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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 -
European Spine Journal : Official... Feb 2022This study aimed to investigate the long-term clinical outcomes after surgical decompression in cauda equina syndrome (CES) and see if any preoperative patient-related... (Meta-Analysis)
Meta-Analysis Review
Outcomes of cauda equina syndrome due to lumbar disc herniation after surgical management and the factors affecting it: a systematic review and meta-analysis of 22 studies with 852 cases.
PURPOSE
This study aimed to investigate the long-term clinical outcomes after surgical decompression in cauda equina syndrome (CES) and see if any preoperative patient-related factors contributed to this outcome.
METHODS
A systematic literature search was conducted in the electronic databases of PubMed, Embase, Scopus, and Ovid. Data regarding outcome parameters from eligible studies were extracted. Meta-analysis was performed using a random-effect model.
RESULTS
A total of 852 patients (492 males and 360 females), with a mean age of 44.6 ± 5.5 years from 22 studies diagnosed with cauda equina syndrome and undergoing surgical decompression, were included in the meta-analysis; however, not all studies reported every outcome. The mean follow-up period was 39.2 months, with a minimum follow-up of 12 months in all included studies. Meta-analysis showed that on long-term follow-up, 43.3% [29.1, 57.5] (n=708) of patients had persistent bladder dysfunction. Persistent bowel dysfunction was observed in 31.1% [14.7, 47.6] (n=439) cases, sensory deficit in 53.3% [37.1, 69.6] (n=519), motor weakness in 38.4% [22.4, 54.4] (n=490), and sexual dysfunction in 40.1% [28.0, 52.1] (n=411). Decompression within 48 hours of the onset of symptoms was associated with a favourable outcome in terms of bladder function with 24.6% [1.6, 50.9] (n=75) patients having persistent dysfunction, whereas 50.3% [10.3, 90.4] (n=185) of patients in studies with a mean time to decompression after 48 hours had persistent bladder dysfunction. Other factors such as speed of onset and sex of the patients were not found to significantly impact long-term bladder outcomes.
CONCLUSION
The long-term outcomes of CES after decompression are enumerated. Decompression within 48 hours of the onset of symptoms appears to result in fewer patients with persistent bladder dysfunction. However, a randomized controlled trial is required to conclusively determine whether early decompression leads to better outcomes.
Topics: Adult; Cauda Equina; Cauda Equina Syndrome; Decompression, Surgical; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Polyradiculopathy; Sexual Dysfunction, Physiological; Urinary Bladder
PubMed: 34581849
DOI: 10.1007/s00586-021-07001-0 -
Journal of Neurology Apr 2021Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré...
Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; COVID-19; Child; Female; Guillain-Barre Syndrome; Humans; Male; Middle Aged; SARS-CoV-2; Young Adult
PubMed: 32840686
DOI: 10.1007/s00415-020-10124-x -
Musculoskeletal Science & Practice Jul 2019To review and statistically pool available evidence on the diagnostic accuracy of red flags to clinically identify MRI confirmed Cauda Equina Syndrome (CES).
OBJECTIVE
To review and statistically pool available evidence on the diagnostic accuracy of red flags to clinically identify MRI confirmed Cauda Equina Syndrome (CES).
STUDY DESIGN
Systematic review.
DATA SOURCES
Embase, Scopus, Ovid Medline, Ovid Healthstar, Amed and CINAHL from inception to January 30, 2018 and a grey literature search.
INCLUSION CRITERIA
Primary diagnostic studies, published in English; comparing red flags for CES; to Magnetic Resonance Imaging (MRI) as reference standard; in humans; older than 18 years.
METHODS
Data extraction, assessment of study quality using a modified QUADAS-2 tool and the use of GRADE to synthesize the results for each test was performed by three independent assessors. Diagnostic accuracy statistics applied to the identified data andpooled analysis performed using Meta-DiSc, version 1.4. Moderator analyses planned for pooled results.
RESULTS
Seven studies (total N = 569 participants) were included. Potential signs or symptoms of CES were compared to MRI findings. Diagnostic data could be pooled for reduced anal tone, leg pain, back pain, saddle anaesthesia, urinary retention, urinary incontinence and bowel incontinence from six of seven studies. The pooled sensitivity for the signs and symptoms ranged from 0.19 (95% CI 0.09 to 0.33) to 0.43 (95% CI 0.30 to 0.56) while the pooled specificity ranged from 0.62 (95% CI 0.59 to 0.73) to 0.88 (95% CI 0.85 to 0.92).
CONCLUSION
Red flags used to identify potential CES appear to be more specific than sensitive. As such, when these are present, they should be considered justification for prompt diagnostic workup.
Topics: Back Pain; Cauda Equina Syndrome; Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Pain Measurement; Polyradiculopathy; Sensitivity and Specificity
PubMed: 31132655
DOI: 10.1016/j.msksp.2019.05.004 -
Deutsches Arzteblatt International Nov 2018The new German S3 guideline on Lyme neuroborreliosis is intended to provide physicians with scientifically based information and recommendations on the diagnosis and...
BACKGROUND
The new German S3 guideline on Lyme neuroborreliosis is intended to provide physicians with scientifically based information and recommendations on the diagnosis and treatment of this disease.
METHODS
The scientific literature was systematically searched and the retrieved publications were assessed at the German Cochrane Center (Deutsches Cochrane Zentrum) in Freiburg in the 12 months beginning in March 2014. In addition to the main search terms "Lyme disease," "neuroborreliosis," "Borrelia," and "Bannwarth," 28 further terms relating to neurological manifestations of the disease were used for the search in the Medline and Embase databases and in the Cochrane Central Register of Controlled Trials.
RESULTS
In the treatment of early Lyme neuroborreliosis, orally administered doxycycline is well tolerated, and its efficacy is equivalent to that of intravenously administered beta-lactam antibiotics (penicillin G, ceftriaxone, and cefotaxime) (relative risk [RR]: 0.98, 95% confidence interval [CI]: [0.68; 1.42], P = 0.93). 14 days of treatment suffice for early Lyme neuroborreliosis, and 14-21 days of treatment usually suffice for late (chronic) Lyme neuroborreliosis.
CONCLUSION
Lyme neuroborreliosis has a favorable prognosis if treated early. The long-term administration of antibiotics over many weeks or even months for putative chronic Lyme neuroborreliosis with nonspecific symptoms yields no additional benefit and carries the risk of serious adverse effects.
Topics: Anti-Bacterial Agents; Borrelia; Doxycycline; Humans; Lyme Neuroborreliosis; Polyradiculopathy; Prognosis; Treatment Outcome
PubMed: 30573008
DOI: 10.3238/arztebl.2018.0751 -
British Journal of Neurosurgery Jun 2017Patients with cauda equina syndrome (CES) are frequently referred late when neurological damage cannot be reversed. National Guidelines for emergency referral, imaging... (Review)
Review
INTRODUCTION
Patients with cauda equina syndrome (CES) are frequently referred late when neurological damage cannot be reversed. National Guidelines for emergency referral, imaging and treatment of CES contain symptoms and/or signs that are those of late often, irreversible CES. Referral at this stage may be too late for that patient.
METHODS
Seven sources were reviewed. Advice re emergency referral/imaging/treatment were reviewed. Symptoms/signs were compared with a standard classification of CES.
RESULTS
37 recommendations: 12 (32%) were symptoms/signs of bilateral radiculopathy (treatment usually leads to favourable outcomes). Thirteen recommendations (35%) were described in an imprecise way (could be interpreted as early or late CES). Twelve sets of symptoms/signs (32%) were those of late, often irreversible CES where an unfavourable outcome would be expected.
CONCLUSIONS
Thirty-two percent of the so-called "red flag" symptoms and signs of CES in seven sources were definitely those of late, irreversible CES. These could be seen as "white flags" [flags of defeat and surrender]. Thirty-five percent of the recommendations if interpreted pessimistically (e.g. absent perineal sensation or urinary incontinence) would also be white flags; potentially therefore two-thirds of the so-called "red flag" symptoms/signs of CES could be those of late irreversible CES. Only 32% of the symptoms/signs were true "red flags" i.e. they warn of further, avoidable damage ahead. Guidelines should be redrawn to emphasise referral of patients who are at risk of developing CES or who have early CES. It is illogical for these guidelines to emphasise the clinical features of severe, often untreatable, CES. Demand for emergency MRI will increase; MRI is part of triage and should be performed at the DGH.
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Polyradiculopathy; Practice Guidelines as Topic; Radiculopathy; Referral and Consultation; Triage; Urinary Incontinence
PubMed: 28637110
DOI: 10.1080/02688697.2017.1297364 -
Definitions of traumatic conus medullaris and cauda equina syndrome: a systematic literature review.Spinal Cord Oct 2017A systematic review. (Review)
Review
STUDY DESIGN
A systematic review.
OBJECTIVES
Conus medullaris syndrome (CMS) and cauda equina syndrome (CES) are well-known neurological entities. It is assumed that these syndromes are different regarding neurological and functional prognosis. However, literature concerning spinal trauma is ambiguous about the exact definition of the syndromes.
METHODS
A MEDLINE, EMBASE and Cochrane literature search was performed. We included original articles in which clinical descriptions of CMS and/or CES were mentioned in patients following trauma to the thoracolumbar spine.
RESULTS
Out of the 1046 articles, we identified 14 original articles concerning patients with a traumatic CMS and/or CES. Based on this review and anatomical data from cadaveric and radiological studies, CMS and CES could be more precisely defined.
CONCLUSION
CMS may result from injury of vertebrae Th12-L2, and it involves damage to neural structures from spinal cord segment Th12 to nerve root S5. CES may result from an injury of vertebrae L3-L5, and it involves damage to nerve roots L3-S5. This differentiation between CMS and CES is necessary to examine the hypothesis that CES patients tend to have a better functional outcome.
Topics: Humans; Nerve Compression Syndromes; Polyradiculopathy; Spinal Cord Compression; Terminology as Topic
PubMed: 28534496
DOI: 10.1038/sc.2017.54 -
World Neurosurgery 2014Cauda equina syndrome (CES) is a rare but important neurosurgical emergency. Despite being a recognized clinical entity since 1934, there remains significant uncertainty... (Review)
Review
OBJECTIVE
Cauda equina syndrome (CES) is a rare but important neurosurgical emergency. Despite being a recognized clinical entity since 1934, there remains significant uncertainty in the literature regarding the urgency for surgical intervention. The past decade has seen the emergence of the much-referred-to 48-hour limit as a possible window of safety. The ramifications of this time point are significant for early patients who may subsequently have urgent treatment delayed, and for litigation cases, after which adverse decisions are more likely to occur.
METHODS
A systematic principally qualitative review of the animal and human clinical literature is presented, examining the evidence for urgent surgical decompression in CES and the much-quoted 48-hour rule.
RESULTS
There is significant discordance in the literature regarding whether emergency surgery improves outcomes; however, a growing consensus is the acknowledgment that biologic systems deteriorate in a continuous rather than stepwise manner. Level of neurological dysfunction at surgery (incomplete CES vs. CES with retention) is probably the most significant determinant of prognosis. Onset and duration of symptoms also are likely to have an impact, if not on overall outcome then at least on duration of neurological recovery.
CONCLUSIONS
There is no strong basis to support 48 hours as a blanket safe time point to delay surgery. Both early and delayed surgery may result in improved neurological outcomes. However, it is likely that the earlier the surgical intervention, the more beneficial the effects for compressed nerves, especially with acute neurological compromise.
Topics: Acute Disease; Decompression, Surgical; Emergency Medical Services; Evidence-Based Medicine; Humans; Polyradiculopathy; Time-to-Treatment
PubMed: 24240024
DOI: 10.1016/j.wneu.2013.11.007 -
European Spine Journal : Official... May 2013Cauda equina syndrome (CES) is a rare complication of lumbar disk herniation. Although micturition, defecation and/or sexual function are by definition affected, little... (Review)
Review
PURPOSE
Cauda equina syndrome (CES) is a rare complication of lumbar disk herniation. Although micturition, defecation and/or sexual function are by definition affected, little seems to be known about long-term outcome. Aim of this study is to review current literature on outcome of micturition, defecation and sexual function in CES due to lumbar disk herniation.
METHODS
A literature search was done in Pubmed, Embase and Web of Science using a sensitive search string combination. Studies were selected by predefined selection criteria and risk of bias was assessed using a Cochrane checklist adjusted for this purpose.
RESULTS
Fifteen studies were included. Risk of bias varied with six studies showing low risk. Mean minimal follow-up time was 17.0 months (range 3-24 months). All studies evaluated micturition and reported dysfunction at follow-up in 42.5% (range 13.3-90.0%). Defecation and sexual function were evaluated in eight and nine studies, respectively, and reported to be 49.6 (range 10.5-90.0%) and 44.3% (range 10.0-76.6%), respectively. Only two studies assessed sexual function in all patients at follow-up.
CONCLUSION
This review offers an insight into the extent of micturition dysfunction, defecation dysfunction and sexual dysfunction (SD) in CES after decompression. Our findings show that dysfunction is extremely common, even at long-term follow-up. A condition as invalidating as CES requires proper patient information and the outcomes presented here may help in providing those data. Bias in included studies, lack of universal definitions and incomplete follow-up results qualify these data as the best we momentarily have, but still subject to improvement. Since SD seems to be severely underreported, we recommend further research to explore the extent of this problem, as well as the use of questionnaires in future clinical (prospective) studies to accomplish a more patient-based approach.
Topics: Defecation; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Polyradiculopathy; Rectal Diseases; Sexual Dysfunction, Physiological; Urination; Urination Disorders
PubMed: 23238848
DOI: 10.1007/s00586-012-2601-8 -
Spine Oct 2009Systematic review. (Review)
Review
STUDY DESIGN
Systematic review.
OBJECTIVE
Analyze the level of evidence in the effectiveness of calcitonin on the treatment of neurogenic claudication in patients with lumbar spinal stenosis.
SUMMARY OF BACKGROUND DATA
One of the most disabling features of lumbar spinal stenosis is neurogenic claudication. There have been proposed different drug therapies for it. The recommendation for calcitonin use in these patients has been sustained on autocontrolled clinical trial (Streifler et al, Neurol Neurosurg Psychiatry 1989;52:543-4), which only included 6 patients.
MATERIAL AND METHOD
We performed a search on electronic databases that included Medline and Embase; we recovered 10 original articles, of which only 4 fulfilled the RCT criteria. These articles were reviewed independent and blinded way by 6 previously capacitated reviewers to extract data and score a quality of them by the criteria of Cochrane Handbook (1996) with maximum score of 1.00 and minimum score of 0.33.
RESULTS
Score quality vary in the 4 articles: Porter and Millar, Spine 1988;13:1061-4 (score, 0.68), Eskola et al, Calcif Tissue Int 1992;50:400-3 (score, 0.88), Podichetty et al, Spine 2004;29:2343-9 (score, 0.88), and Tafazal et al, Eur Spine J 2007;16:207-12 (score, 0.92). Due to the great heterogenicity observed (sample sizes, selection criteria, doses, frequency, and duration of calcitonin, and outcome measurements), we were unable to perform a meta-analysis. Only one of these studies (Porter and Millar, Spine 1988;13:1061-4; score, 0.68) found favorable results for the use of calcitonin compared with placebo; of the 3 remaining trials none found significative evidence between drug therapy and placebo.
CONCLUSION
The present data suggest that calcitonin administration in the treatment for neurogenic claudication has no benefit in patients with lumbar spinal stenosis.
Topics: Bone Density Conservation Agents; Calcitonin; Humans; Intermittent Claudication; Lumbar Vertebrae; Outcome Assessment, Health Care; Polyradiculopathy; Radiography; Spinal Cord Compression; Spinal Stenosis; Treatment Outcome
PubMed: 19829246
DOI: 10.1097/BRS.0b013e3181afe60a