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Musso G, Zoccarato M, Gallo N, Plebani M, Basso D. Hook-effect in MAGLUMI immunoassay for serum anti-GAD antibodies in neurological disorders: When "wrong" matrix is the right choice. Clin Chim Acta 2024; 558:119679. [PMID: 38642630 DOI: 10.1016/j.cca.2024.119679] [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: 02/15/2024] [Revised: 03/26/2024] [Accepted: 04/17/2024] [Indexed: 04/22/2024]
Abstract
Antibodies against glutamic acid decarboxylase (anti-GAD) are a valuable diagnostic tool to detect severe autoimmune conditions as type 1 diabetes mellitus (T1DM) and anti-GAD related neurological disorders, having the latter more often anti-GAD concentrations in serum multiple times higher than in the former. Automated immunoassays, either with ELISA or chemiluminescent technology, are validated for diagnostic use in serum with analytical ranges suitable for T1DM diagnosis. In a patient presenting with a suspected autoimmune ataxia, anti-GAD testing on an automated chemiluminescent immunoassay (CLIA) resulted in slightly abnormal concentrations in serum (39.2 KIU/L) and very high concentrations in CSF (>280 KIU/L), thus prompting to proceed to serum dilutions to exclude a false negative result and a misdiagnosis. Different dilutions of serum resulted in nonlinear concentrations with endpoint result of 276,500 KIU/L at dilution 1:1000. CSF dilution was instead linear with endpoint result of 4050 KIU/L. In this case report we found that anti-GAD testing in CSF was essential to establish the clinical diagnosis and to suspect hook-effect in serum due to the excess of autoantibodies in this severe autoimmune condition.
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Affiliation(s)
- G Musso
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy.
| | - M Zoccarato
- Neurology Unit, Ospedale Sant'Antonio, University-Hospital of Padova, Padova, Italy
| | - N Gallo
- Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - M Plebani
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
| | - D Basso
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Laboratory Medicine Unit, University-Hospital of Padova, Padova, Italy
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Vogrig A, Tartaglia S, Dentoni M, Fabris M, Bax F, Belluzzo M, Verriello L, Bagatto D, Gastaldi M, Tocco P, Zoccarato M, Zuliani L, Pilotto A, Padovani A, Villagrán-García M, Davy V, Gigli GL, Honnorat J, Valente M. Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study. Front Immunol 2024; 15:1344184. [PMID: 38375477 PMCID: PMC10876052 DOI: 10.3389/fimmu.2024.1344184] [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: 11/25/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Background COVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination. Methods Multicenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis. Results Nineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2. Conclusion CNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment.
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Affiliation(s)
- Alberto Vogrig
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Sara Tartaglia
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Marta Dentoni
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Department of Laboratory Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Francesco Bax
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Marco Belluzzo
- Neurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Unit of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierluigi Tocco
- Neurology and Stroke Unit, “Spirito Santo” Hospital of Pescara, Pescara, Italy
| | - Marco Zoccarato
- UOC Neurologia O.S.A. - Azienda Ospedale Università di Padova, Padua, Italy
| | - Luigi Zuliani
- Neurology Unit, AULSS8 Berica, San Bortolo Hospital, Vicenza, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
| | - Macarena Villagrán-García
- French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Davy
- Department of Neurology, Hôpital Pitié Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gian Luigi Gigli
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Jérôme Honnorat
- French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Mariarosaria Valente
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
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Zoccarato M, Grisold W. Paraneoplastic neurologic manifestations of neuroendocrine tumors. Handb Clin Neurol 2024; 200:397-407. [PMID: 38494292 DOI: 10.1016/b978-0-12-823912-4.00023-2] [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] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors arising from the transformation of neuroendocrine cells in several organs, most notably the gastro-entero-pancreatic system and respiratory tract. The classification was recently revised in the 5th Edition of the WHO Classification of Endocrine and Neuroendocrine Tumors. NENs can rarely spread to the central or peripheral nervous systems. Neurologic involvement is determined by the rare development of paraneoplastic syndromes, which are remote effects of cancer. Mechanisms depend on immunologic response to a tumor, leading to the immune attack on the nervous system or the production of biologically active ("functioning") substances, which can determine humoral (endocrine) effects with neurologic manifestations. Paraneoplastic neurologic syndromes (PNS) are immunologically mediated and frequently detected in small cell lung cancer but rarely seen in other forms of NEN. PNS and Merkel cell carcinoma is increasingly reported, especially with Lambert Eaton myasthenic syndrome. Endocrine manifestations are found in a wide spectrum of NENs. They can develop at any stage of the diseases and determine neurologic manifestations. Patient outcomes are influenced by tumor prognosis, neurologic complications, and the severity of endocrine effects.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit O.S.A., Azienda Ospedale-Università di Padova, Padova, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria.
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Musso G, Zoccarato M, Gallo N, Padoan A, Cosma C, Zuliani L, De Gaspari P, Pegoraro E, Plebani M, Basso D. Analytical evaluation of a GAD65 antibodies chemiluminescence immunoassay for CSF in neurological syndromes. Clin Chem Lab Med 2023; 61:1802-1807. [PMID: 37114858 DOI: 10.1515/cclm-2023-0072] [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: 01/18/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES Antibodies against glutamic acid decarboxylase isoform 65 (GAD-Ab) have been found in different severe neurological conditions associated with altered synthesis of γ-aminobutyric acid (GABA). Serum GAD-Ab can be found in up to 90 % of patients with type 1 diabetes mellitus (T1DM), mostly at relatively low concentrations, while high concentrations of GAD-ab are thought to be more frequently associate to a neurological condition, with levels 100-folds higher than those found in T1DM. Although CSF testing is recommended when suspecting a GAD-associated neurological syndrome, no commercial immunoassay is validated for this use and no cut-off is internationally recognized to support the diagnosis. METHODS In this study we validated CSF testing of GAD-Ab on an automated chemiluminescence (CLIA) immunoassay that had previously shown good agreement with ELISA on serum. RESULTS We tested 43 CSF from patients with typical GAD-associated neurological disorders and patients with other neurological conditions, identifying a clinical cut-off of 18 kIU/L that discriminated GAD-disease with an area under the curve (AUC) of 0.921. CLIA showed good analytical performances on repeatability and recovery tests in CSF and confirmed an excellent agreement with ELISA. CONCLUSIONS GAD-Ab associated neurological disorders are rare but CSF testing for GAD-Ab is a common request for neurologists when suspecting an insidious autoimmune central nervous system disease. CLIA platforms are expected to be increasingly adopted in clinical laboratories due to their flexibility and reliability, therefore studies on decisional levels should be implemented for improving the interpretation and utilization of laboratory data.
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Affiliation(s)
- Giulia Musso
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Marco Zoccarato
- Neurology Unit, Ospedale Sant'Antonio, University-Hospital of Padova, Padova, Italy
| | - Nicoletta Gallo
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
| | - Andrea Padoan
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Chiara Cosma
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- QI.LAB.MED, Spin-off of the University of Padova, Padova, Italy
| | - Luigi Zuliani
- Department of Neurology, Ospedale San Bortolo, Vicenza, Italy
| | - Piera De Gaspari
- Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", Padova, Italy
| | - Elena Pegoraro
- Department of Neurosciences DNS, University of Padova, Padova, Italy
| | - Mario Plebani
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
- QI.LAB.MED, Spin-off of the University of Padova, Padova, Italy
| | - Daniela Basso
- Department of Laboratory Medicine, University-Hospital of Padova, Padova, Italy
- Department of Medicine-DIMED, University of Padova, Padova, Italy
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Zoccarato M, Ferrati C, D'Errico I. Superficial Brainstem FLAIR Hyperintensity and Restricted Diffusion Leading to the Detection of Non-Small-Cell Lung Cancer. Neurology 2023:WNL.0000000000207123. [PMID: 36797066 DOI: 10.1212/wnl.0000000000207123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/12/2023] [Indexed: 02/18/2023] Open
Affiliation(s)
- Marco Zoccarato
- Neurology Unit, Ospedale Sant'Antonio, Azienda Ospedale Università Padova, Italy
| | - Chiara Ferrati
- Neurology Unit, Ospedale Sant'Antonio, Azienda Ospedale Università Padova, Italy
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Matricardi S, Casciato S, Bozzetti S, Mariotto S, Stabile A, Freri E, Deleo F, Sartori S, Nosadini M, Pappalardo I, Meletti S, Giovannini G, Zucchi E, Di Bonaventura C, Di Gennaro G, Ferrari S, Zuliani L, Zoccarato M, Vogrig A, Lattanzi S, Michelucci R, Gambardella A, Ferlazzo E, Fusco L, Granata T, Villani F. Epileptic phenotypes in autoimmune encephalitis: from acute symptomatic seizures to autoimmune-associated epilepsy. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-329195. [PMID: 35879055 DOI: 10.1136/jnnp-2022-329195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 07/06/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the clinical and paraclinical findings, treatment options and long-term outcomes in autoimmune encephalitis (AE), with a close look to epilepsy. METHODS In this retrospective observational cohort study, we enrolled patients with new-onset seizures in the context of AE. We compared clinical and paraclinical findings in patients with and without evidence of antibodies. RESULTS Overall, 263 patients (138 females; median age 55 years, range 4-86) were followed up for a median time of 30 months (range 12-120). Antineuronal antibodies were detected in 63.50%.Antibody-positive patients had multiple seizure types (p=0.01) and prevalent involvement of temporal regions (p=0.02). A higher prevalence of episodes of SE was found in the antibody-negative group (p<0.001).Immunotherapy was prescribed in 88.60%, and effective in 61.80%. Independent predictors of favourable outcome of the AE were early immunotherapy (p<0.001) and the detection of antineuronal surface antibodies (p=0.01).Autoimmune-associated epilepsy was the long-term sequela in 43.73%, associated with cognitive and psychiatric disturbances in 81.73%. Independent predictors of developing epilepsy were difficult to treat seizures at onset (p=0.04), a high number of antiseizure medications (p<0.001), persisting interictal epileptiform discharges at follow-up (p<0.001) and poor response to immunotherapy during the acute phase (p<0.001). CONCLUSIONS The recognition of seizures secondary to AE represents a rare chance for aetiology-driven seizures management. Early recognition and treatment at the pathogenic level may reduce the risk of long-term irreversible sequelae. However, the severity of seizures at onset is the major risk factor for the development of chronic epilepsy.This study provides class IV evidence for management recommendations.
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Affiliation(s)
- Sara Matricardi
- Child Neurology and Psychiatry Unit, Children's Hospital "G. Salesi", Ospedali Riuniti Ancona, Polytechnic University of Marche, Ancona, Italy
| | | | - Silvia Bozzetti
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
- Department of Neurology/Stroke Unit, San Maurizio Hospital, Bolzano, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Andrea Stabile
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Elena Freri
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Deleo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy
| | - Irene Pappalardo
- Division of Clinical Neurophysiology and Epilepsy Centre, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Stefano Meletti
- Dept of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Dept, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
| | - Giada Giovannini
- Dept of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Dept, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
| | - Elisabetta Zucchi
- Dept of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
- Neurology Dept, Azienda Ospedaliera-Universitaria di Modena, Modena, Italy
| | | | | | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Marco Zoccarato
- Neurology Unit O.S.A. - Azienda Ospedale Università Padova, Padova, Italy
| | - Alberto Vogrig
- Department of Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, Ancona, Italy
| | - Roberto Michelucci
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Unit of Neurology, Bologna, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, University Magna Graecia, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Center, BMM Great Metropolitan Hospital, Reggio Calabria, Italy
- Department of Medical and Surgical Sciences, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Lucia Fusco
- Department of Neuroscience, Bambino Gesù Children's Hospital, Rome, Italy
| | - Tiziana Granata
- Department of Paediatric Neuroscience, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Flavio Villani
- Division of Clinical Neurophysiology and Epilepsy Centre, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Dinoto A, Gastaldi M, Iorio R, Marini S, Damato V, Farina A, Zoccarato M, Sechi E, Pinna F, Maniscalco GT, Barnabei R, Zuliani L, Ferrari S, Mariotto S. Safety profile of SARS-CoV-2 vaccination in patients with antibody-mediated CNS disorders. Mult Scler Relat Disord 2022; 63:103827. [PMID: 35508101 PMCID: PMC9035564 DOI: 10.1016/j.msard.2022.103827] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 03/29/2022] [Revised: 04/11/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022]
Abstract
Objectives: In this retrospective multicenter study, we evaluated the safety of SARS-CoV-2 vaccination in patients harboring autoantibodies targeting neuronal surface and/or synaptic antigens. Methods: From eight Italian Neurology Units, we included patients with: a) serum and/or CSF positivity for specific neuronal autoantibodies; b) a compatible neurological syndrome; and c) available follow-up ≥6 weeks after vaccination with any of the approved SARS-CoV-2 vaccines. Demographics, clinical data, and information regarding previous SARS-CoV-2 infection and vaccination were collected. Disease relapses were considered “post-infectious” or “post-vaccination” when occurring within 6 weeks from infection/vaccination. Results: We included 66 patients; 7/66 (11%) had a previous history of SARS-CoV-2 infection and 1/7 (14%) had post-infection relapses. BNT162b2-Pfizer-BioNTec was administered in 55 cases (83.3%) and mRNA-1273-Moderna in 11 (16.7%). The median number of doses administered per patient was 2 (1–3) and >50% of patients did not experience side effects. Five patients (8%) had post-vaccination relapses (seizure 3/5); 4/5 improved after immunotherapy, while one did not receive immunotherapy and worsened. Patients with post-vaccination relapses had higher disability scores at vaccination (p = 0.025), a trend favoring Leucine-rich glioma-inactivated protein 1 LGI1 glutamic acid decarboxylase 65 (GAD65) antibodies (p = 0.054) and shorter time from last relapse (p = 0.057). Discussion: Our data support the safety of SARS-CoV-2 vaccines in patients with neurological disorders associated with antibodies to neuronal and synaptic antigens.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Raffaele Iorio
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sofia Marini
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valentina Damato
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Antonio Farina
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - Marco Zoccarato
- UOC Neurologia O.S.A. - Azienda Ospedale Università Di Padova, Padua, Italy
| | - Elia Sechi
- Azienda Ospedaliera Universitaria Sassari, Unit of Neurology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Francesca Pinna
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giorgia Teresa Maniscalco
- Neurological Clinic and Stroke Unit, Multiple Sclerosis Center, "A. Cardarelli" Hospital, Naples, Italy
| | | | | | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy.
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8
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Zoccarato M, Grisold W, Grisold A, Poretto V, Boso F, Giometto B. Paraneoplastic Neuropathies: What's New Since the 2004 Recommended Diagnostic Criteria. Front Neurol 2021; 12:706169. [PMID: 34659082 PMCID: PMC8517070 DOI: 10.3389/fneur.2021.706169] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
The diagnostic criteria published by the PNS (Paraneoplastic Neurological Syndromes) Euronetwork in 2004 provided a useful classification of PNS, including paraneoplastic neuropathies. Subacute sensory neuronopathy (SSN) was the most frequently observed peripheral PNS, whereas other forms of neuropathy, as sensory polyneuropathy, sensorimotor polyneuropathy, demyelinating neuropathies, autonomic neuropathies, and focal nerve or plexus lesions, were less frequent. At the time of publication, the main focus was on onconeural antibodies, but knowledge regarding the mechanisms has since expanded. The antibodies associated with PNS are commonly classified as onconeural (intracellular) and neuronal surface antibodies (NSAbs). Since 2004, the number of antibodies and the associated tumors has increased. Knowledge has grown on the mechanisms underlying the neuropathies observed in lymphoma, paraproteinemia, and multiple myeloma. Moreover, other unrevealed mechanisms underpin sensorimotor neuropathies and late-stage neuropathies, where patients in advanced stages of cancer—often associated with weight loss—experience some mild sensorimotor neuropathy, without concomitant use of neurotoxic drugs. The spectrum of paraneoplastic neuropathies has increased to encompass motor neuropathies, small fiber neuropathies, and autonomic and nerve hyperexcitability syndromes. In addition, also focal neuropathies, as cranial nerves, plexopathies, and mononeuropathies, are considered in some cases to be of paraneoplastic origin. A key differential diagnosis for paraneoplastic neuropathy, during the course of cancer disease (the rare occurrence of a PNS), is chemotherapy-induced peripheral neuropathy (CIPN). Today, novel complications that also involve the peripheral nervous system are emerging from novel anti-cancer therapies, as targeted and immune checkpoint inhibitor (ICH) treatment. Therapeutic options are categorized into causal and symptomatic. Causal treatments anecdotally mention tumor removal. Immunomodulation is sometimes performed for immune-mediated conditions but is still far from constituting evidence. Symptomatic treatment must always be considered, consisting of both drug therapy (e.g., pain) and attempts to treat disability and neuropathic pain.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit O.S.A., Azienda Ospedale-Università di Padova, Padova, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology Donaueschingenstraße 13 A-1200 Vienna, Vienna, Austria
| | - Anna Grisold
- Department of Neurology, Medical University Vienna, Vienna, Austria
| | - Valentina Poretto
- Neurology Unit, Ospedale S Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Federica Boso
- Neurology Unit, Ospedale S Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy
| | - Bruno Giometto
- Neurology Unit, Ospedale S Chiara, Azienda Provinciale per i Servizi Sanitari (APSS), Trento, Italy.,Department of Neurology, University of Trieste, Trieste, Italy
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9
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Orlandi R, Mariotto S, Gobbin F, Mancinelli CR, Rossi F, Zoccarato M, Zuliani L, Ferraro D, Turatti M, Gajofatto A. Brain volume measures in adults with MOG-antibody associated disease: A longitudinal multicentre study. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.118108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Diamanti L, Picca A, Bini P, Gastaldi M, Alfonsi E, Pichiecchio A, Rota E, Rudà R, Bruno F, Villani V, Galiè E, Vogrig A, Valente M, Zoccarato M, Poretto V, Giometto B, Cimminiello C, Del Vecchio M, Marchioni E. Characterization and management of neurological adverse events during immune-checkpoint inhibitors treatment: an Italian multicentric experience. Neurol Sci 2021; 43:2031-2041. [PMID: 34424427 DOI: 10.1007/s10072-021-05561-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neurological immune-related adverse events (nirAEs) are rare toxicities of immune-checkpoint inhibitors (ICI). With the increase of ICI oncological indications, their incidence is growing. Their recognition and management remain nevertheless challenging. METHODS A national, web-based database was built to collect cases of neurological symptoms in patients receiving ICI and not attributable to other causes after an adequate workup. RESULTS We identified 27 patients who developed nirAEs (20 males, median age 69 years). Patients received anti-PD1/PDL1 (78%), anti-CTLA4 (4%), or both (19%). Most common cancers were melanoma (30%) and non-small cell lung cancer (26%). Peripheral nervous system was mostly affected (78%). Median time to onset was 43.5 days and was shorter for peripheral versus central nervous system toxicities (36 versus 144.5 days, p = 0.045). Common manifestations were myositis (33%), inflammatory polyradiculoneuropathies (33%), and myasthenia gravis (19%), alone or in combination, but the spectrum of diagnoses was broad. Most patients received first-line glucocorticoids (85%) or IVIg (15%). Seven patients (26%) needed second-line treatments. At last follow-up, four (15%) patients were deceased (encephalitis, 1; myositis/myasthenia with concomitant myocarditis, 2; acute polyradiculoneuropathy, 1), while seven (26%) had a complete remission, eight (30%) partial improvement, and six (22%) stable/progressing symptoms. ICI treatment was discontinued in most patients (78%). CONCLUSIONS Neurological irAEs are rare but potentially fatal. They primarily affect neuromuscular structures but encompass a broad range of presentations. A prompt recognition is mandatory to timely withheld immunotherapy and administrate glucocorticoids. In corticoresistant or severely affected patients, second-line treatments with IVIg or plasmapheresis may result in additional benefit.
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Affiliation(s)
- Luca Diamanti
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Alberto Picca
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy.
| | - Paola Bini
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Gastaldi
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Enrico Alfonsi
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Anna Pichiecchio
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Eugenia Rota
- Neurology Unit, Ospedale San Giacomo, Novi Ligure, ASL Alessandria, Italy
| | - Roberta Rudà
- Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | - Francesco Bruno
- University and City of Health and Science of Turin, Turin, Italy
| | | | - Edvina Galiè
- IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alberto Vogrig
- Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Mariarosaria Valente
- Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Presidio Ospedaliero Santa Maria della Misericordia, Udine, Italy
| | - Marco Zoccarato
- UOC Neurologia O.S.A. - Azienda Ospedale Università Di Padova, Padua, Italy
| | - Valentina Poretto
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | - Bruno Giometto
- Department of Emergency, Neurology Unit, Santa Chiara Hospital, Trento, Italy
| | | | | | - Enrico Marchioni
- "C. Mondino" National Neurological Institute, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
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11
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Zuliani L, Marangoni S, De Gaspari P, Rosellini I, Nosadini M, Fleming JM, De Riva V, Galloni E, Perini F, Frigo AC, Sartori S, Zoccarato M, Giometto B. Epidemiology of neuronal surface antibody-mediated autoimmune encephalitis and antibody-based diagnostics. J Neuroimmunol 2021; 357:577598. [PMID: 34099270 DOI: 10.1016/j.jneuroim.2021.577598] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 11/18/2022]
Abstract
Epidemiologic data on neuronal surface antibody (NSAb)-associated autoimmune encephalitides (NSAE) are scarce and heterogeneous. We review our 13-year-long biobank-data collection and provide the incidence of NSAE in two Italian provinces (approx. Population of 1,400,000) over a 5-year period (July 2013-June 2018). NSAbs were diagnosed in 75 out of 1179 tested patients (6.4%). The most common NSAbs were anti-LGI1 (30 cases), followed by NMDAR (24). Eleven cases of NSAE were diagnosed in Treviso and Trento provinces with an estimated incidence of 1.54 per 1,000,000 population (LGI1-encephalitis 0.84; C.I. 0.38-1.88). LGI1-E is the most frequent NSAE among adults.
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Affiliation(s)
- Luigi Zuliani
- Department of Neurology, Ospedale San Bortolo, Azienda ULSS8 Berica, Via Rodolfi 37, 36100 Vicenza, Italy; Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", Padova, Italy.
| | | | - Piera De Gaspari
- Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", Padova, Italy
| | - Irene Rosellini
- Department of Neurology, Azienda ULSS2 Marca Trevigiana, Treviso, Italy
| | - Margherita Nosadini
- Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", Padova, Italy; Department of Women's and Children's Health, Pediatric Neurology and Neurophysiology Unit, Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Joanne M Fleming
- Department of Neurology, O.S.A., Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Valentina De Riva
- Department of Neurology, Ospedale San Bortolo, Azienda ULSS8 Berica, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Elisabetta Galloni
- Department of Neurology, Ospedale San Bortolo, Azienda ULSS8 Berica, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Francesco Perini
- Department of Neurology, Ospedale San Bortolo, Azienda ULSS8 Berica, Via Rodolfi 37, 36100 Vicenza, Italy
| | - Anna Chiara Frigo
- Department of Cardiac, Thoracic, and Vascular Sciences, Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Stefano Sartori
- Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", Padova, Italy; Department of Women's and Children's Health, Pediatric Neurology and Neurophysiology Unit, Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Marco Zoccarato
- Neuroimmunology Group, Pediatric Research Institute "Città della Speranza", Padova, Italy; Department of Neurology, O.S.A., Azienda Ospedaliera-University of Padua Medical School, Italy
| | - Bruno Giometto
- Department of Neurology, Ospedale Santa Chiara, Trento, Italy
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12
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Zoccarato M, Nardetto L, Basile AM, Giometto B, Zagonel V, Lombardi G. Seizures, Edema, Thrombosis, and Hemorrhages: An Update Review on the Medical Management of Gliomas. Front Oncol 2021; 11:617966. [PMID: 33828976 PMCID: PMC8019972 DOI: 10.3389/fonc.2021.617966] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
Patients affected with gliomas develop a complex set of clinical manifestations that deeply impact on quality of life and overall survival. Brain tumor-related epilepsy is frequently the first manifestation of gliomas or may occur during the course of disease; the underlying mechanisms have not been fully explained and depend on both patient and tumor factors. Novel treatment options derive from the growing use of third-generation antiepileptic drugs. Vasogenic edema and elevated intracranial pressure cause a considerable burden of symptoms, especially in high-grade glioma, requiring an adequate use of corticosteroids. Patients with gliomas present with an elevated risk of tumor-associated venous thromboembolism whose prophylaxis and treatment are challenging, considering also the availability of new oral anticoagulant drugs. Moreover, intracerebral hemorrhages can complicate the course of the illness both due to tumor-specific characteristics, patient comorbidities, and side effects of antithrombotic and antitumoral therapies. This paper aims to review recent advances in these clinical issues, discussing the medical management of gliomas through an updated literature review.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit, O.S.A., Azienda Ospedale-Università, Padua, Italy
| | - Lucia Nardetto
- Neurology Unit, O.S.A., Azienda Ospedale-Università, Padua, Italy
| | | | - Bruno Giometto
- Neurology Unit, Trento Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, Trento, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCSS, Padua, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCSS, Padua, Italy
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13
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Pacenti M, Sinigaglia A, Martello T, De Rui ME, Franchin E, Pagni S, Peta E, Riccetti S, Milani A, Montarsi F, Capelli G, Doroldi CG, Bigolin F, Santelli L, Nardetto L, Zoccarato M, Barzon L. Clinical and virological findings in patients with Usutu virus infection, northern Italy, 2018. ACTA ACUST UNITED AC 2020; 24. [PMID: 31771697 PMCID: PMC6885746 DOI: 10.2807/1560-7917.es.2019.24.47.1900180] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BackgroundUsutu virus (USUV) is a mosquito-borne flavivirus, which shares its transmission cycle with the phylogenetically related West Nile virus (WNV). USUV circulates in several European countries and its activity has increased over the last 5 years.AimTo describe human cases of USUV infection identified by surveillance for WNV and USUV infection in the Veneto Region of northern Italy in 2018.MethodsFrom 1 June to 30 November 2018, all cases of suspected autochthonous arbovirus infection and blood donors who had a reactive WNV nucleic acid test were investigated for both WNV and USUV infection by in-house molecular methods. Anti-WNV and anti-USUV IgM and IgG antibodies were detected by ELISA and in-house immunofluorescence assay, respectively; positive serum samples were further tested by WNV and USUV neutralisation assays run in parallel.ResultsEight cases of USUV infection (one with neuroinvasive disease, six with fever and one viraemic blood donor who developed arthralgia and myalgia) and 427 cases of WNV infection were identified. A remarkable finding of this study was the persistence of USUV RNA in the blood and urine of three patients during follow-up. USUV genome sequences from two patients shared over 99% nt identity with USUV sequences detected in mosquito pools from the same area and clustered within lineage Europe 2.ConclusionsClinical presentation and laboratory findings in patients with USUV infection were similar to those found in patients with WNV infection. Cross-reactivity of serology and molecular tests challenged the differential diagnosis.
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Affiliation(s)
- Monia Pacenti
- These authors contributed equally as first authors.,Microbiology and Virology Unit, Padua University Hospital, Padova, Italy
| | - Alessandro Sinigaglia
- Department of Molecular Medicine, University of Padova, Padova, Italy.,These authors contributed equally as first authors
| | | | | | - Elisa Franchin
- Department of Molecular Medicine, University of Padova, Padova, Italy.,These authors contributed equally as first authors
| | - Silvana Pagni
- Department of Molecular Medicine, University of Padova, Padova, Italy.,These authors contributed equally as first authors
| | - Elektra Peta
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Silvia Riccetti
- Department of Molecular Medicine, University of Padova, Padova, Italy
| | - Adelaide Milani
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro PD, Italy
| | - Fabrizio Montarsi
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro PD, Italy
| | - Gioia Capelli
- Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro PD, Italy
| | | | - Francesco Bigolin
- Medicine Unit, Camposampiero Hospital, Azienda ULSS 6 Euganea, Padova, Italy
| | - Luca Santelli
- Neurology Department, Ospedale S. Antonio, Azienda ULSS 6 Euganea, Padova, Italy
| | - Lucia Nardetto
- Neurology Department, Ospedale S. Antonio, Azienda ULSS 6 Euganea, Padova, Italy
| | - Marco Zoccarato
- Neurology Department, Ospedale S. Antonio, Azienda ULSS 6 Euganea, Padova, Italy
| | - Luisa Barzon
- Department of Molecular Medicine, University of Padova, Padova, Italy.,These authors contributed equally as first authors
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14
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Caccese M, Padovan M, D'Avella D, Chioffi F, Gardiman MP, Berti F, Busato F, Bellu L, Bergo E, Zoccarato M, Fassan M, Zagonel V, Lombardi G. Anaplastic Astrocytoma: State of the art and future directions. Crit Rev Oncol Hematol 2020; 153:103062. [PMID: 32717623 DOI: 10.1016/j.critrevonc.2020.103062] [Citation(s) in RCA: 4] [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: 01/16/2020] [Revised: 06/17/2020] [Accepted: 07/12/2020] [Indexed: 01/05/2023] Open
Abstract
Anaplastic Astrocytoma(AA) is a malignant, diffusely infiltrating, primary brain tumor. According to the WHO 2016 classification of central-nervous-system tumors, AA has been described as a glial tumor with no co-deletion of 1p/19q, and is divided into IDH mutated tumor, characterized by better prognosis, and IDH wild-type form, with worse prognosis. The standard of care is maximal safe resection followed by radiotherapy and chemotherapy with temozolomide. Several efforts have been made to evaluate, according to molecular selection, which is the best post-surgical treatment. At recurrence, the treatment remains challenging and some trials are ongoing to evaluate new potential drugs, alone or in combination with chemotherapy. We performed a description of the status of the art on diagnosis, molecular characteristics and treatment of AA. In particular, we focused our details on new drugs; indeed, a deeper knowledge of the molecular characteristics of gliomas could lead to to development of active personalized treatments according with precision medicine.
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Affiliation(s)
- Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy; Clinical and Experimental Oncology and Immunology PhD Program, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
| | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Domenico D'Avella
- Accademic Neurosurgery, Department of Neurosciences, University of Padua Medical School, Padua, Italy
| | - Franco Chioffi
- Department of Neurosurgery, Padua University Hospital, Padua, Italy
| | - Marina Paola Gardiman
- Surgical Pathology Unit, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy
| | - Franco Berti
- Radiation Therapy and Nuclear Medicine Unit, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Fabio Busato
- Radiation Therapy and Nuclear Medicine Unit, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Luisa Bellu
- Radiation Therapy and Nuclear Medicine Unit, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Eleonora Bergo
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Marco Zoccarato
- Department of Neurology, Ospedale S. Antonio, Azienda Ospedaliera Di Padova, Padua, Italy
| | - Matteo Fassan
- Surgical Pathology Unit, Department of Medicine (DIMED), University Hospital of Padua, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology - IRCCS, Padua, Italy
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15
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Orlandi R, Mariotto S, Ferrari S, Gobbin F, Sechi E, Capra R, Mancinelli CR, Bombardi R, Zuliani L, Zoccarato M, Rossi F, Camera V, Ferraro D, Benedetti MD, Reindl M, Gajofatto A. Diagnostic features of initial demyelinating events associated with serum MOG-IgG. J Neuroimmunol 2020; 344:577260. [PMID: 32442864 DOI: 10.1016/j.jneuroim.2020.577260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/03/2020] [Accepted: 05/04/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG)-IgG associated disorders are increasingly recognized as a distinct disease entity. However, diagnostic sensitivity and specificity of serum MOG-IgG as well as recommendations for testing are still debated. MATERIALS AND METHODS Between October 2015 and July 2017 we tested serum MOG-IgG in 91 adult patients (49 females) with a demyelinating event (DE) not fulfilling 2010 McDonald criteria for MS at sampling, negative for neuromyelitis optica (NMO)-IgG and followed-up for at least 12 months. We assessed the sensitivity and specificity of a live-cell MOG-IgG assay for each final diagnosis at last follow-up, for the 2018 international recommendations for MOG-IgG testing, and for other combinations of clinical and laboratory characteristics. RESULTS Clinical presentations included acute myelitis (n = 48), optic neuritis (n = 36), multifocal encephalomyelitis (n = 4), and brainstem syndrome (n = 3). Twenty-four patients were MOG-IgG positive. Sensitivity and specificity of MOG-IgG test applied to the 2018 international recommendations were 28.4% and 86.7%, while they were 42.1% and 88.6% when applied to DE of unclear aetiology as defined above with two or more among: 1_no periventricular and juxtacortical MS-like lesions on brain MRI; 2_longitudinally extensive MRI optic nerve lesion; 3_no CSF-restricted oligoclonal bands; 4_CSF protein > 50 mg/dl. CONCLUSIONS Simplified requirements compared to those currently proposed for MOG-IgG testing could facilitate the applicability of the assay in the diagnosis of adults with DEs of unclear aetiology.
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Affiliation(s)
- Riccardo Orlandi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Francesca Gobbin
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Elia Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili di Brescia, Montichiari, Brescia, Italy
| | | | - Roberto Bombardi
- Neurology Unit, San Bassiano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Luigi Zuliani
- Neurology Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | | | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | - Valentina Camera
- Department of Biomedical, Metabolic and Neurological sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Diana Ferraro
- Department of Biomedical, Metabolic and Neurological sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Markus Reindl
- Clinical Department of Neurology, University of Innsbruck, Innsbruck, Austria
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona and Neurology Unit B, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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16
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Zoccarato M, Basile AM, Padovan M, Caccese M, Zagonel V, Lombardi G. Eslicarbazepine in patients with brain tumor-related epilepsy: a single-center experience. Int J Neurosci 2020; 131:879-884. [PMID: 32316814 DOI: 10.1080/00207454.2020.1759590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE Brain tumor-related epilepsy (BTRE) is frequent in patients affected with glioma. Most patients have refractory seizures and require polytherapy. Promising treatment options derive from the development of novel anti-epileptic drugs (AEDs), like Eslicarbazepine (ESL), whose role in BTRE has not yet been explored. Our aim was to report a retrospective cohort of patients affected by BTRE treated with ESL as an adjunctive therapy and to discuss the potential role of this third-generation AED in this clinical context. METHODS We analyzed a single-center, retrospectively collected cohort of patients affected by glioma and BTRE, treated with ESL as an adjunctive therapy. RESULTS Analysis included 5 males and 3 females with age ranging from 37 to 75 years (mean = 55.5). Mean baseline Karnofsky performance status was 87.5 (range 70-100). Patients were affected by diffuse astrocytoma (3), low grade oligodendroglioma (2), anaplastic glioma (2) and glioblastoma (1). Mean follow-up was 19 months (range 6-59). Mean dose at the last follow-up was 950 mg daily. Mean weekly seizures in the month before initiation of ESL numbered 17.6 (range 0.25-50). At the last follow-up, mean weekly seizures were 2.2 (range 0-10), i.e. significantly lower than baseline (p = 0.03). The mean reduction of seizures achieved after introduction of ESL was 65%, with 6/8 patients (75%) showing a reduction of more than 50%. Two patients (25%) were seizure free. CONCLUSIONS This single-center experience suggests that ESL may be a well-tolerated, efficacious option as an add-on drug in the treatment of BTRE.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit, O.S.A., Azienda Ospedaliera di Padova, Padua, Italy
| | | | - Marta Padovan
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Mario Caccese
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
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17
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Affiliation(s)
- Luigi Zuliani
- Department of Neurology, San Bortolo Hospital, AULSS8 Berica, Vicenza, Italy
- Neuroimmunology Group, Pediatric Research Institute “Città della Speranza”, Padova, Italy
| | - Marco Zoccarato
- Neuroimmunology Group, Pediatric Research Institute “Città della Speranza”, Padova, Italy
- Department of Neurology, Sant’Antonio Hospital, Padua, Italy
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18
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Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
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Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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19
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Mariotto S, Ferrari S, Gastaldi M, Franciotta D, Sechi E, Capra R, Mancinelli C, Schanda K, Alberti D, Orlandi R, Bombardi R, Zuliani L, Zoccarato M, Benedetti MD, Tanel R, Calabria F, Rossi F, Pavone A, Grazian L, Sechi G, Batzu L, Murdeu N, Janes F, Fetoni V, Fulitano D, Stenta G, Federle L, Cantalupo G, Reindl M, Monaco S, Gajofatto A. Neurofilament light chain serum levels reflect disease severity in MOG-Ab associated disorders. J Neurol Neurosurg Psychiatry 2019; 90:1293-1296. [PMID: 30952681 DOI: 10.1136/jnnp-2018-320287] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Sara Mariotto
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy, Pavia, Italy
| | - Elia Sechi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Sassari, Sassari, Italy
| | - Ruggero Capra
- MS Center, Spedali Civili of Brescia, Brescia, Italy
| | | | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Alberti
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Riccardo Orlandi
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Roberto Bombardi
- Neurology Unit, San Bassiano Hospital, Bassano Del Grappa, Italy
| | - Luigi Zuliani
- Department of Neurology, Ospedale Ca' Foncello, Treviso, Italy
| | | | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | | | | | - Francesca Rossi
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy, Verona, Italy
| | - Antonino Pavone
- Neurology Unit, Garibaldi Hospital, Catania, Italy, Catania, Italy
| | - Luisa Grazian
- Pediatric Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy, Treviso, Italy
| | - GianPietro Sechi
- Department of Clinical and Experimental Medicine, NeurologyUnit, University of Sassari, Sassari, Italy
| | - Lucia Batzu
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Sassari, Sassari, Italy
| | - Noemi Murdeu
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Sassari, Sassari, Italy
| | - Francesco Janes
- Neurology Unit, Department of Neuroscience ASUIUD, Udine, Italy, Udine, Italy
| | - Vincenza Fetoni
- Neurology Department, ASST Fatebenefratelli Sacco, Milano, Italy, Milano, Italy
| | | | - Gianola Stenta
- Multiple Sclerosis Centre, S. Bortolo Hospital, Vicenza, Italy, Vicenza, Italy
| | - Lisa Federle
- Multiple Sclerosis Centre, S. Bortolo Hospital, Vicenza, Italy, Vicenza, Italy
| | - Gaetano Cantalupo
- Child Neuropsychiatry, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine, and Movement Sciences, Section of Neurology, University of Verona, Verona, Italy
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20
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Zoccarato M, Valeggia S, Zuliani L, Gastaldi M, Mariotto S, Franciotta D, Ferrari S, Lombardi G, Zagonel V, De Gaspari P, Ermani M, Signori A, Pichiecchio A, Giometto B, Manara R. Conventional brain MRI features distinguishing limbic encephalitis from mesial temporal glioma. Neuroradiology 2019; 61:853-860. [PMID: 31028423 DOI: 10.1007/s00234-019-02212-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/31/2019] [Accepted: 04/04/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE Radiological hallmark of autoimmune limbic encephalitis (LE) is a hyperintense signal in MRI T2-weighted images of mesial temporal structures. We aimed to identify conventional magnetic resonance imaging (MRI) features that can help distinguish LE from temporal glioma. METHODS Brain MRIs of 25 patients affected by antibody-positive autoimmune LE, 24 patients affected by temporal glioma (tumor group), and 5 negative controls were retrospectively blindly evaluated in random order. RESULTS Ten brain MRIs from the LE group were correctly recognized; one additional patient with mesial temporal hyperintensity with anti-AK5 abs LE was wrongly diagnosed as having a tumor. The brain MRIs of the remaining 14 of the 25 patients with LE were judged negative or, in three cases, showed features not typical for LE. In the tumor group, all MRIs showed pathological alterations diagnosed as tumors in 22/24 cases and as LE in two (2/22, 9%). Unilateral lesions were more common in tumors than in neuroradiologically abnormal LE (96% vs. 18%, p < 0.001). T2/FLAIR hyperintensity of the parahippocampal gyrus was associated more with tumor than with LE (71% vs. 18%) (p = 0,009), as T2/FLAIR hyperintensity of extralimbic structures (p = 0.015), edema (p = 0.041), and mass effect (p = 0.015). Maintenance of gray/white matter distinction was strongly associated with LE (91% vs. 17%, p < 0.001). CONCLUSION Conventional brain MRI is a fundamental tool in the differential diagnosis between LE and glioma. Bilateral involvement and maintenance of gray/white matter distinction at the cortical/subcortical interface are highly suggestive of LE.
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Affiliation(s)
- Marco Zoccarato
- Neurology Unit, AULSS 6 Euganea, Padua, Italy. .,Neuroimmunology Group, Istituto di Ricerca Pediatrica, Padua, Italy.
| | | | - Luigi Zuliani
- Neuroimmunology Group, Istituto di Ricerca Pediatrica, Padua, Italy.,Department of Neurology, Ospedale San Bortolo, AULSS 8 Berica, Vicenza, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCSS Mondino Foundation, Pavia, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCSS Mondino Foundation, Pavia, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Lombardi
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Vittorina Zagonel
- Department of Oncology, Oncology 1, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Piera De Gaspari
- Neuroimmunology Group, Istituto di Ricerca Pediatrica, Padua, Italy
| | - Mario Ermani
- Department of Neurosciences (DNS), Statistic and Informatics Unit, School of Medicine, University of Padua, Padua, Italy
| | - Alessio Signori
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Anna Pichiecchio
- Department of Neuroradiology, IRCSS Mondino Foundation, Pavia, Italy
| | - Bruno Giometto
- Department of Neurology, Ospedale Santa Chiara, Trento, Italy
| | - Renzo Manara
- Neuroradiology, Department of Medicine and Surgery, Sezione di Neuroscienze, University of Salerno, Salerno, Italy
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21
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Crimì F, Camporese G, Lacognata C, Fanelli G, Cecchin D, Zoccarato M. Ovarian Teratoma or Uterine Malformation? PET/MRI as a Novel Useful Tool in NMDAR Encephalitis. In Vivo 2018; 32:1231-1233. [PMID: 30150449 DOI: 10.21873/invivo.11369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 05/27/2018] [Accepted: 05/30/2018] [Indexed: 01/05/2023]
Abstract
This is a case report of a 17-year-old girl affected by N-methyl-D-aspartate-receptor (NMDAR) encephalitis suspected for a paraneoplastic syndrome. Ultrasound (US) and computed tomography (CT) imaging identified an ovarian lesion compatible with teratoma. 18F-fluorodeoxyglucose (FDG) positron emission tomography/magnetic resonance imaging (PET/MRI), performed to evaluate metabolic activity of the brain and of the ovarian mass, correctly changed the diagnosis to uterine malformation that was later histologically proven.
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Affiliation(s)
- Filippo Crimì
- Radiology Unit, Department of Medicine - DIMED, University-Hospital Padua, Padua, Italy
| | | | - Carmelo Lacognata
- Radiology Unit, Department of Medicine - DIMED, University-Hospital Padua, Padua, Italy
| | - Giuseppe Fanelli
- Surgical Pathology & Cytopathology Unit, Department of Medicine - DIMED, University-Hospital of Padua, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital Padua, Padua, Italy
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22
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Zoccarato M, Gastaldi M, Zuliani L, Biagioli T, Brogi M, Bernardi G, Corsini E, Bazzigaluppi E, Fazio R, Giannotta C, Nobile-Orazio E, Costa G, Iorio R, Evoli A, Mariotto S, Ferrari S, Galloni E, De Riva V, Zardini E, Franciotta D, Giometto B. Diagnostics of paraneoplastic neurological syndromes. Neurol Sci 2018; 38:237-242. [PMID: 29030766 DOI: 10.1007/s10072-017-3031-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This document presents the guidelines for onconeural antibody testing that have been developed following a consensus process built on questionnaire-based surveys, internet contacts, and discussions at workshops of the sponsoring Italian Association of Neuroimmunology (AINI) congresses. Essential clinical information on paraneoplastic neurological syndromes, indications and limits of onconeural antibody testing, instructions for result interpretation, and an agreed laboratory protocol (Appendix) are reported for the communicative community of neurologists and clinical pathologists.
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Affiliation(s)
| | - Matteo Gastaldi
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | - Luigi Zuliani
- Ospedale Ca' Foncello AULSS2 Marca Trevigiana, Treviso, Italy
| | | | | | | | | | | | | | | | | | | | - Raffaele Iorio
- Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Amelia Evoli
- Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement, University of Verona, Verona, Italy
| | | | | | - Elisabetta Zardini
- C. Mondino National Neurological Institute, University of Pavia, Pavia, Italy
| | | | - Bruno Giometto
- Ospedale S. Antonio AULSS Euganea, Padua, Italy. .,UO Neurologia, Ospedale S.Antonio, AULSS 6 Euganea, Via Facciolati 71 -, 35127, Padova, Italy.
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23
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Casciato S, D'Aniello A, Mascia A, Quarato PP, De Risi M, Grammaldo LG, Esposito V, Zoccarato M, Di Gennaro G. Possible autoantibody-negative limbic encephalitis after anterior temporal lobectomy for hippocampal sclerosis. Int J Neurosci 2017; 128:464-466. [PMID: 29053037 DOI: 10.1080/00207454.2017.1394852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Amnestic syndromes are acknowledged to be associated to bilateral hippocampal damage. MATERIALS AND METHODS We briefly report the case of a young man who underwent anterior left temporal lobectomy for a medically refractory temporal lobe epilepsy due to hippocampal sclerosis with an excellent seizure and neuropsychological outcome. Approximately 10 years later, he presented with a subacute severe global amnesia and neuroimaging findings of a damage involving the contralateral mesial temporal lobe structures. RESULTS A diagnosis of a possible autoimmune encephalitis was made. CONCLUSIONS Due to its peculiarities (compared with other cases of bilateral temporal lesions, the damage occurred on two distinct occasions), this case might contribute to shed light on the issue of the possible contralateral reorganization of memory processes subserved by the mesial temporal lobe structures chronically involved in epileptogenesis.
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Affiliation(s)
| | | | | | | | | | | | - Vincenzo Esposito
- a IRCCS NEUROMED Pozzilli (IS) , Italy.,b Department of Neurosurgery , "Sapienza" University of Rome , Rome , Italy
| | - Marco Zoccarato
- c Department of Neurology , Ospedale S.Antonio , Padua , Italy
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24
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Mariotto S, Ferrari S, Monaco S, Benedetti MD, Schanda K, Alberti D, Farinazzo A, Capra R, Mancinelli C, De Rossi N, Bombardi R, Zuliani L, Zoccarato M, Tanel R, Bonora A, Turatti M, Calabrese M, Polo A, Pavone A, Grazian L, Sechi G, Sechi E, Urso D, Delogu R, Janes F, Deotto L, Cadaldini M, Bianchi MR, Cantalupo G, Reindl M, Gajofatto A. Clinical spectrum and IgG subclass analysis of anti-myelin oligodendrocyte glycoprotein antibody-associated syndromes: a multicenter study. J Neurol 2017; 264:2420-2430. [PMID: 29063242 PMCID: PMC5688213 DOI: 10.1007/s00415-017-8635-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 15.7] [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: 08/28/2017] [Revised: 09/28/2017] [Accepted: 09/30/2017] [Indexed: 12/24/2022]
Abstract
Anti-myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) recently emerged as a potential biomarker in patients with inflammatory demyelinating diseases of the central nervous system. We here compare the clinical and laboratory findings observed in a cohort of MOG-Ab seropositive and seronegative cases and describe IgG subclass analysis results. Consecutive serum samples referred to Verona University Neuropathology Laboratory for aquaporin-4 (AQP4)-Ab and/or MOG-Ab testing were analysed between March 2014 and May 2017. The presence of AQP4-Ab was determined using a cell-based assay. A live cell immunofluorescence assay was used for the detection of MOG-IgG and IgG subclass analysis. Among 454 analysed samples, 29 were excluded due to AQP4-Ab positivity or to the final demonstration of a disorder not compatible with MOG-Ab. We obtained clinical data in 154 out of 425 cases. Of these, 22 subjects resulted MOG-Ab positive. MOG-Ab positive patients were mainly characterised by the involvement of the optic nerve and/or spinal cord. Half of the cases presented relapses and the recovery was usually partial. Brain MRI was heterogeneous while short lesions were the prevalent observation on spinal cord MRI. MOG-Ab titre usually decreased in non-relapsing cases. In all MOG-IgG positive cases, we observed IgG1 antibodies, which were predominant in most subjects. IgG2 (5/22), IgG3 (9/22) and IgG4 (3/22) antibodies were also detectable. We confirm that MOG-Ab-related syndromes have distinct features in the spectrum of demyelinating conditions, and we describe the possible role of the different IgG subclasses in this condition.
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Affiliation(s)
- Sara Mariotto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy.
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
| | - Sergio Ferrari
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Maria Donata Benedetti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Alberti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Alessia Farinazzo
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Ruggero Capra
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Chiara Mancinelli
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Nicola De Rossi
- Multiple Sclerosis Centre, Spedali Civili of Brescia, Montichiari, Brescia, Italy
| | - Roberto Bombardi
- Neurology Unit, St Bassano Hospital, Bassano del Grappa, Vicenza, Italy
| | - Luigi Zuliani
- Neurology Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | | | | | | | - Marco Turatti
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Massimiliano Calabrese
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
| | - Alberto Polo
- Neurology Unit, Mater Salutis Hospital, Legnago, Verona, Italy
| | | | - Luisa Grazian
- Pediatric Unit, ULSS 2 Marca Trevigiana, Ca' Foncello Hospital, Treviso, Italy
| | - GianPietro Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Elia Sechi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Daniele Urso
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Rachele Delogu
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy
| | - Francesco Janes
- Neurology Unit, Department of Neuroscience, ASUIUD, Udine, Italy
| | | | | | | | | | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alberto Gajofatto
- Department of Neuroscience, Biomedicine and Movement Sciences, Neurology Unit, University of Verona, Verona, Italy
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25
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Nardetto L, Zoccarato M, Santelli L, Tiberio I, Cecchin D, Giometto B. 18F-FDG PET/MRI in cryptogenic new-onset refractory status epilepticus: a potential marker of disease location, activity and prognosis? J Neurol Sci 2017; 381:100-102. [DOI: 10.1016/j.jns.2017.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/28/2017] [Accepted: 08/15/2017] [Indexed: 11/25/2022]
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26
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Godani M, Zoccarato M, Beronio A, Zuliani L, Benedetti L, Giometto B, Del Sette M, Raggio E, Baldi R, Vincent A. Voltage-Gated Potassium Channel Antibodies in Slow-Progression Motor Neuron Disease. NEURODEGENER DIS 2016; 17:59-62. [PMID: 27710962 DOI: 10.1159/000447715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The spectrum of autoimmune neurological diseases associated with voltage-gated potassium channel (VGKC)-complex antibodies (Abs) ranges from peripheral nerve disorders to limbic encephalitis. Recently, low titers of VGKC-complex Abs have also been reported in neurodegenerative disorders, but their clinical relevance is unknown. OBJECTIVE The aim of the study was to explore the prevalence of VGKC-complex Abs in slow-progression motor neuron disease (MND). METHODS We compared 11 patients affected by slow-progression MND with 9 patients presenting typical progression illness. Sera were tested for VGKC-complex Abs by radioimmunoassay. The distribution of VGKC-complex Abs was analyzed with the Mann-Whitney U test. RESULTS The statistical analysis showed a significant difference between the mean values in the study and control groups. A case with long-survival MND harboring VGKC-complex Abs and treated with intravenous immunoglobulins is described. CONCLUSION Although VGKC-complex Abs are not likely to be pathogenic, these results could reflect the coexistence of an immunological activation in patients with slow disease progression.
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Suppiej A, Nosadini M, Zuliani L, Pelizza MF, Toldo I, Bertossi C, Tison T, Zoccarato M, Marson P, Giometto B, Dale RC, Sartori S. Plasma exchange in pediatric anti-NMDAR encephalitis: A systematic review. Brain Dev 2016; 38:613-22. [PMID: 26926399 DOI: 10.1016/j.braindev.2016.01.009] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To clarify the most frequent modalities of use of plasma exchange (PE) in pediatric anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis and to establish the most effective association with other immunotherapies. METHODS Systematic literature review on PE in pediatric anti-NMDAR encephalitis (2007-2015). RESULTS Seventy-one articles were included (mostly retrospective), reporting a total of 242 subjects (73.2%, 93/127 females; median age at onset 12years, range 1-18). Median time to immunotherapy was 21days (range 0-190). In most cases, PE was given with steroids and IVIG (69.5%, 89/128), or steroids only (18%, 23/128); in a minority, it was associated with IVIG only (7%, 9/128), or was the only first-line treatment (5.5%, 7/128). In 54.5% (65/119), PE was the third treatment after steroids and IVIG, in 31.1% (37/119) the second after steroids or IVIG; only in 14.3% (17/119) was it the first treatment. Second-line immunotherapies were administered in 71.9% (100/139). Higher rates of full/substantial recovery at follow-up were observed with immunotherapy given ⩽30days from onset (69.4%, 25/36) compared to later (59.2%, 16/27), and when PE was associated with steroids (66.7%, 70/105) rather than not (46.7%, 7/15). Significant adverse reactions to PE were reported in 6 patients. CONCLUSION Our review disclosed a paucity of quality data on PE in pediatric anti-NMDAR encephalitis. PE use in this condition has been increasingly reported, most often with steroids and IVIG. Despite the limited number of patients, our data seem to confirm the trend towards a better outcome when PE was administered early, and when given with steroids.
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Affiliation(s)
- Agnese Suppiej
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy.
| | - Margherita Nosadini
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Luigi Zuliani
- Department of Neurology, Ospedale Ca' Foncello, Treviso, Italy
| | - Maria Federica Pelizza
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Irene Toldo
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Chiara Bertossi
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
| | - Tiziana Tison
- Immunotransfusion Section, University Hospital of Padua, Italy
| | - Marco Zoccarato
- Department of Neurology, Ospedale Ca' Foncello, Treviso, Italy
| | - Piero Marson
- Immunotransfusion Section, University Hospital of Padua, Italy
| | - Bruno Giometto
- Department of Neurology, Ospedale Ca' Foncello, Treviso, Italy
| | - Russell C Dale
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia
| | - Stefano Sartori
- Pediatric Neurology Unit, Department of Woman's and Child's Health, University Hospital of Padua, Italy
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Benedetti L, Franciotta D, Zoccarato M, Beronio A, Godani M, Schirinzi E, Siciliano G, Ciarmiello A, Del Sette M. Post-therapy normalization of brain FDG-PET in Morvan's syndrome. J Neurol Sci 2015; 353:175-6. [DOI: 10.1016/j.jns.2015.03.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 03/13/2015] [Accepted: 03/20/2015] [Indexed: 11/25/2022]
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Zuliani L, Ferlazzo E, Andrigo C, Casano A, Cianci V, Zoccarato M, Leite MI, Waters P, Woodhall M, Della Mora E, Morra M, Giometto B, Aguglia U, Vincent A. Glycine receptor antibodies in 2 cases of new, adult-onset epilepsy. Neurol Neuroimmunol Neuroinflamm 2014; 1:e16. [PMID: 25340068 PMCID: PMC4202683 DOI: 10.1212/nxi.0000000000000016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 05/28/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Luigi Zuliani
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Edoardo Ferlazzo
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Cinzia Andrigo
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Alessandro Casano
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Vittoria Cianci
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Marco Zoccarato
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Maria Isabel Leite
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Patrick Waters
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Mark Woodhall
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Ernesto Della Mora
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Michele Morra
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Bruno Giometto
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Umberto Aguglia
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
| | - Angela Vincent
- Department of Neurology (L.Z., M.Z., B.G.), Ospedale Ca'Foncello, Treviso, Italy; Magna Græcia University of Catanzaro and Regional Epilepsy Centre, Bianchi-Melacrino-Morelli Hospital (E.F., V.C., U.A.), Reggio Calabria, Italy; Ospedale di Arzignano ULSS5 (C.A., A.C., E.D.M., M.M.) Ovest Vicentino, Italy; and Nuffield Department of Clinical Neurosciences (M.I.L., P.W., M.W., A.V.), University of Oxford, UK
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Mariotto S, Tamburin S, Salviati A, Ferrari S, Zoccarato M, Giometto B, Bertolasi L, Alessandrini F, Benedetti MD, Monaco S. Anti-N-methyl-d-aspartate receptor encephalitis causing a prolonged depressive disorder evolving to inflammatory brain disease. Case Rep Neurol 2014; 6:38-43. [PMID: 24707266 PMCID: PMC3975751 DOI: 10.1159/000358820] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a rapidly evolving condition that combines psychiatric and neurologic manifestations. Much remains unclear about its clinical onset and subsequent course. Although successful treatment depends on diagnosing the disorder early and therefore minimizing long-term complications, this is a difficult task owing to the atypical onset of this condition and the prolonged clinical course that has been observed in some patients. This report, illustrating a patient with slowly progressing psychiatric manifestations, unusual imaging and electrophysiological features, extends the information on varied clinical phenotypes. Case Report A 32-year-old woman suffered from an isolated depressive disorder for 4 months before undergoing psychiatric evaluation. During the following 5 months, she manifested hypersexuality, dysarthria, imbalance, dyskinesias and decreased word output. Brain magnetic resonance imaging (MRI) showed multifocal hyperintense T2/FLAIR lesions, a few contrast-enhanced, involving the corona radiata, the periventricular white matter, the deep gray nuclei, the optic nerves and the brainstem. MRI spectroscopy disclosed confluent bilateral demyelination and focal optic nerve involvement suggesting widespread encephalitis. Visual evoked potential studies indicated a demyelinating disorder. Serological screening and total body positron-emission tomography yielded negative findings for malignancies. Cerebrospinal fluid examination disclosed IgG oligoclonal bands and anti-NMDAR antibodies. Corticosteroids and intravenous immunoglobulin provided only slight improvement, whereas switching to cyclophosphamide markedly improved her neurological status. Conclusion In patients with a prolonged clinical course, including psychiatric and neurological symptoms, the differential diagnosis should be anti-NMDAR encephalitis. This report expands the known disease phenotypes in this emerging condition.
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Affiliation(s)
- Sara Mariotto
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Stefano Tamburin
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Alessandro Salviati
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Sergio Ferrari
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Marco Zoccarato
- Department of Neurology, Regional Hospital 'Ca' Foncello', Treviso, Italy
| | - Bruno Giometto
- Department of Neurology, Regional Hospital 'Ca' Foncello', Treviso, Italy
| | - Laura Bertolasi
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
| | - Franco Alessandrini
- Division of Neuroradiology, AOUI, Verona, Regional Hospital 'Ca' Foncello', Treviso, Italy
| | | | - Salvatore Monaco
- Department of Neurological and Movement Sciences, University of Verona, Treviso, Italy
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Zoccarato M, Zuliani L, Saddi M, Serra G, Pelizza M, Rosellini I, Peddone L, Ticca A, Giometto B. AQP4-neuromyelitis optica following NMDAR-encephalitis: A case report. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2296] [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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Zuliani L, Zoccarato M, Sartori S, Pelizza M, Rosellini I, Argentiero V, Marson P, Suppiej A, Giometto B. Anti-NMDAR encephalitis: Clinical and immunological characterization of a case series. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.2312] [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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Abstract
Paraneoplastic neurological syndromes (PNS) are remote effects of cancer that may involve any part of the nervous system. Rarity hinders their diagnosis and management and at least 60% of cases do not present a tumor at neurological symptoms onset. An important diagnostic element is detection, in patients' serum or cerebrospinal fluid, of onconeuronal antibodies which recognize antigens expressed by the nervous system and by neoplastic cells during de-differentiation. Their detection also implies that PNS have autoimmune origin and that immunomodulation could be an effective treatment. The lack of clinical trials due to the rarity of PNS makes it hard to test the efficacy of immunomodulatory therapy, but dividing the diseases into two groups permits preliminary analysis. A humoral immunoresponse prevails in group one and antibodies seem to have a pathogenetic role, indicating antibody removal strategies. Group two are mainly PNS of the central nervous system with autoantibodies directed against intracellular antigens, probably involving a cell-mediated mechanism. Immunotherapy with steroids or cytotoxic immunosuppressive agents may be useful here. Immunomodulatory treatment is always indicated when a tumor is not found but neurological symptoms are progressing, since first line treatment is tumor identification and, where possible, removal.
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Affiliation(s)
- Roberta Vitaliani
- Department of Neuroscience, University of Padova, Unità Operativa di Neurologia, Ospedale Regionale Ca' Foncello, 31100 Treviso, Italy.
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