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Motte J, Sturm D, Fisse A, Labedi A, Grüter T, Greiner T, Eitner L, Kumowski N, Enax-Krumova E, Maier C, Tegenthoff M, Gold R, Schmidt-Wilcke T, Yoon M, Pitarokoili K. FV 18 Corneal immune cell infiltration in corneal confocal microscopy confirm as biomarker for disease activity in autoimmune inflammatory neuropathies. Clin Neurophysiol 2019. [DOI: 10.1016/j.clinph.2019.04.628] [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: 10/26/2022]
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Pitarokoili K, Sgodzai M, Grüter T, Bachir H, Motte J, Ambrosius B, Pedreiturria X, Yoon MS, Gold R. Intrathecal triamcinolone acetonide exerts anti-inflammatory effects on Lewis rat experimental autoimmune neuritis and direct anti-oxidative effects on Schwann cells. J Neuroinflammation 2019; 16:58. [PMID: 30851725 PMCID: PMC6408772 DOI: 10.1186/s12974-019-1445-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/25/2019] [Indexed: 02/08/2023] Open
Abstract
Background Corticosteroids dominate in the treatment of chronic autoimmune neuropathies although long-term use is characterized by devastating side effects. Methods We introduce the intrathecal application of the synthetic steroid triamcinolone (TRIAM) as a novel therapeutic option in experimental autoimmune neuritis in Lewis rats Results After immunization with neuritogenic P2 peptide, we show a dose-dependent therapeutic effect of one intrathecal injection of 0.3 or 0.6 mg/kg TRIAM on clinical and electrophysiological parameters of neuritis with a lower degree of inflammatory infiltrates (T cells and macrophages) and demyelination in the sciatic nerve. In vitro studies in Schwann cell cultures showed an increased expression of IL-1 receptor antagonist and reduced expression of Toll-like receptor 4 after incubation with TRIAM as well as a protective effect of TRIAM against oxidative stress after H2O2 exposure. Conclusion Intrathecal TRIAM application could be a novel immunomodulatory and potentially neuroprotective option for autoimmune neuropathies with a direct effect on Schwann cells.
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Affiliation(s)
- Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
| | - Melissa Sgodzai
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Hussein Bachir
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Björn Ambrosius
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Xiomara Pedreiturria
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
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48
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Fisse AL, Pitarokoili K, Motte J, Gamber D, Kerasnoudis A, Gold R, Yoon MS. Nerve echogenicity and intranerve CSA variability in high-resolution nerve ultrasound (HRUS) in chronic inflammatory demyelinating polyneuropathy (CIDP). J Neurol 2018; 266:468-475. [PMID: 30554264 DOI: 10.1007/s00415-018-9158-3] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/09/2018] [Accepted: 12/12/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE HRUS is increasingly being used in the diagnosis and evaluation of autoimmune neuropathies such as CIDP. Recently, studies focused not only on changes of nerves size, but also the fascicular structure and the echogenicity changes in CIDP. However, little is known about the alterations of echogenicity in the long-term course in CIDP. The aim of this study was to evaluate echogenicity in CIDP patients in a long-term follow-up period and to analyze the benefit of the evaluation of echogenicity compared to nerve size. METHODS 20 patients fulfilling the definite diagnostic criteria of CIDP received clinical examination, nerve conduction studies and HRUS every 6 months over a median follow-up time of 34 months. Patients were divided into clinically stable/regressive disease course or progressive disease course according to the development of the inflammatory neuropathy cause and treatment overall disability sum score. Echogenicity of peripheral nerves was measured semi-automated and quantitative. Echogenicity was divided into three classes by fraction of black: hypoechogenic, mixed hypo-/hyperechogenic, hyperechogenic. RESULTS Patients with hyperechogenic arm nerves more frequently show clinical worsening, whereas patients with hypoechogenic arm nerves remain stable or even improved over time. In the long-term course of the disease, echogenicity mostly did not change, and if changes occured echogenicity did not correspond to ODSS changes. CONCLUSION Echogenicity of the arm nerves in CIDP may be used as a prognostic marker, but not as a follow-up tool for evaluating clinical changes. Further studies in a larger cohort are needed to confirm these results.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstrasse 56, 44791, Bochum, Germany.
| | - Kalliopi Pitarokoili
- Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Donata Gamber
- Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Antonios Kerasnoudis
- Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, Ruhr University Bochum, St. Josef-Hospital, Gudrunstrasse 56, 44791, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Evangelisches Krankenhaus Hattingen, Bredenscheider Str. 54, 45525, Hattingen, Germany
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49
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Johnen A, Bürkner PC, Landmeyer NC, Ambrosius B, Calabrese P, Motte J, Hessler N, Antony G, König IR, Klotz L, Hoshi MM, Aly L, Groppa S, Luessi F, Paul F, Tackenberg B, Bergh FT, Kümpfel T, Tumani H, Stangel M, Weber F, Bayas A, Wildemann B, Heesen C, Zettl UK, Zipp F, Hemmer B, Meuth SG, Gold R, Wiendl H, Salmen A. Can we predict cognitive decline after initial diagnosis of multiple sclerosis? Results from the German National early MS cohort (KKNMS). J Neurol 2018; 266:386-397. [PMID: 30515631 PMCID: PMC6373354 DOI: 10.1007/s00415-018-9142-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/14/2018] [Accepted: 11/26/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Cognitive impairment (CI) affects approximately one-third of the patients with early multiple sclerosis (MS) and clinically isolated syndrome (CIS). Little is known about factors predicting CI and progression after initial diagnosis. METHODS Neuropsychological screening data from baseline and 1-year follow-up of a prospective multicenter cohort study (NationMS) involving 1123 patients with newly diagnosed MS or CIS were analyzed. Employing linear multilevel models, we investigated whether demographic, clinical and conventional MRI markers at baseline were predictive for CI and longitudinal cognitive changes. RESULTS At baseline, 22% of patients had CI (impairment in ≥2 cognitive domains) with highest frequencies and severity in processing speed and executive functions. Demographics (fewer years of academic education, higher age, male sex), clinical (EDSS, depressive symptoms) but no conventional MRI characteristics were linked to baseline CI. At follow-up, only 14% of patients showed CI suggesting effects of retesting. Neither baseline characteristics nor initiation of treatment between baseline and follow-up was able to predict cognitive changes within the follow-up period of 1 year. CONCLUSIONS Identification of risk factors for short-term cognitive change in newly diagnosed MS or CIS is insufficient using only demographic, clinical and conventional MRI data. Change-sensitive, re-test reliable cognitive tests and more sophisticated predictors need to be employed in future clinical trials and cohort studies of early-stage MS to improve prediction.
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Affiliation(s)
- Andreas Johnen
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany.
| | - Paul-Christian Bürkner
- Department of Statistics, Faculty of Psychology, Westfälische-Wilhelms-University, Münster, Germany
| | - Nils C Landmeyer
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Björn Ambrosius
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Pasquale Calabrese
- Department of Neuropsychology and Behavioral Neurology, University of Basel, Basel, Switzerland
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nicole Hessler
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Gisela Antony
- Central Information Office (CIO), Philipps-University Marburg, Marburg, Germany
| | - Inke R König
- Institute of Medical Biometry and Statistics, University of Lübeck, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Luisa Klotz
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Muna-Miriam Hoshi
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Lilian Aly
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sergiu Groppa
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Felix Luessi
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charité, University Medicine Berlin and Max Delbrueck Center for Molecular Medicine, Berlin, Germany
| | - Björn Tackenberg
- Department of Neurology, Philipps-University Marburg, Marburg, Germany
| | | | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University of Munich, Munich, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany
- Clinic of Neurology Dietenbronn, Schwendi, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Frank Weber
- Neurology, Max-Planck-Institute of Psychiatry, Munich, Germany
- Neurological Clinic, Sana Kliniken des Landkreises Cham, Cham, Germany
| | - Antonios Bayas
- Department of Neurology, Klinikum Augsburg, Augsburg, Germany
| | | | - Christoph Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Uwe K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
| | - Frauke Zipp
- Department of Neurology and Focus Program Translational Neuroscience (FTN), Rhine Main Neuroscience Network (rmn2), University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Sven G Meuth
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Heinz Wiendl
- Department of Neurology, University Hospital Münster, Westfälische-Wilhelms-University Münster, Münster, Germany
| | - Anke Salmen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, Inselspital Bern, Bern University Hospital and University of Bern, Bern, Switzerland
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50
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Fisse AL, Pitarokoili K, Trampe N, Motte J, Kerasnoudis A, Gold R, Yoon MS. Clinical, Sonographic, and Electrophysiologic Longitudinal Features of Chronic Inflammatory Demyelinating Polyneuropathy. J Neuroimaging 2018; 29:223-232. [PMID: 30407676 DOI: 10.1111/jon.12579] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/30/2018] [Accepted: 10/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Several studies have aimed to find potential biomarkers to simplify the diagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP) and to monitor and predict the disease course. However, reliable markers are still lacking. We aimed to investigate whether high-resolution nerve ultrasound (HRUS) is suitable for monitoring the long-term clinical course of CIDP. METHODS Twenty patients fulfilling the definite diagnostic criteria of CIDP received clinical examination, evaluation of the INCAT (inflammatory neuropathy cause and treatment) overall disability sum score (ODSS) as well as nerve conduction studies, and HRUS every 6 months over a median follow-up time of 34 months. Patients were divided into clinically stable/regressive disease course or progressive disease course according to the development of the ODSS. RESULTS The intranerve cross-sectional-area (CSA) variability of the nerves of the lower extremity increased with disease progression, whereas it remained unchanged in patients with a stable or remitting disease course. CONCLUSION Nerve ultrasound can be used as a method to objectify the long-term disease course in CIDP patients. The intranerve CSA variability is suitable for monitoring the clinical course of patients with CIDP.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | | | - Nadine Trampe
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
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