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Journal of Neurology, Neurosurgery, and... Dec 2022The diagnostic value of new criteria of the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) for chronic inflammatory demyelinating polyneuropathy (CIDP)...
BACKGROUND
The diagnostic value of new criteria of the European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) for chronic inflammatory demyelinating polyneuropathy (CIDP) is unknown.
METHODS
We performed a retrospective study of fulfilment of EAN/PNS 2021 criteria on 120 consecutive patients with a clinical diagnosis of 'suspected CIDP' and objective treatment response, attending University Hospitals Birmingham, UK. Specificity was evaluated versus 100 consecutive controls.
RESULTS
The sensitivity of EAN/PNS criteria for 'CIDP' was 83.3%. The sensitivity for 'CIDP' or 'possible CIDP' was 93.3%. Specificity was of 94% for 'CIDP' and 79% for 'CIDP' or 'possible CIDP'. No sensitivity/specificity differences were ascertained with previous versions ('CIDP': sensitivity: 83.3% vs 81.3%, p=0.74, specificity: 94% vs 96.1%, p=0.38, respectively; 'CIDP' or 'possible CIDP': sensitivity: 93.3% vs 96.7%, p=0.25 and specificity: 79% vs 69.2 %, p=0.09, respectively). F-wave prolongation, proximal and distal temporal dispersion were the most likely parameters to contribute to false positives, whereas distal motor latency was the least likely. No impact of sensory electrophysiology could be ascertained. 'Typical CIDP' represented 79% of the CIDP cohort. The largest component of the 'variant CIDP' group was represented by focal/multifocal forms (14%). With new criteria, 6.7% of the cohort did not meet requirements, among whom the majority (75%) had paranodopathy or chronic immune sensory polyradiculopathy (CISP).
DISCUSSION
The sensitivity and specificity of new EAN/PNS criteria for CIDP is equivalent to that of previous versions. The exclusion of paranodopathies and CISP from the CIDP spectrum impacts on management of a non-negligible proportion of treatment-responsive patients.
Topics: Humans; Polyradiculoneuropathy, Chronic Inflammatory Demyelinating; Retrospective Studies; Peripheral Nerves; Sensitivity and Specificity; Neurology; Neural Conduction
PubMed: 36190956
DOI: 10.1136/jnnp-2022-329633 -
Mymensingh Medical Journal : MMJ Oct 2022Cauda equina syndrome (CES) is a serious neurologic state in which neurological dysfunction affects the lumbar and sacral nerve roots within the vertebral canal. The... (Observational Study)
Observational Study
Cauda equina syndrome (CES) is a serious neurologic state in which neurological dysfunction affects the lumbar and sacral nerve roots within the vertebral canal. The nerves of the cauda equine provide the muscles that manage the bladder, bowel and the legs and the dysfunction producing impairment of bladder, bowel or sexual function and perianal or saddle numbness. Identification of CES is not only important to neurosurgeons and spine surgeons, but also to prime care practitioners, emergency room physicians, physiotherapists and allied health care professionals concerned in management of back pain. It is a significant diagnosis from a clinical and medico-legal outlook. Early surgical decompression is endorsed by most authors to best support patient's revival and trim down long term disability. This cross sectional observational study was conducted at Shaheed Suhrawardy Medical College Hospitals, Dhaka, Bangladesh from January 2015 to January 2021 and the aim of this study was to find the predictors and the clinical outcome of cauda equina syndrome after spinal decompression with delayed presentation. Among 680 patients of degenerative disc diseases; 32 cases (4.7%) had CES, those presenting late in course of disease. Time interval between bladder and bowel dysfunction and admission to hospital varied from 2-64 days with mean delay of 15.4 days. The average follow-up was 22.6 months, ranging from 12 to 34 months. There was significant positive correlation (p<0.05) between duration taken for total recovery and delay in surgery and between delayed decompression and a poor outcome. Also there was a clear correlation between the presence of complete perineal anaesthesia and absence of anal wink as both univariate and multivariate predictors of a poor outcome. There was significant association between a slower onset of CES and a favourable outcome. There was no significant correlation found between initial motor function loss, bilateral sciatica and level of the lesions as predictors of a poor outcome.
Topics: Humans; Bangladesh; Cauda Equina Syndrome; Cross-Sectional Studies; Decompression, Surgical; Developing Countries; Intervertebral Disc Displacement; Polyradiculopathy; Treatment Outcome
PubMed: 36189561
DOI: No ID Found -
Legal Medicine (Tokyo, Japan) Nov 2022
Topics: Humans; Phrenic Nerve; SARS-CoV-2; Polyradiculopathy; COVID-19; Death, Sudden
PubMed: 36182710
DOI: 10.1016/j.legalmed.2022.102153 -
Medicina Intensiva Oct 2022
Topics: COVID-19; Humans; Polyradiculopathy; SARS-CoV-2
PubMed: 36155685
DOI: 10.1016/j.medine.2022.01.002 -
Medicina Intensiva Oct 2022
Topics: COVID-19; Humans; Polyradiculopathy; SARS-CoV-2
PubMed: 36155684
DOI: 10.1016/j.medine.2021.12.014 -
Infectious Disease Clinics of North... Sep 2022Early disseminated Lyme disease can involve the peripheral or central nervous system, but with early diagnosis and treatment, prognosis for full recovery is excellent.... (Review)
Review
Early disseminated Lyme disease can involve the peripheral or central nervous system, but with early diagnosis and treatment, prognosis for full recovery is excellent. The typical clinical presentations of neuroborreliosis are highlighted, and an approach to diagnosis and treatment is described.
Topics: Cranial Nerve Diseases; Humans; Lyme Disease; Meningitis; Polyradiculopathy
PubMed: 36116833
DOI: 10.1016/j.idc.2022.02.006 -
JBJS Case Connector Apr 2022"Baastrup's disease" is a relatively common anatomical condition, controversially recognized as a possible cause of back pain but frequently missed by clinicians of...
CASE
"Baastrup's disease" is a relatively common anatomical condition, controversially recognized as a possible cause of back pain but frequently missed by clinicians of different specialties. We present a rare case of Baastrup's disease causing compression to the cauda equina nerves due to the formation of a large pseudotumoral epidural mass. The patient underwent a successful surgical decompression with remarkable improvement in her neurological presentation. The histopathological findings consisted of increased collagen deposition and chondroid metaplasia.
CONCLUSION
Clinicians should be aware of possible cauda equina syndrome in rare cases of Baastrup's disease due to pseudotumoral mass compression in the lumbar spine.
Topics: Cauda Equina; Cauda Equina Syndrome; Decompression, Surgical; Female; Humans; Lumbar Vertebrae; Polyradiculopathy
PubMed: 36099503
DOI: 10.2106/JBJS.CC.22.00121 -
Immunologic Research Dec 2022Since the beginning of worldwide vaccination against coronavirus disease 2019 (COVID-19), studies have reported a possible association between vaccination and... (Review)
Review
Since the beginning of worldwide vaccination against coronavirus disease 2019 (COVID-19), studies have reported a possible association between vaccination and Guillain-Barré syndrome (GBS). In this regard, we conducted a systematic review assessing different demographic, clinical, and neurophysiological aspects of patients with GBS following immunization with COVID-19 vaccines. A comprehensive search of PubMed, Web of Science, Scopus, and Google Scholar was performed. Articles in English between January 2020 and November 2021 were included. Data on demographics, clinical characteristics, vaccines information, treatment approaches, and outcomes were extracted. The data of a total of 88 patients out of 41 studies was included. The mean age of patients was 58.7 ± 16.6 years and 55 cases (62.5%) were male. AstraZeneca was the most-reported vaccine associated with GBS with 52 cases (59.1%) followed by Pfizer with 20 cases (22.7%). GBS occurred after the first dose of vaccination in 70 cases (79.5%). The mean time interval between vaccination and symptom onset was 13.9 ± 7.4 days. Limb weakness (47.7%), sensory disturbance (38.6%), and facial weakness (27.3%) were the most common reported symptoms, respectively. Albuminocytologic dissociation was seen in 65% of patients who underwent lumbar puncture (n = 65). Acute inflammatory demyelinating polyradiculopathy was the most common GBS subtype, which was reported in 38 patients (43.2%). While one-fifth of patients underwent intubation (n = 17), a favorable outcome was achieved in the majority of subjects (n = 46, 63%). Overall, a small rise in GBS incidence, following various COVID-19 vaccines, was observed. Notably, 85% of affected individuals experienced at least a partial recovery.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; COVID-19; COVID-19 Vaccines; Guillain-Barre Syndrome; Vaccination; Vaccines
PubMed: 36098903
DOI: 10.1007/s12026-022-09316-6 -
Investigational New Drugs Dec 2022Classic Hodgkin lymphoma (cHL) accounts for more than 90% of HL in developed countries. Although the current combined modality therapy make it have a high cure rate, the... (Review)
Review
Classic Hodgkin lymphoma (cHL) accounts for more than 90% of HL in developed countries. Although the current combined modality therapy make it have a high cure rate, the prognosis for heavily pretreated patients with relapsed or refractory (R/R) cHL remains poor. A novel antibody-drug conjugate (ADC), named camidanlumab tesirine (ADCT-301, Cami), is currently being evaluated for its efficacy and safety in R/R cHL. The primary objective of this review is to examine the current pharmacological properties of camidanlumab tesirine as well as its clinical antitumor activity and safety. Camidanlumab tesirine comprises a human IgG1 anti-CD25 monoclonal antibody HuMax®-TAC, conjugated to a pyrrolobenzodiazepine dimer toxin. Once it bound to CD25-expressing cells, camidanlumab tesirine is internalized by cells and delivers SG3199, then SG3199 irreversibly binds to DNA and forms DNA interstrand crosslinks, ultimately leading to cell death. In the phase 1 study, patients with R/R cHL who received camidanlumab tesirine had an overall response rate (ORR) of 71% and a complete response rate (CRR) of 42%. Additionally, the recommended doses provided in R/R cHL were determined to be 30 and 45 μg/kg. The pivotal phase 2 trial showed significant antitumor activity of camidanlumab tesirine in heavily pretreated R/R cHL patients who failed brentuximab vedotin and programmed death-1 blockade: ORR was 70.1% and CRR was 33.3%, and the median duration of response was 13.7 months. Adverse events such as fatigue, maculopapular rash, and anemia were frequently observed following administration of camidanlumab tesirine. Moreover, camidanlumab tesirine may cause Guillain-Barré syndrome or polyradiculopathy.
Topics: Humans; Antineoplastic Agents; Brentuximab Vedotin; Hodgkin Disease; Immunoconjugates; Neoplasm Recurrence, Local; Clinical Trials, Phase II as Topic
PubMed: 36074313
DOI: 10.1007/s10637-022-01300-z -
Muscle & Nerve Nov 2022
Topics: Humans; Facial Paralysis; Polyradiculopathy; RNA, Viral; COVID-19; SARS-CoV-2; Guillain-Barre Syndrome; Paralysis; Vaccines
PubMed: 36059144
DOI: 10.1002/mus.27711