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Mastrangelo A, Mammana A, Baiardi S, Tiple D, Colaizzo E, Rossi M, Vaianella L, Polischi B, Equestre M, Poleggi A, Capellari S, Ladogana A, Parchi P. Evaluation of the impact of CSF prion RT-QuIC and amended criteria on the clinical diagnosis of Creutzfeldt-Jakob disease: a 10-year study in Italy. J Neurol Neurosurg Psychiatry 2023; 94:121-129. [PMID: 36428087 DOI: 10.1136/jnnp-2022-330153] [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: 08/12/2022] [Accepted: 10/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The introduction of the prion Real-Time Quaking-Induced Conversion assay (RT-QuIC) has led to a revision of the diagnostic criteria for sporadic Creutzfeldt-Jakob disease (sCJD).Validation studies are needed for the amended criteria, especially for their diagnostic value in the clinical setting. METHODS We studied 1250 patients with suspected CJD referred for diagnosis to two Italian reference centres between 2010 and 2020. Focusing on the first diagnostic assessment, we compared the diagnostic value of the old and the amended criteria and that of different combinations of clinical variables and biomarker results. RESULTS The studied cohort comprised 850 participants with CJD (297 definite sCJD, 151 genetic CJD, 402 probable sCJD) and 400 with non-CJD (61 with neuropathology). At first clinical evaluation, the sensitivity of the old criteria (76.8%) was significantly lower than that of the amended criteria (97.8%) in the definite CJD cohort with no difference between definite and probable sCJD cases. Specificity was ~94% for both criteria against the non-CJD cohort (82.0% against definite non-CJD group). Cerebrospinal fluid (CSF) RT-QuIC was highly sensitive (93.9%) and fully specific against definite non-CJD patients. Limiting the criteria to a positive RT-QuIC or/and the combination of a clinical course compatible with possible CJD with a positive MRI (Q-CM criteria) provided higher diagnostic accuracy than both the old and amended criteria, overcoming the suboptimal specificity of ancillary test results (ie, CSF protein 14-3-3). CONCLUSIONS CSF RT-QuIC is highly sensitive and specific for diagnosing CJD in vitam. The Q-CM criteria provide a high diagnostic value for CJD.
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Affiliation(s)
- Andrea Mastrangelo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Angela Mammana
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Simone Baiardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Dorina Tiple
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Elisa Colaizzo
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Marcello Rossi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luana Vaianella
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Barbara Polischi
- IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Michele Equestre
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Anna Poleggi
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Sabina Capellari
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Anna Ladogana
- Department of Neuroscience, Istituto Superiore di Sanità, Roma, Italy
| | - Piero Parchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy .,IRCCS Istituto Delle Scienze Neurologiche di Bologna, Bologna, Italy
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Banerjee G, Samra K, Adams ME, Jaunmuktane Z, Parry-Jones AR, Grieve J, Toma AK, Farmer SF, Sylvester R, Houlden H, Rudge P, Mead S, Brandner S, Schott JM, Collinge J, Werring DJ. Iatrogenic cerebral amyloid angiopathy: an emerging clinical phenomenon. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-328792. [PMID: 35577510 DOI: 10.1136/jnnp-2022-328792] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/15/2022] [Indexed: 11/04/2022]
Abstract
In the last 6 years, following the first pathological description of presumed amyloid-beta (Aβ) transmission in humans (in 2015) and subsequent experimental confirmation (in 2018), clinical cases of iatrogenic cerebral amyloid angiopathy (CAA)-attributed to the transmission of Aβ seeds-have been increasingly recognised and reported. This newly described form of CAA is associated with early disease onset (typically in the third to fifth decade), and often presents with intracerebral haemorrhage, but also seizures and cognitive impairment. Although assumed to be rare, it is important that clinicians remain vigilant for potential cases, particularly as the optimal management, prognosis, true incidence and public health implications remain unknown. This review summarises our current understanding of the clinical spectrum of iatrogenic CAA and provides a diagnostic framework for clinicians. We provide clinical details for three patients with pathological evidence of iatrogenic CAA and present a summary of the published cases to date (n=20), identified following a systematic review. Our aims are: (1) To describe the clinical features of iatrogenic CAA, highlighting important similarities and differences between iatrogenic and sporadic CAA; and (2) To discuss potential approaches for investigation and diagnosis, including suggested diagnostic criteria for iatrogenic CAA.
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Affiliation(s)
- Gargi Banerjee
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Kiran Samra
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - Matthew E Adams
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Zane Jaunmuktane
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Adrian Robert Parry-Jones
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Joan Grieve
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ahmed K Toma
- Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Simon F Farmer
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Richard Sylvester
- Department of Neurology, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Henry Houlden
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK
| | - Peter Rudge
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Simon Mead
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - Sebastian Brandner
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
- Division of Neuropathology, National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan M Schott
- Department of Neurodegenerative Disease, UCL Queen Square Institute of Neurology, London, UK
| | - John Collinge
- MRC Prion Unit at UCL, Institute of Prion Diseases, London, UK
| | - David J Werring
- Stroke Research Centre, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology and National Hospital for Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
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3
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Kenny J, Woollacott I, Koriath C, Hosszu L, Adamson G, Rudge P, Rossor MN, Collinge J, Rohrer JD, Mead S. A novel prion protein variant in a patient with semantic dementia. J Neurol Neurosurg Psychiatry 2017; 88:890-892. [PMID: 28572272 PMCID: PMC5629930 DOI: 10.1136/jnnp-2017-315577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Joanna Kenny
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ione Woollacott
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Carolin Koriath
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Laszlo Hosszu
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Gary Adamson
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Martin N Rossor
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - John Collinge
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jonathan D Rohrer
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Simon Mead
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK.,NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
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Affiliation(s)
- Maurizio Pocchiari
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Ladogana
- Department of Cell Biology and Neurosciences, Istituto Superiore di Sanità, Rome, Italy
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Assar H, Topakian R, Weis S, Rahimi J, Trenkler J, Höftberger R, Aboulenein-Djamshidian F, Ströbel T, Budka H, Yull H, Head MW, Ironside JW, Kovacs GG. A case of variably protease-sensitive prionopathy treated with doxycyclin. J Neurol Neurosurg Psychiatry 2015; 86:816-8. [PMID: 25575846 DOI: 10.1136/jnnp-2014-309871] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [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: 11/06/2014] [Accepted: 12/19/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Hamid Assar
- Neuromedizinisches Ambulanzzentrum, State Neuropsychiatric Hospital Wagner-Jauregg, Medical School, Johannes Kepler University of Linz, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Serge Weis
- Laboratory of Neuropathology, Department of Pathology and Neuropathology, State Neuropsychiatric Hospital Wagner-Jauregg, Medical School, Johannes Kepler University of Linz, Linz, Austria
| | - Jasmin Rahimi
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
| | - Johannes Trenkler
- Institute of Radiology, State Neuropsychiatric Hospital Wagner-Jauregg, Medical School, Johannes Kepler University of Linz, Linz, Austria
| | - Romana Höftberger
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
| | - Fahmy Aboulenein-Djamshidian
- Department of Neurology, SMZ-Ost Donauspital, Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders, Vienna, Austria
| | - Thomas Ströbel
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
| | - Herbert Budka
- Institute of Neuropathology, University Hospital Zürich, Zürich, Switzerland
| | - Helen Yull
- National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - Mark W Head
- National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - James W Ironside
- National CJD Research & Surveillance Unit, University of Edinburgh, Edinburgh, UK
| | - Gabor G Kovacs
- Institute of Neurology, Medical University of Vienna and Austrian Reference Centre for Human Prion Diseases, Vienna, Austria
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Abstract
Recent advances in understanding amyotrophic lateral sclerosis (ALS) have delivered new questions. Disappointingly, the initial enthusiasm for transgenic mouse models of the disease has not been followed by rapid advances in therapy or prevention. Monogenic models may have inadvertently masked the true complexity of the human disease. ALS has evolved into a multisystem disorder, involving a final common pathway accessible via multiple upstream aetiological tributaries. Nonetheless, there is a common clinical core to ALS, as clear today as it was to Charcot and others. We stress the continuing relevance of clinical observations amid the increasing molecular complexity of ALS.
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Affiliation(s)
- Martin R Turner
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Michael Swash
- Queen Mary University of London, London, UK University of Lisbon, Lisbon, Portugal
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Rossi M, Mead S, Collinge J, Rudge P, Vincent A. Neuronal antibodies in patients with suspected or confirmed sporadic Creutzfeldt-Jakob disease. J Neurol Neurosurg Psychiatry 2015; 86:692-4. [PMID: 25246643 PMCID: PMC4453627 DOI: 10.1136/jnnp-2014-308695] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 08/14/2014] [Accepted: 08/31/2014] [Indexed: 01/28/2023]
Abstract
OBJECTIVES There have been reports of patients with antibodies to neuronal antigens misdiagnosed as sporadic Creutzfeldt-Jakob disease (sCJD). Conversely, low levels of antibodies to neuronal proteins have been reported in patients with sCJD. However, the frequency of misdiagnoses, or of antibodies in patients with subsequently confirmed sCJD, is not clear. METHODS We reviewed 256 consecutive cases of sCJD seen in the National Prion Clinic, of whom 150 had sera previously referred for selected antibody tests. Eighty-two available samples were retested for antibodies to N-methyl-d-aspartate receptor (NMDAR), the glycine receptor (GlyR), voltage-gated potassium channel (VGKC)-complex and the associated proteins, leucine-rich glioma inactivated 1 (LGI1) and contactin-associated protein 2 (CASPR2). RESULTS Four of the initial 150 sera referred were positive; two had antibodies to NMDAR, and two to the VGKC-complex, one of which was also positive for GlyR antibodies. Of the 82 sCJD sera retested, one had VGKC-complex antibodies confirming the previous result, two had CASPR2 and GlyR antibodies and one had CASPR2 and NMDAR antibodies; all antibodies were at low levels. Over the same period three patients with autoimmune encephalitis and high VGKC-complex antibodies were initially referred as sCJD. CONCLUSIONS This study indicates that <5% patients with sCJD develop serum antibodies to these neuronal antigens and, when positive, only at low titres. By contrast, three patients referred with possible prion disease had a clinical picture in keeping with autoimmune encephalitis and very high VGKC-complex/LGI1 antibodies. Low titres of neuronal antibodies occur only rarely in suspected patients with sCJD and when present should be interpreted with caution.
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Affiliation(s)
- Meghan Rossi
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Simon Mead
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - John Collinge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Peter Rudge
- NHS National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, UK
- MRC Prion Unit, Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Newman PK, Todd NV, Scoones D, Mead S, Knight RSG, Will RG, Ironside JW. Postmortem findings in a case of variant Creutzfeldt-Jakob disease treated with intraventricular pentosan polysulfate. J Neurol Neurosurg Psychiatry 2014; 85:921-4. [PMID: 24554103 PMCID: PMC4112497 DOI: 10.1136/jnnp-2013-305590] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 10/29/2013] [Accepted: 01/23/2014] [Indexed: 12/04/2022]
Abstract
BACKGROUND A small number of patients with variant Creutzfeldt-Jakob disease (vCJD) have been treated with intraventicular pentosan polysulfate (iPPS) and extended survival has been reported in some cases. To date, there have been no reports on the findings of postmortem examination of the brain in treated patients and the reasons for the extended survival are uncertain. We report on the neuropathological findings in a case of vCJD treated with PPS. METHODS Data on survival in vCJD is available from information held at the National CJD Research and Surveillance Unit and includes the duration of illness in 176 cases of vCJD, five of which were treated with iPPS. One of these individuals, who received iPPS for 8 years and lived for 105 months, underwent postmortem examination, including neuropathological examination of the brain. RESULTS The mean survival in vCJD is 17 months, with 40 months the maximum survival in patients not treated with PPS. In the 5 patients treated with PPS survival was 16 months, 45 months, 84 months, 105 months and 114 months. The patient who survived 105 months underwent postmortem examination which confirmed the diagnosis of vCJD and showed severe, but typical, changes, including neuronal loss, astrocytic gliosis and extensive prion protein (PrP) deposition in the brain. The patient was also given PPS for a short period by peripheral infusion and there was limited PrP immunostaining in lymphoreticular tissues such as spleen and appendix. CONCLUSIONS Treatment with iPPS did not reduce the overall neuropathological changes in the brain. The reduced peripheral immunostaining for PrP may reflect atrophy of these tissues in relation to chronic illness rather than a treatment effect. The reason for the long survival in patients treated with iPPS is unclear, but a treatment effect on the disease process cannot be excluded.
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Affiliation(s)
- P K Newman
- Department of Neurology, James Cook University Hospital, Middlesborough, UK
| | - N V Todd
- Department of Neurosurgery, Northern Medical Services, Newcastle, UK
| | - D Scoones
- Department of Neurology, James Cook University Hospital, Middlesborough, UK
| | - S Mead
- National Prion Clinic, London, UK
| | - R S G Knight
- National CJD Research and Surveillance Unit, Western General Hospital, Edinburgh, UK
| | - R G Will
- National CJD Research and Surveillance Unit, Western General Hospital, Edinburgh, UK
| | - J W Ironside
- National CJD Research and Surveillance Unit, Western General Hospital, Edinburgh, UK
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