Immune-mediated diseases involving central and peripheral nervous systems.


Journal

European journal of neurology
ISSN: 1468-1331
Titre abrégé: Eur J Neurol
Pays: England
ID NLM: 9506311

Informations de publication

Date de publication:
02 2023
Historique:
revised: 03 10 2022
received: 22 05 2022
accepted: 03 11 2022
pubmed: 12 11 2022
medline: 7 1 2023
entrez: 11 11 2022
Statut: ppublish

Résumé

In addition to combined central and peripheral demyelination, other immune diseases could involve both the central nervous system (CNS) and peripheral nervous system (PNS). To identify immune-mediated diseases responsible for symptomatic combined central/peripheral nervous system involvement (ICCPs), we conducted a multicentric retrospective study and assessed clinical, electrophysiological, and radiological features of patients fulfilling our ICCP criteria. Thirty patients (20 males) were included and followed during a median of 79.5 months (interquartile range [IQR] = 43-145). The median age at onset was 51.5 years (IQR = 39-58). Patients were assigned to one of four groups: (i) monophasic disease with concomitant CNS/PNS involvement including anti-GQ1b syndrome (acute polyradiculoneuropathy + rhombencephalitis, n = 2), checkpoint inhibitor-related toxicities (acute polyradiculoneuropathy + encephalitis, n = 3), and anti-glial fibrillary acidic protein astrocytopathy (subacute polyradiculoneuropathy and meningoencephalomyelitis with linear gadolinium enhancements, n = 2); (ii) chronic course with concomitant CNS/PNS involvement including paraneoplastic syndromes (ganglionopathy/peripheral hyperexcitability + limbic encephalitis, n = 4); (iii) chronic course with sequential CNS/PNS involvement including POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome (polyradiculoneuropathy + strokes, n = 2), histiocytosis (polyradiculoneuropathy + lepto-/pachymeningitis, n = 1), and systemic vasculitis (multineuropathy + CNS vasculitis/pachymeningitis, n = 2); and (iv) chronic course with concomitant or sequential CNS/PNS involvement including combined central and peripheral demyelination (polyradiculoneuropathy + CNS demyelinating lesions, n = 10) and connective tissue diseases (ganglionopathy/radiculopathy/multineuropathy + limbic encephalitis/transverse myelitis/stroke, n = 4). We diagnosed nine ICCPs. The timing of central and peripheral manifestations and the disease course help determine the underlying immune disease. When antibody against neuroglial antigen is identified, CNS and PNS involvement is systematically concomitant, suggesting a common CNS/PNS antigen and a simultaneous disruption of blood-nerve and blood-brain barriers.

Sections du résumé

BACKGROUND AND PURPOSE
In addition to combined central and peripheral demyelination, other immune diseases could involve both the central nervous system (CNS) and peripheral nervous system (PNS).
METHODS
To identify immune-mediated diseases responsible for symptomatic combined central/peripheral nervous system involvement (ICCPs), we conducted a multicentric retrospective study and assessed clinical, electrophysiological, and radiological features of patients fulfilling our ICCP criteria.
RESULTS
Thirty patients (20 males) were included and followed during a median of 79.5 months (interquartile range [IQR] = 43-145). The median age at onset was 51.5 years (IQR = 39-58). Patients were assigned to one of four groups: (i) monophasic disease with concomitant CNS/PNS involvement including anti-GQ1b syndrome (acute polyradiculoneuropathy + rhombencephalitis, n = 2), checkpoint inhibitor-related toxicities (acute polyradiculoneuropathy + encephalitis, n = 3), and anti-glial fibrillary acidic protein astrocytopathy (subacute polyradiculoneuropathy and meningoencephalomyelitis with linear gadolinium enhancements, n = 2); (ii) chronic course with concomitant CNS/PNS involvement including paraneoplastic syndromes (ganglionopathy/peripheral hyperexcitability + limbic encephalitis, n = 4); (iii) chronic course with sequential CNS/PNS involvement including POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, skin changes) syndrome (polyradiculoneuropathy + strokes, n = 2), histiocytosis (polyradiculoneuropathy + lepto-/pachymeningitis, n = 1), and systemic vasculitis (multineuropathy + CNS vasculitis/pachymeningitis, n = 2); and (iv) chronic course with concomitant or sequential CNS/PNS involvement including combined central and peripheral demyelination (polyradiculoneuropathy + CNS demyelinating lesions, n = 10) and connective tissue diseases (ganglionopathy/radiculopathy/multineuropathy + limbic encephalitis/transverse myelitis/stroke, n = 4).
CONCLUSIONS
We diagnosed nine ICCPs. The timing of central and peripheral manifestations and the disease course help determine the underlying immune disease. When antibody against neuroglial antigen is identified, CNS and PNS involvement is systematically concomitant, suggesting a common CNS/PNS antigen and a simultaneous disruption of blood-nerve and blood-brain barriers.

Identifiants

pubmed: 36366904
doi: 10.1111/ene.15628
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

490-500

Informations de copyright

© 2022 European Academy of Neurology.

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Auteurs

Aurelie Leboyan (A)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.

Florence Esselin (F)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.

Anne-Laure Bascou (AL)

Clinical Research and Epidemiology Unit, University Hospital Center, University of Montpellier, Montpellier, France.

Claire Duflos (C)

Clinical Research and Epidemiology Unit, University Hospital Center, University of Montpellier, Montpellier, France.

Ioana Ion (I)

Department of Neurology, Caremeau University Hospital Center, Nîmes, France.

Mahmoud Charif (M)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.

Giovanni Castelnovo (G)

Department of Neurology, Caremeau University Hospital Center, Nîmes, France.

Clarisse Carra-Dalliere (C)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.

Xavier Ayrignac (X)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.

Philippe Kerschen (P)

Department of Neurology, Luxembourg Hospital Center, Luxembourg City, Luxembourg.

Mohamed Chbicheb (M)

Department of Neurology, Narbonne Hospital Center, Narbonne, France.

Ludovic Nguyen (L)

Department of Neurology, Perpignan Hospital Center, Perpignan, France.

Alexandre T J Maria (ATJ)

Department of Internal Medicine, Saint Eloi University Hospital Center, Montpellier, France.

Philippe Guilpain (P)

Department of Internal Medicine, Saint Eloi University Hospital Center, Montpellier, France.

Mathilde Carriere (M)

Department of Neuroradiology, Gui de Chauliac University Hospital Center, Montpellier, France.

Nicolas Menjot de Champfleur (NM)

Department of Neuroradiology, Gui de Chauliac University Hospital Center, Montpellier, France.

Thierry Vincent (T)

Department of Immunology, Saint Eloi University Hospital Center, Montpellier, France.

Alexandre Jentzer (A)

Department of Immunology, Saint Eloi University Hospital Center, Montpellier, France.

Pierre Labauge (P)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.

Jérôme J Devaux (JJ)

Institute of Functional Genomics, National Center for Scientific Research UMR5203, Montpellier, France.

Guillaume Taieb (G)

Department of Neurology, Gui de Chauliac University Hospital Center, Montpellier, France.
Institute of Functional Genomics, National Center for Scientific Research UMR5203, Montpellier, France.

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