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Afanasiev V, Tsouni P, Kuntzer T, Cairoli A, Delmont E, Vallat JM, Devaux J, Théaudin M. Successful autologous hematopoietic stem cell transplantation in a refractory anti-Caspr1 antibody nodopathy. J Peripher Nerv Syst 2024; 29:116-119. [PMID: 38123899 DOI: 10.1111/jns.12610] [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: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
AIM Autoimmune nodopathies have specific clinicopathologic features, antibodies directed against nodal proteins (neurofascin 186) or paranodal proteins (neurofascin 155, contactin 1, contactin-associated protein 1 (Caspr1)), and usually have a poor response to first-line therapies for chronic inflammatory demyelinating polyradiculoneuropathy. Anti-Caspr1 nodopathy treated with autologous hematopoietic stem cell transplantation (AHSCT) has not been previously reported. METHODS We report the first case of an anti-Caspr1 antibody-positive nodopathy refractory to high-intensity immunosuppressive treatment, including rituximab, that responded dramatically to AHSCT. RESULTS A 53-year-old woman presented with a rapidly progressive generalized ataxic, painful motor, and inflammatory neuropathy supported by neurophysiologic and MRI studies. Initial tests for antibodies to nodal/paranodal proteins were negative. She was treated with multiple courses of intravenous immunoglobulin and methylprednisolone, plasma exchange, rituximab, and cyclophosphamide without significant clinical benefit. Repeated testing for antibodies to nodal/paranodal proteins yielded a positive result for anti-Caspr1/IgG4 isotype antibodies. Given the poor response to multiple high intensity treatments and the relatively young age of the patient, we decided to perform AHSCT at 30 months post-onset. Immediately after AHSCT, she stopped all immunomodulatory or immunosuppressive therapy. The Overall Neuropathy Limitation Score improved from 8/12 to 4/12 at 6 months post-AHSCT. At 3 months post-AHSCT, IgG4 against Caspr1 was negative and no reactivity against paranodes could be detected. CONCLUSION We report a particularly severe anti-Caspr1 antibody autoimmune nodopathy that responded dramatically to AHSCT. Although the rarity of the disease limits the possibility of larger studies, AHSCT may be a valuable therapy in treatment-refractory cases.
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Affiliation(s)
- Vadim Afanasiev
- Department of Neurology, Neurocentre, Hôpital du Valais, Sion, Switzerland
| | - Pinelopi Tsouni
- Department of Neurology, Neurocentre, Hôpital du Valais, Sion, Switzerland
| | - Thierry Kuntzer
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Anne Cairoli
- Department of Hematology, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Jean-Michel Vallat
- Department and Laboratory of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges), Limoges, France
| | - Jérôme Devaux
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Marie Théaudin
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
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Ripellino P, Lascano AM, Scheidegger O, Schilg-Hafer L, Schreiner B, Tsouni P, Vicino A, Peyer AK, Humm AM, Décard BF, Pianezzi E, Zezza G, Sparasci D, Hundsberger T, Dietmann A, Jung H, Kuntzer T, Wilder-Smith E, Martinetti-Lucchini G, Petrini O, Fontana S, Gowland P, Niederhauser C, Gobbi C. Neuropathies related to hepatitis E virus infection: A prospective, matched case-control study. Eur J Neurol 2024; 31:e16030. [PMID: 37548584 DOI: 10.1111/ene.16030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/11/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Acute hepatitis E virus (HEV) infection has recently emerged as a potential trigger for acute dysimmune neuropathies, but prospective controlled studies are lacking. AIMS To compare the frequency of concomitant acute HEV infection in patients with neuralgic amyotrophy (NA), Guillain-Barré syndrome (GBS), and Bell's palsy with a matched control population. METHODS Swiss multicenter, prospective, observational, matched case-control study over 3 years (September 2019-October 2022). Neurological cases with NA, GBS, or Bell's palsy were recruited within 1 month of disease onset. Healthy controls were matched for age, sex, geographical location, and timing of blood collection. Diagnostic criteria for acute hepatitis E were reactive serum anti-HEV IgM and IgG assays (ELISA test) and/or HEV RNA detection in serum by real-time polymerase chain reaction (RT-PCR). RT-PCR was performed on sera to confirm IgM positivity. RESULTS We included 180 patients (59 GBS, 51 NA, 70 Bell's palsy cases) and corresponding matched controls (blood donors) with median age 51 years for both groups and equal gender distribution. Six IgM+ cases were detected in the NA, two in the GBS, and none in the Bell's palsy group. Two controls were anti-HEV IgM-positive. At disease onset, most cases with acute HEV infection had increased liver enzymes. A moderate association (p = 0.027, Fisher's exact test; Cramér's V = -0.25) was observed only between acute HEV infection and NA. CONCLUSION This prospective observational study suggests an association between concomitant acute HEV infection and NA, but not with GBS or Bell's palsy.
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Affiliation(s)
- Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Agustina Maria Lascano
- Neurology Division, Department of Clinical Neuroscience, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | | | - Bettina Schreiner
- Department of Neurology, University and Hospital Zurich, Zurich, Switzerland
| | | | - Alex Vicino
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne-Kathrin Peyer
- Cantonal Hospital, Lucerne, Switzerland
- Neuroliestal, Liestal, Switzerland
| | - Andrea Monika Humm
- Department of Medicine, Neurology Unit, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland
| | | | - Enea Pianezzi
- Laboratory of Microbiology EOC, Bellinzona, Switzerland
| | - Giulia Zezza
- Laboratory of Microbiology EOC, Bellinzona, Switzerland
| | - Davide Sparasci
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
| | | | - Anelia Dietmann
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Hans Jung
- Department of Neurology, University and Hospital Zurich, Zurich, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Einar Wilder-Smith
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
- Cantonal Hospital, Lucerne, Switzerland
| | | | - Orlando Petrini
- University of Applied Sciences and Arts of Southern Switzerland, Bellinzona, Switzerland
| | - Stefano Fontana
- Blood Transfusion Service SRC Southern Switzerland, Lugano, Switzerland
- Interregional Blood Transfusion SRC, Bern, Switzerland
| | - Peter Gowland
- Interregional Blood Transfusion SRC, Bern, Switzerland
| | - Christoph Niederhauser
- Interregional Blood Transfusion SRC, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Claudio Gobbi
- Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Feilchenfeldt-Maharoof S, Schaller MD, Berger MM, Tsouni P, Kuntzer T, Ben-Hamouda N. Foodborne botulism, a forgotten yet life-threatening disease: a case report. Eur Rev Med Pharmacol Sci 2022; 26:4770-4773. [PMID: 35856369 DOI: 10.26355/eurrev_202207_29202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Botulism is a very rare disease in Switzerland, with less than one case per year, an incidence of 0.01 cases for 100,000 inhabitants. Indeed, over the past ten years, 9 cases have been reported to Public Health registry. Foodborne botulism (FB) is caused by ingestion of preformed botulinum neurotoxin. Characteristic features should be rapidly recognized, and prompt treatment should be administered to avoid further progression towards respiratory failure and death. CASE REPORT We report the case of a patient who developed gastrointestinal symptoms just after a sandwich consumption followed by rapidly progressive cranial nerve impairment, truncal muscle weakness in a descending pattern and respiratory failure requiring mechanical ventilation. The diagnosis of foodborne botulism was delayed due to differential diagnosis considerations. Specific antitoxin therapy was administered immediately after firm clinical conviction of botulism, without waiting for serologic results that later confirmed the diagnosis. As expected, muscle weakness recovery was slow, with persistent chronic deficits nine years later. CONCLUSIONS This case highlights differential diagnosis issues of botulism. These include acute neuromuscular disorders such as myasthenia gravis, Guillain-Barré syndrome, or tick-borne encephalitis. The importance of careful medical history and repeated clinical evaluation to avoid misdiagnosis can be lifesaving. Our case highlights the typical warning signs.
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Affiliation(s)
- S Feilchenfeldt-Maharoof
- Department of Adult Intensive Care Medicine, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
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Luijten LWG, Leonhard SE, van der Eijk AA, Doets AY, Appeltshauser L, Arends S, Attarian S, Benedetti L, Briani C, Casasnovas C, Castellani F, Dardiotis E, Echaniz-Laguna A, Garssen MPJ, Harbo T, Huizinga R, Humm AM, Jellema K, van der Kooi AJ, Kuitwaard K, Kuntzer T, Kusunoki S, Lascano AM, Martinez-Hernandez E, Rinaldi S, Samijn JPA, Scheidegger O, Tsouni P, Vicino A, Visser LH, Walgaard C, Wang Y, Wirtz PW, Ripellino P, Jacobs BC. Guillain-Barré syndrome after SARS-CoV-2 infection in an international prospective cohort study. Brain 2021; 144:3392-3404. [PMID: 34553216 PMCID: PMC8677532 DOI: 10.1093/brain/awab279] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/29/2021] [Accepted: 07/04/2021] [Indexed: 12/22/2022] Open
Abstract
In the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, an increasing number of patients with neurological disorders, including Guillain-Barré syndrome (GBS), have been reported following this infection. It remains unclear, however, if these cases are coincidental or not, as most publications were case reports or small regional retrospective cohort studies. The International GBS Outcome Study is an ongoing prospective observational cohort study enrolling patients with GBS within 2 weeks from onset of weakness. Data from patients included in this study, between 30 January 2020 and 30 May 2020, were used to investigate clinical and laboratory signs of a preceding or concurrent SARS-CoV-2 infection and to describe the associated clinical phenotype and disease course. Patients were classified according to the SARS-CoV-2 case definitions of the European Centre for Disease Prevention and Control and laboratory recommendations of the World Health Organization. Forty-nine patients with GBS were included, of whom eight (16%) had a confirmed and three (6%) a probable SARS-CoV-2 infection. Nine of these 11 patients had no serological evidence of other recent preceding infections associated with GBS, whereas two had serological evidence of a recent Campylobacter jejuni infection. Patients with a confirmed or probable SARS-CoV-2 infection frequently had a sensorimotor variant 8/11 (73%) and facial palsy 7/11 (64%). The eight patients who underwent electrophysiological examination all had a demyelinating subtype, which was more prevalent than the other patients included in the same time window [14/30 (47%), P = 0.012] as well as historical region and age-matched control subjects included in the International GBS Outcome Study before the pandemic [23/44 (52%), P = 0.016]. The median time from the onset of infection to neurological symptoms was 16 days (interquartile range 12-22). Patients with SARS-CoV-2 infection shared uniform neurological features, similar to those previously described in other post-viral GBS patients. The frequency (22%) of a preceding SARS-CoV-2 infection in our study population was higher than estimates of the contemporaneous background prevalence of SARS-CoV-2, which may be a result of recruitment bias during the pandemic, but could also indicate that GBS may rarely follow a recent SARS-CoV-2 infection. Consistent with previous studies, we found no increase in patient recruitment during the pandemic for our ongoing International GBS Outcome Study compared to previous years, making a strong relationship of GBS with SARS-CoV-2 unlikely. A case-control study is required to determine if there is a causative link or not.
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Affiliation(s)
- Linda W G Luijten
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Sonja E Leonhard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Annemiek A van der Eijk
- Department of Viroscience, Unit Clinical Virology, Erasmus MC, University Medical Center Rotterdam, 3015 CN, Rotterdam, The Netherlands
| | - Alex Y Doets
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | | | - Samuel Arends
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Shahram Attarian
- Reference Center for Neuromuscular Disorders and ALS, Hôpital de La Timone, 13005 Marseille, France
| | - Luana Benedetti
- Department of Neurology, IRCCS Ospedale Policlinico, San Martino, Genova, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Carlos Casasnovas
- Neuromuscular Unit, Department of Neurology, Bellvitge University Hospital, Neurometabolic Diseases Group, IDIBELL and CIBERER, Barcelona, Spain
| | - Francesca Castellani
- Neurology Unit, Department of Neuroscience, University of Padova, 35128 Padova, Italy
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, 41110 Larissa, Greece
| | | | - Marcel P J Garssen
- Department of Neurology, Jeroen Bosch Hospital, 5223 GZ ‘s-Hertogenbosch, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Ruth Huizinga
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Andrea M Humm
- Unit of Neurology, Department of Internal Medicine, HFR Fribourg—Hôpital Cantonal, CH-1708 Fribourg, Switzerland
| | - Korné Jellema
- Department of Neurology, Haaglanden Medical Center, 2512 VA, Den Haag, The Netherlands
| | - Anneke J van der Kooi
- Department of Neurology, Amsterdam University Medical Center, Location AMC, University of Amsterdam, Neuroscience institute, 1105 AZ Amsterdam, The Netherlands
| | - Krista Kuitwaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Thierry Kuntzer
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama City, Osaka 589-8511, Japan
| | - Agustina M Lascano
- Department of Neurology, Geneva University Hospitals and University of Geneva, 1205 Geneva, Switzerland
| | | | - Simon Rinaldi
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, OX3 9DU Oxford, UK
| | - Johnny P A Samijn
- Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Olivier Scheidegger
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Pinelopi Tsouni
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland,Department of Neurology, Hôpital du Valais, 1950 Sion, Switzerland
| | - Alex Vicino
- Nerve-muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital CHUV and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Leo H Visser
- Department of Neurology, St. Elisabeth-TweeSteden Hospital, 5022 GC, Tilburg, The Netherlands
| | - Christa Walgaard
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Neurology, Maasstad Hospital, 3079 DZ Rotterdam, The Netherlands
| | - Yuzhong Wang
- Department of Neurology, Affiliated Hospital of Jining Medical University, 272029 Jining, China
| | - Paul W Wirtz
- Department of Neurology, Haga Hospital, 2545 AA Den Haag, The Netherlands
| | - Paolo Ripellino
- Department of Neurology, Neurocenter of Southern Switzerland, 6903 Lugano, Switzerland
| | - Bart C Jacobs
- Department of Neurology, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands,Department of Immunology, Erasmus MC, University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands,Correspondence to: Bart C. Jacobs, MD, PhD Departments of Neurology and Immunology, Erasmus MC University Medical Center Rotterdam, Room number: EE-2289 Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands E-mail:
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Aliu B, Demeestere D, Seydoux E, Boucraut J, Delmont E, Brodovitch A, Oberholzer T, Attarian S, Théaudin M, Tsouni P, Kuntzer T, Derfuss T, Steck AJ, Ernst B, Herrendorff R, Hänggi P. Selective inhibition of anti-MAG IgM autoantibody binding to myelin by an antigen-specific glycopolymer. J Neurochem 2020; 154:486-501. [PMID: 32270492 PMCID: PMC7497077 DOI: 10.1111/jnc.15021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/11/2020] [Accepted: 03/18/2020] [Indexed: 12/13/2022]
Abstract
Anti‐myelin‐associated glycoprotein (MAG) neuropathy is a disabling autoimmune peripheral neuropathy that is caused by circulating monoclonal IgM autoantibodies directed against the human natural killer‐1 (HNK‐1) epitope. This carbohydrate epitope is highly expressed on adhesion molecules such as MAG, a glycoprotein present in myelinated nerves. We previously showed the therapeutic potential of the glycopolymer poly(phenyl disodium 3‐O‐sulfo‐β‐d‐glucopyranuronate)‐(1→3)‐β‐d‐galactopyranoside (PPSGG) in selectively neutralizing anti‐MAG IgM antibodies in an immunological mouse model and ex vivo with sera from anti‐MAG neuropathy patients. PPSGG is composed of a biodegradable backbone that multivalently presents a mimetic of the HNK‐1 epitope. In this study, we further explored the pharmacodynamic properties of the glycopolymer and its ability to inhibit the binding of anti‐MAG IgM to peripheral nerves. The polymer selectively bound anti‐MAG IgM autoantibodies and prevented the binding of patients’ anti‐MAG IgM antibodies to myelin of non‐human primate sciatic nerves. Upon PPSGG treatment, neither activation nor inhibition of human and murine peripheral blood mononuclear cells nor alteration of systemic inflammatory markers was observed in mice or ex vivo in human peripheral blood mononuclear cells. Intravenous injections of PPSGG to mice immunized against the HNK‐1 epitope removed anti‐MAG IgM antibodies within less than 1 hr, indicating a fast and efficient mechanism of action as compared to a B‐cell depletion with anti‐CD20. In conclusion, these observations corroborate the therapeutic potential of PPSGG for an antigen‐specific treatment of anti‐MAG neuropathy. ![]()
Read the Editorial Highlight for this article on page 465.
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Affiliation(s)
- Butrint Aliu
- Institute of Molecular Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Delphine Demeestere
- Institute of Molecular Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | | | - José Boucraut
- Immunology laboratory, AP-HM, Marseille, France.,INT, UMR CNRS 7289, Aix-Marseille University, Marseille, France
| | - Emilien Delmont
- Center for Neuromuscular Disorders and ALS La Timone Hospital, AP-HM, Marseille, France
| | - Alexandre Brodovitch
- Immunology laboratory, AP-HM, Marseille, France.,Center for Neuromuscular Disorders and ALS La Timone Hospital, AP-HM, Marseille, France
| | | | - Shahram Attarian
- Center for Neuromuscular Disorders and ALS La Timone Hospital, AP-HM, Marseille, France
| | - Marie Théaudin
- Nerve-Muscle Unit, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Pinelopi Tsouni
- Nerve-Muscle Unit, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Service of Neurology, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Tobias Derfuss
- Clinic of Neurology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Andreas J Steck
- Clinic of Neurology, Department of Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Beat Ernst
- Institute of Molecular Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Ruben Herrendorff
- Institute of Molecular Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Polyneuron Pharmaceuticals AG, Basel, Switzerland
| | - Pascal Hänggi
- Institute of Molecular Pharmacy, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Polyneuron Pharmaceuticals AG, Basel, Switzerland
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Di Virgilio G, Grapperon AM, Fayerstein J, Goudot M, Nollet S, Ochsner F, Théaudin M, Truffert A, Tsouni P, Vial C, Wang FC, Pasquier J, Tatu L, Attarian S, Kuntzer T. Ulnar neuropathy at the elbow: Reappraisal of the wrist-upper arm latency difference between ulnar and median nerves. Clin Neurophysiol 2019; 131:372-376. [PMID: 31865138 DOI: 10.1016/j.clinph.2019.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 03/13/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the sensitivity and specificity of the latency difference (DLat) between ulnar and median nerves of the arm after stimulation at the wrist; one of the easiest techniques proposed for recognizing ulnar neuropathy at the elbow (UNE). As latency difference is not a standardized technique, we set up a multicenter study to recruit large numbers of normal subjects and patients with UNE or generalized neuropathy. METHODS Six centers participated in the study with data obtained from three groups of participants, controls (CTRLs), patients with UNE and patients with generalized neuropathy (GNP). We first verified the anatomical superposition of the ulnar and median nerves in cadaver examination. The optimal recording site for these two nerves was found to be 10 cm above the medial epicondyle. We then standardized the position of the arm with full extension of the elbow and stimulated first the median and then the ulnar nerves at the wrist. CTRLs were examined on both arms at two consecutive visits. RESULTS We recorded 32 idiopathic UNE cases, 44 GNP patients and 62 controls. We demonstrated that a DLat cut-off value of 0.69 ms brings a sensitivity of 0.86 and specificity of 0.89 to discriminate CTRLs from UNE. We also validated that intra-examiner reproducibility was good. CONCLUSION We report a lower normal value for DLat than reported in several non-standardized studies and CTRL and UNE groups have clearly separated DLat values. SIGNIFICANCE Due to its high sensitivity, our standardized technique could be used as a first-line diagnostic tool when UNE is suspected.
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Affiliation(s)
- G Di Virgilio
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - A M Grapperon
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France
| | - J Fayerstein
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France
| | - M Goudot
- Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - S Nollet
- Service de Neurologie-Électrophysiologie clinique, University Hospital (CHRU), Besançon, France
| | - F Ochsner
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - M Théaudin
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - A Truffert
- Unité de Neuroimmunologie et des maladies Neuromusculaires, Hôpitaux Universitaires de Genève (HUG), Switzerland
| | - P Tsouni
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; Unité de Neuroimmunologie et des maladies Neuromusculaires, Hôpitaux Universitaires de Genève (HUG), Switzerland
| | - C Vial
- Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - F C Wang
- Neurophysiology Department, CHU Sart Tilman, Liège, Belgium
| | - J Pasquier
- Département Formation, Recherche et Innovation, Centre universitaire de médecine générale et santé publique, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - L Tatu
- Service de Neurologie-Électrophysiologie clinique, University Hospital (CHRU), Besançon, France
| | - S Attarian
- Reference Center for Neuromuscular Disorders and ALS, CHU La Timone, Aix-Marseille University, Marseille, France
| | - T Kuntzer
- Unité Nerf-Muscle, Service de Neurologie, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland.
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7
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Royer‐Bertrand B, Tsouni P, Mullen P, Campos Xavier B, Mittaz Crettol L, Lobrinus AJ, Ghika J, Baumgartner MR, Rivolta C, Superti‐Furga A, Kuntzer T, Francklyn C, Tran C. Peripheral neuropathy and cognitive impairment associated with a novel monoallelic HARS variant. Ann Clin Transl Neurol 2019; 6:1072-1080. [PMID: 31211171 PMCID: PMC6562026 DOI: 10.1002/acn3.791] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/20/2019] [Accepted: 04/05/2019] [Indexed: 12/31/2022] Open
Abstract
Background A 49‐year‐old male presented with late‐onset demyelinating peripheral neuropathy, cerebellar atrophy, and cognitive deficit. Nerve biopsy revealed intra‐axonal inclusions suggestive of polyglucosan bodies, raising the suspicion of adult polyglucosan bodies disease (OMIM 263570). Methods and Results While known genes associated with polyglucosan bodies storage were negative, whole‐exome sequencing identified an unreported monoallelic variant, c.397G>T (p.Val133Phe), in the histidyl‐tRNA synthetase (HARS) gene. While we did not identify mutations in genes known to be associated with polygucosan body disease, whole‐exome sequencing revealed an unreported monoallelic variant, c.397G>T in the histidyl‐tRNA synthetase (HARS) gene, encoding a substitution (Val133Phe) in the catalytic domain. Expression of this variant in patient cells resulted in reduced aminoacylation activity in extracts obtained from dermal fibroblasts, without compromising overall protein synthesis. Interpretation Genetic variants in the genes coding for the different aminoacyl‐tRNA synthases are associated with various clinical conditions. To date, a number of HARS variant have been associated with peripheral neuropathy, but not cognitive deficits. Further studies are needed to explore why HARS mutations confer a neuronal‐specific phenotype.
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Affiliation(s)
- Béryl Royer‐Bertrand
- Division of Genetic MedicineLausanne University Hospital (CHUV)LausanneSwitzerland
- Department of Computational BiologyUnit of Medical GeneticsUniversity of LausanneLausanneSwitzerland
| | - Pinelopi Tsouni
- Nerve‐Muscle UnitDepartment of Clinical NeurosciencesLausanne University Hospital (CHUV)LausanneSwitzerland
- Leenaards Memory CentreDepartment of Clinical NeurosciencesLausanne University Hospital (CHUV)LausanneSwitzerland
| | - Patrick Mullen
- Department of BiochemistryLarner College of MedicineUniversity of VermontBurlingtonVermont
| | | | | | | | - Joseph Ghika
- Leenaards Memory CentreDepartment of Clinical NeurosciencesLausanne University Hospital (CHUV)LausanneSwitzerland
| | - Matthias R. Baumgartner
- Division of Metabolism and Children's Research Center (CRC)University Children's HospitalZurichSwitzerland
- radiz ‐ Rare Disease Initiative ZurichClinical Research Priority Program for Rare DiseasesUniversity of ZurichZurichSwitzerland
| | - Carlo Rivolta
- Department of Computational BiologyUnit of Medical GeneticsUniversity of LausanneLausanneSwitzerland
- Department of Genetics and Genome BiologyUniversity of LeicesterLeicesterUnited Kingdom
| | - Andrea Superti‐Furga
- Division of Genetic MedicineLausanne University Hospital (CHUV)LausanneSwitzerland
| | - Thierry Kuntzer
- Nerve‐Muscle UnitDepartment of Clinical NeurosciencesLausanne University Hospital (CHUV)LausanneSwitzerland
| | - Christopher Francklyn
- Department of BiochemistryLarner College of MedicineUniversity of VermontBurlingtonVermont
| | - Christel Tran
- Division of Genetic MedicineLausanne University Hospital (CHUV)LausanneSwitzerland
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Cuendet D, Sarro R, Merz L, Jiménez MC, Maeder P, Du Pasquier R, Tsouni P. An unusual case of miliary PML-IRIS in an HIV+ patient. Neurol Neuroimmunol Neuroinflamm 2017. [PMID: 28638853 PMCID: PMC5473180 DOI: 10.1212/nxi.0000000000000370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- David Cuendet
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
| | - Rossella Sarro
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
| | - Laurent Merz
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
| | - Mayté Castro Jiménez
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
| | - Philippe Maeder
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
| | - Renaud Du Pasquier
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
| | - Pinelopi Tsouni
- Division of Neurology (D.C., M.C.J., R.D.P., P.T.), Department of Clinical Neurosciences, Department of Pathology (R.S.), Department of Infectious Diseases (L.M.), and Department of Radiology (P.M.), Lausanne University Hospital (CHUV), Switzerland
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Tsouni P, Lobrinus JA, Steck AJ, Kuntzer T. Sensory mononeuritis: differentiating pure neural leprosy from non-systemic vasculitic neuropathy. LEPROSY REV 2017. [DOI: 10.47276/lr.88.2.274] [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: 11/04/2022]
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Tsouni P, Bill O, Truffert A, Liaudat C, Ochsner F, Steck AJ, Kuntzer T. Anti-TNF alpha medications and neuropathy. J Peripher Nerv Syst 2016; 20:397-402. [PMID: 26309233 DOI: 10.1111/jns.12147] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [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: 07/31/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/26/2022]
Abstract
We studied the clinical, electrophysiological, and pathological features, outcome, and frequency of anti-tumor necrosis factor alpha (a-TNF) medications-induced neuropathies (ATIN) in patients with inflammatory disorders. Of 2,017 patients treated with a-TNF medication, 12 patients met our inclusion criteria for a prevalence of 0.60% and an incidence of 0.4 cases per 1,000 person-years. The median time from a-TNF medication treatment to ATIN was 16.8 months (range 2-60 months). Six patients had focal or multifocal peripheral neuropathies. The other six had generalized neuropathies. For all, a-TNF medication was stopped. Seven patients received immunoglobulin infusions. ATIN outcome was favorable in all but one patient. ATINs are rare and heterogeneous neuropathies. In 10 patients, the neuropathy was "inflammatory", suggesting that it could be due to systemic pro-inflammatory effects of a-TNF agents.
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Affiliation(s)
- Pinelopi Tsouni
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Olivier Bill
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - André Truffert
- Division of Neurology, Department of Clinical Neurosciences, University Hospital of Geneva (HUG), Geneva, Switzerland
| | - Christelle Liaudat
- Department of Rheumatology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - François Ochsner
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Andreas J Steck
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland.,Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Thierry Kuntzer
- Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Silva M, Wicki B, Tsouni P, Cunningham S, Doerig C, Zanetti G, Aubert V, Sahli R, Moradpour D, Kuntzer T. Hepatitis E virus infection as a direct cause of neuralgic amyotrophy. Muscle Nerve 2016; 54:325-7. [PMID: 26939568 DOI: 10.1002/mus.25096] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 12/19/2022]
Abstract
INTRODUCTION We describe a patient who developed neuralgic amyotrophy (NA) related to hepatitis E virus (HEV) infection. METHODS The patient underwent neurological and electrodiagnostic examinations, high-resolution analysis of serological changes, and HEV load profile, and was treated with intravenous immunoglobulin. RESULTS There was evidence of bilateral, asymmetric acute inflammatory cervical polyradiculopathy and possible brachial plexopathy. Positive serum anti-HEV IgM was followed by seroconversion to anti-HEV IgG positivity. A calculated anti-HEV antibody index was compatible with intrathecal synthesis, and HEV genotype 3 RNA was found in serum and cerebrospinal fluid (CSF). Liver function tests returned to normal within 6 weeks. CONCLUSIONS Bilateral involvement of cervical nerve roots and/or plexus, elevated liver function tests, and abnormal CSF are typical features of HEV-associated NA. The pathogenesis involves possible immune-mediated mechanisms. However, our findings support the hypothesis that HEV-related NA is associated with direct infection. Muscle Nerve 54: 325-327, 2016.
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Affiliation(s)
- Mauro Silva
- Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Benoît Wicki
- Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Pinelopi Tsouni
- Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Sophie Cunningham
- Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Christopher Doerig
- Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Giorgio Zanetti
- Service of Infectious Diseases, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.,Service of Hospital Preventive Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Vincent Aubert
- Service of Immunology and Allergy, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Roland Sahli
- Institute of Microbiology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Darius Moradpour
- Service of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Thierry Kuntzer
- Service of Neurology, Department of Clinical Neurosciences, University Hospital Lausanne (CHUV), Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
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Nemitz I, Tsouni P, Kuntzer T. [Not Available]. Rev Med Suisse 2016; 12:1245-1247. [PMID: 27506071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Tsouni P, Panaite PA, Puttini S, Kuntzer T, Steck AJ. Intravenous Immunoglobulins Lower Inflammatory Gene Expression in Skin Biopsies of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Patients. Eur Neurol 2016; 75:290-1. [PMID: 27286956 DOI: 10.1159/000447127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 05/17/2016] [Indexed: 11/19/2022]
Affiliation(s)
- Pinelopi Tsouni
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Neurology Service, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Tsouni P, Kuntzer T, Ochsner F. [Neurological manifestations in musculoskeletal disorders]. Rev Med Suisse 2014; 10:966-969. [PMID: 24834619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Musculoskeletal disorders are a crossroad among diverse specialties: neurology, rehabilitation, orthopedics, occupational medicine and psycho-traumatology. They are integrated into occupational medicine and encompass overuse syndromes, repeated micro-trauma and focal compressive neuropathies linked with professional or sports' activity. Neurological manifestations are omnipresent. Yet, their importance is not always recognized despite frequent resort to neurologists specialized in peripheral nervous system disorders and neurophysiology, as well as, to behavioral cognition specialists. Therapeutic approaches require preventive and work organization measures, neurophysiologic investigations and imaging in expert hands, and conservative treatment with physiotherapy, with or without paraneural and intra-articular injections.
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Tsouni P, Bill O, Benninger D, Ochsner F, Kuntzer T. Neuropathies induites par les agents immunosuppresseurs. Rev Neurol (Paris) 2014. [DOI: 10.1016/j.neurol.2014.01.168] [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: 11/17/2022]
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