Clinical association of intrathecal and mirrored oligoclonal bands in paediatric neurology
|
|
- Brenda Garrett
- 6 years ago
- Views:
Transcription
1 DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY ORIGINAL ARTICLE Clinical association of intrathecal and mirrored oligoclonal bands in paediatric neurology ADRIANE J SINCLAIR 1 LOUISE WIENHOLT 2 ESTHER TANTSIS 3 FABIENNE BRILOT 3 RUSSELL C DALE 3 1 Department of Child Neurology, Sydney Children's Hospital, Sydney; 2 Immunology laboratory, Royal Prince Alfred Hospital, Sydney; 3 Neuroimmunology Group, Institute for Neuroscience and Muscle Research, the Children's Hospital at Westmead, University of Sydney, Australia. Correspondence to Professor Russell C Dale at Clinical School, the Children's Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia. russell.dale@health.nsw.gov.au This article is commented on by Lim on pages of this issue. PUBLICATION DATA Accepted for publication 21st July Published online 24th October ABBREVIATIONS ADEM Acute disseminated encephalomyelitis CSF Cerebrospinal fluid HSV Herpes simplex virus NMDAR N-methyl-D-aspartate receptor OCB Oligoclonal band VGKC Voltage-gated potassium channel AIM Biomarkers such as autoantibodies, neopterin, and oligoclonal bands (OCBs) are increasingly used for the diagnosis of treatable inflammatory central nervous system (CNS) disorders. We investigated the correlation between the results of OCB testing and clinical diagnoses in a large contemporary cohort of children with a broad range of neurological conditions. METHOD Cerebrospinal fluid (CSF) and serum from 200 children (94 females, 106 males; age range 2mo 15y 10mo, mean age 6y 9mo, SD ±4.9) who underwent CSF investigation for their neurological condition were tested for OCBs using isoelectric focusing. RESULTS The patients were divided into those with inflammatory (n=58) and non-inflammatory (n=142) CNS disorders. Intrathecal OCBs (OCBs restricted to the CSF) were found in 11 out of 58 (19%) of those with inflammatory CNS disorders compared with none of the 142 patients with non-inflammatory CNS disorders (p<0.001). Diseases associated with intrathecal OCB were multiple sclerosis, Rasmussen encephalitis, N-methyl-D-aspartate receptor (NMDAR) encephalitis, voltage-gated potassium channel (VGKC) encephalopathy, herpes (HSV) encephalitis, other encephalitides, acute cerebellar ataxia, and aseptic meningitis. Mirrored OCBs (identical OCBs in the serum and CSF) were less specific but were still found in 14 out of 58 (24%) children with inflammatory CNS disorders compared with only 6 out of 142 (4%) children with non-inflammatory CNS disorders (p<0.001). Diseases associated with mirrored OCBs included acute disseminated encephalomyelitis (ADEM), VGKC encephalopathy, West syndrome, NMDAR encephalitis, other encephalitides, polio-like illness, Rasmussen encephalitis, cerebral vasculitis, metachromatic leukodystrophy, and bacterial meningitis. Intrathecal OCBs and mirrored OCBs had a positive predictive value for inflammatory CNS disease of 1 (95% confidence interval [CI] ) and 0.7 (95% CI ) respectively. CONCLUSION Intrathecal OCBs were restricted to patients with inflammatory CNS disorders. They are a useful, but non-specific, biomarker of CNS inflammation of multiple causes. Mirrored OCBs are less specific, but still support a possible inflammatory CNS disorder. The presence of either intrathecal or mirrored OCBs should raise suspicion of an inflammatory CNS disorder. There is increasing interest in biomarkers that diagnose potentially treatable inflammatory central nervous system (CNS) disorders. 1 Some serum and cerebrospinal fluid (CSF) autoantibodies are specific biomarkers associated with autoimmune syndromes such as N-methyl-D-aspartate receptor (NMDAR) encephalitis and voltage-gated potassium channel (VGKC) encephalopathy. Other biomarkers, including CSF neopterin and oligoclonal bands (OCBs), are less specific, but they are still useful markers of immune activation or inflammation in the CNS. 2 Before the discovery of the NMDAR antibody biomarker, OCBs were used to support the hypothesis that encephalitis lethargica and immunemediated chorea encephalopathy syndrome were autoimmune diseases; these syndromes have subsequently been shown to be NMDAR encephalitis. 3 5 OCBs have also been useful in the identification of unusual variants of known autoimmune encephalopathy. 6 OCBs are clones of immunoglobulin (typically IgG) that can be detected in the CSF and or serum. The qualitative method of isoelectric focusing on agarose gels followed by immunoblotting is the accepted standard method for OCB detection. The IgG index (the ratio of CSF serum IgG to CSF serum albumin), a quantitative method of analysis, is a less sensitive test, and when elevated is suggestive of a CNS B-cell response. There are limited reports of use of the IgG index in paediatric studies, but in adult studies the IgG index has been found to be only rarely elevated in patients with multiple sclerosis who have negative OCBs Alper et al., 7 in a paediatric cohort, found that the IgG index was less frequently elevated in those with acute disseminated encephalo- ª The Authors. Developmental Medicine & Child Neurology ª 2012 Mac Keith Press DOI: /j x 71
2 myelitis (ADEM) than in those with multiple sclerosis. 7 Interpretation of OCBs is dependent on the comparison of CSF and serum samples, with a number of patterns described (Fig. 1). 8 WhenOCBsarepresentintheCSFandabsentfromthe serum, this is termed an intrathecal pattern and is indicative of local antibody production and hence a humoral immune response within the CNS. When identical clones of IgG are present in the CSF and serum, this is termed a mirrored pattern and suggests that IgG has entered the CNS from the systemic circulation, such as occurs in blood brain barrier damage. A combination of mirrored and intrathecal patterns can occur, in which identical clones of IgG are present in the CSF and serum; however, the CSF also contains additional OCBs. This is consistent with both CNS contamination and local (intrathecal) IgG synthesis. Intrathecal OCBs are accepted to be of greater clinical significance than mirrored OCBs in the diagnosis of inflammatory CNS disorders. 10 Data pertaining to OCBs in paediatric patients are largely restricted to specific diseases, for example multiple sclerosis, 12 ADEM, 13 and opsoclonus myoclonus syndrome. 14 In 1986, Kostulas et al. 9 reported OCB findings in a paediatric cohort with varying neurological diagnoses. They found OCBs most commonly in patients with inflammatory disorders; however, they also reported finding OCBs in children with presumed non-inflammatory disorders such as epilepsy and migraine. In recent years, the ability to diagnose disorders of inflammatory aetiology has greatly improved. We studied the diagnostic What this paper adds Intrathecal OCBs have a strong positive predictive value of inflammatory CNS disease in children. Although less specific, mirrored OCBs are also found more commonly in children with inflammatory CNS disease. associations and sensitivity specificity of intrathecal and mirrored OCB in a contemporary cohort of children with neurological diseases. METHOD We identified 205 paediatric neurology patients who had OCB testing between January 2006 and February During that time, OCB testing was routinely requested for all paediatric neurology patients at the Children s Hospital at Westmead undergoing CSF analysis. This study was part of ethically approved studies of inflammatory and autoimmune disorders of the CNS at the hospital. We excluded five patients in whom paired CSF and serum samples or clinical information was unavailable. Patients were aged 2 months to 15 years 10 months, with a mean age of 6 years 9 months SD ±4.9. There were 94 females and 106 males. All CSF and sera specimens were analysed by isoelectric focusing at a single laboratory. In the case of those patients with acquired disorders, analysis was performed on samples taken during the acute period of illness, and in the first episode if the disorder was relapsing. The study also included patients with chronic illnesses who were undergoing CSF analysis in an elective manner. Patient case notes were reviewed and patients were categorized by pathophysiology (inflammatory vs non-inflam- 1. CSF No OCB 2. Serum 3. CSF 4. Serum Intrathecal 5. CSF Mirrored 6. Serum 7. CSF Mirrored and intrathecal 8. Serum Figure 1: Isoelectric focusing on agarose gels followed by immunoblotting. Lanes 1 and 2: no oligoclonal bands (OCBs) detected in cerebrospinal fluid (CSF) or serum. Lanes 3 and 4: OCB detected in CSF but not in serum indicative of intrathecal immunoglobulin G (IgG) production. Lanes 5 and 6: identical OCB detected in both CSF and serum suggestive of an abnormal CSF-blood barrier (mirrored pattern). Lanes 7 and 8: combination of mirrored and intrathecal IgG production, a pattern not observed in this study but observed in subacute sclerosing panencephalitis. 72 Developmental Medicine & Child Neurology 2013, 55: 71 75
3 matory CNS disease), disease group, and diagnosis (Table I). Case note review and patient categorization were performed by a neurology registrar (AJS), with verification provided by a paediatric neurologist (RCD). Assigned diagnoses were based on those documented in the case notes by the treating paediatric neurologist. The inflammatory CNS group (n=58; 29%) included patients with diagnoses with an established infectious, autoimmune, immune-mediated, or inflammatory cause. The term inflammatory CNS will be used to describe infectious, autoimmune, inflammatory, or immune-mediated CNS disorders. The non-inflammatory CNS group (n=142; 71%) included patients with diagnoses for which there was no established inflammatory pathophysiology and patients in whom we were unable to assign a diagnosis. We subdivided the inflammatory CNS group into demyelinating diseases (n=26), infection-mediated diseases (n=11), autoantibody-associated diseases (n=7), and other immunemediated diseases (n=14). Diagnoses within these subgroups are presented in Table I. Within the infection-mediated group, six patients were categorized as having other encephalitides. These patients had evidence of encephalitis (acute or chronic) fulfilling criteria for encephalitis but without definite evidence of a specific infectious agent. 15 The non-inflammatory CNS group included patients with very diverse diagnoses (Table I) along with patients in whom the diagnosis was unknown (n=15). The two-tailed Fisher s exact test was used to calculate p-values, and a p-value <0.05 was considered significant; 95% confidence intervals (CI) are presented for positive predictive value and negative predictive value. RESULTS Intrathecal OCBs were detected in patients with inflammatory CNS disorders (11 58; 19%), but not in those with noninflammatory CNS disorders (0 142; 0%; p<0.001; Table II). Diagnoses associated with intrathecal OCBs were multiple sclerosis (n=3), Rasmussen encephalitides (n=2), NMDAR encephalitis (n=1), VGKC encephalopathy (n=1), acute cerebellar ataxia (n=1), aseptic meningitis (n=1), herpes simplex virus (HSV) encephalitis (n=1), and other encephalitis (n=1; Table II). Mirrored OCBs were found more frequently in those with inflammatory CNS disorders (14 58, 24%) than in those with non-inflammatory CNS disorders (6 142; 4%; p<0.001; Table II). Mirrored OCBs were detected in patients with ADEM (n=4), VGKC encephalopathy (n=1), NMDAR encephalitis (n=2), basal ganglia encephalitis (n=1), other encephalitides (n=1), polio-like illness (n=2), Rasmussen encephalitis (n=1), varicella zoster-associated cerebral vasculitis (n=1), bacterial meningitis (n=1), West syndrome (n=2), and metachromatic leukodystrophy (n=1), and in several patients with unknown diagnoses (n=3). No patient showed a combination of mirrored and intrathecal patterns. Intrathecal OCBs had a sensitivity of 0.19 (95% CI ), a specificity of 1 (95% CI ), a positive predictive value of 1 (95% CI ), and a negative predictive value of 0.75 (95% CI ) for the presence of inflammatory CNS disease (Table II). Mirrored OCBs had a sensitivity of 0.24 (95% CI ), a specificity of 0.96 (95% CI ), a positive predictive value of 0.7 (95% CI ), and a negative predictive value of 0.76 (95% CI ; Table II). Table I: Disease groups and diagnoses Disease group (n) Non-inflammatory CNS (n=142) Epilepsy (n=58) Static encephalopathy (n=15) Progressive genetic or metabolic (n=8) Other (n=61) Inflammatory CNS (n=58) Demyelinating (n=26) Infection-mediated (n=11) Autoantibody-associated (n=7) Other immune-mediated (n=14) Diagnoses (n) Electroclinical syndromes: West syndrome (n=6), Dravet syndrome (n=1), febrile seizures plus (n=1), epilepsy with myoclonic astatic atonic seizures (n=2), juvenile absence epilepsy (n=1) Structural or metabolic: perinatal brain injury (n=1), traumatic brain injury (n=1), hypoglycaemia (n=1), malformation of cortical development (n=4), previous CNS infection (n=3) Genetic: PCDH19 mutation (n=1), SCN1A (n=2) Other or unknown (n=34) Cerebral palsy (n=3), developmental delay (n=4), chromosomal disorders (n=6), unknown (n=2) Metachromic leukodystrophy (n=1), Menkes disease (n=1), mitochondrial probable mitochondrial (n=2), hereditary spastic paraplegia (n=2), unknown (n=2) Functional disorders (n=10), movement disorders (n=10), Guillain Barré syndrome (n=5), headache disorders (n=4), stroke (n=4), miscellaneous a (n=13), unknown (n=15) MS (n=6), ADEM (n=11), clinically isolated syndrome (n=9): optic neuritis (n=3), transverse myelitis (n=3), other (n=3) Bacterial meningitis (n=1), aseptic meningitis (n=1), other encephalitides (n=6), acute necrotizing encephalopathy (n=2), HSV encephalitis (n=1) NMDAR encephalitis (n=3), VGKC encephalopathy (n=3), basal ganglia encephalitis (n=1) Rasmussen encephalitis (n=3), acute cerebellar ataxia (n=4), Polio-like illness (n=2), cerebral vasculitis (n=1), opsoclonus myoclonus syndrome (n=2), Sydenham chorea (n=1), Aicardi Goutières syndrome (n=1) a Miscellaneous: paroxysmal tonic upgaze of infancy, idiopathic intracranial hypertension, isolated cranial nerve palsy, acquired brain injury, pseudoparalysis secondary to vitamin C deficiency, posterior reversible encephalopathy syndrome, autism spectrum disorder with behavioural disturbance, hydrocephalus with ventriculoperitoneal shunt dysfunction, myasthenia gravis, hereditary motor sensory neuropathy, urea cycle disorder, syncope, malformation of cortical development. CNS, central nervous system; MS, multiple sclerosis; ADEM, acute disseminated encephalomyelitis; HSV, herpes simplex virus; NMDAR, N-methyl-D aspartate receptor; VGKC, voltage-gated potassium channel. Intrathecal and Mirrored OCBs in Paediatric Neurology Adriane Sinclair et al. 73
4 Table II: Clinical correlation of intrathecal and mirrored oligoclonal bands (OCBs) OCB result Disease groups and diagnoses Intrathecal, n (%) Mirrored, n (%) Total (6) (10) Non-inflammatory CNS (0) (4) Epilepsy 0 58 (0) 2 58 (3) Static encephalopathy 0 15 (0) 0 15 (0) Progressive genetic 0 8(0) 1 8(13) or metabolic Other 0 61 (0) 3 61 (5) Inflammatory CNS (19) (24) Demyelinating 3 26 (12) 4 26 (15) ADEM 0 11 (0) 4 11 (36) Clinically isolated syndrome 0 9(0) 0 9(0) Multiple sclerosis 3 6(50) 0 6(0) Infection-mediated 3 11 (27) 2 11 (18) Bacterial meningitis Aseptic meningitis HSV encephalitis Other encephalitides Acute necrotizing encephalopathy Autoantibody-associated 2 7(29) 4 7(57) NMDAR encephalitis VGKC encephalopathy Basal ganglia encephalitis Other immune-mediated 3 14 (21) 4 14 (29) Rasmussen encephalitis Acute cerebellar ataxia Polio-like illness Opsoclonus myoclonus syndrome Varicella zoster vasculitis Aicardi Goutières syndrome Sydenham chorea CNS, central nervous system; ADEM, acute disseminated encephalomyelitis; HSV, herpes simplex virus; NMDAR, N-methyl-D aspartate receptor; VGKC, voltage-gated potassium channel. Those with autoantibody-associated disorders were likely to have either intrathecal or mirrored OCBs (6 7; 86%). In both patients with NMDAR encephalitis whose initial samples showed mirrored OCBs, CSF samples taken 59 and 70 days after the first samples were found to contain intrathecal OCBs. Among those with demyelinating disorders, intrathecal OCBs were detected only in patients with multiple sclerosis (3 6; 50%), whereas mirrored OCBs were detected only in those patients with ADEM (4 11; 36%). All three patients with Rasmussen encephalitis had either intrathecal or mirrored OCBs. Patients with infection-mediated disorders (n=11) had either intrathecal (3 11; 27%) or mirrored OCBs (2 11; 18%). DISCUSSION We sought to investigate the utility of OCBs in a contemporary group of child neurology patients and make diagnostic associations. We found intrathecal OCBs only in patients with evidence of inflammatory CNS disease; however, a variety of autoantibody-associated, demyelinating, infection-mediated, and other immune-mediated diseases were associated with intrathecal OCBs. Mirrored OCBs were less specific than intrathecal OCBs for CNS inflammation, but were still more likely to be found in patients with inflammatory CNS disease than in those with non-inflammatory CNS disease (24% vs 4%; p<0.001) and therefore can also be of clinical utility. Mirrored OCBs imply the presence of clonal IgG in both CSF and serum. Indeed, many of the autoantibody biomarkers that are useful in CNS inflammation, such as antibodies against neuromyelitis optica aquaporin-4, VGKC, leucinerich glioma-inactivated 1, and myelin oligodendrocyte glycoprotein are measured in the serum, rather than in the CSF. In the case of many autoantibody-associated CNS disorders, the production of autoantibody might be first triggered in the periphery, rather than in the CNS, and the importance of serum versus CSF antibody production is a central emerging theme in neuroimmunology. 16,17 For these reasons, we believe that mirrored OCBs should not be ignored but may be an important biomarker in inflammatory CNS disorders. Many of the patients in this report with mirrored OCBs had autoantibody-associated disorders, such as NMDAR encephalitis and VGKC encephalopathy. Interestingly, we noted that the patients with NMDAR encephalitis who initially had mirrored OCBs subsequently developed intrathecal OCBs, suggesting that patients initially have a systemic autoimmune response, which subsequently becomes localized intrathecally. No patient was found to have a combination of both a mirrored and intrathecal OCB pattern, suggesting that this may be an uncommon finding in paediatric populations, or a pattern that develops in chronic disease, such as in subacute sclerosing panencephalitis. Specific diseases associated with OCBs were generally consistent with findings previously reported by others. Among our patients with demyelinating disorders (n=26), intrathecal OCBs were detected only in patients with multiple sclerosis, and mirrored OCBs were found only in patients with ADEM. Our numbers were small; however, studies specifically of paediatric patients with demyelinating diseases have also reported a higher frequency of intrathecal OCBs in children with multiple sclerosis than with ADEM or CIS. 7,12,13,18 The presence of mirrored OCBs in ADEM has also been reported in other studies. 19,20 Intrathecal OCBs were also found in patients with Rasmussen encephalitis and acute cerebellar ataxia, as previously reported. 21,22 Although OCBs can be useful, we failed to detect OCBs in many patients with recognized inflammatory CNS diseases. The absence of OCBs should not preclude consideration of an inflammatory CNS process, or testing for specific autoantibodies. There is emerging evidence that autoantibodies against VGKC and NMDAR are specific in autoimmune encephalopathy and it could be argued that these specific biomarkers will increasingly replace non-specific markers of inflammation or immune activation, such as OCBs and CSF neopterin. 1,2 However, non-specific biomarkers are likely continue to be of clinical utility as they can alert the clinician to atypical variants of autoimmune encephalopathy or to potential autoimmune diseases yet to be fully defined. 6 Additionally, specific autoantibody tests are less widely available than OCBs and may have a longer processing time; given that early diagnosis and treat- 74 Developmental Medicine & Child Neurology 2013, 55: 71 75
5 ment can improve outcomes, OCBs are likely to continue to play a useful role. Assessing a diagnostic test such as OCBs ideally requires comparison with a criterion standard, but unfortunately there is no practical criterion standard test for CNS inflammation as brain biopsy is too invasive. The group with CNS inflammatory disorders in this study is a heterogeneous group in which the precision of diagnosis and the certainty regarding the inflammatory basis of the disease varies substantially. A prospective study with an extended follow-up time would allow for collection of all pertinent data (such as auxiliary evidence of inflammation) and would increase the level of accuracy for the less precise diagnoses and would perhaps reduce the numbers of patients in whom the diagnosis is unknown. ACKNOWLEDGEMENTS The authors have funding from the National Health Medical Research Council, the University of Sydney, Multiple Sclerosis Research Australia, and the Star Scientific Foundation. REFERENCES 1. Dale RC, Brilot F. Biomarkers of inflammatory and autoimmune central nervous system disorders. Curr Opin Pediatr 2010; 22: Dale RC, Brilot F, Fagan E, Earl J. Cerebrospinal fluid neopterin in paediatric neurology: a marker of active central nervous system inflammation. Dev Med Child Neurol 2009; 51: Dale RC, Church AJ, Surtees RA, et al. Encephalitis lethargica syndrome: 20 new cases and evidence of basal ganglia autoimmunity. Brain 2004; 127: Dale RC, Irani SR, Brilot F, et al. N-methyl-D-aspartate receptor antibodies in pediatric dyskinetic encephalitis lethargica. Ann Neurol 2009; 66: Hartley LM, Ng SY, Dale RC, Church AJ, Martinez A, de Sousa C. Immune mediated chorea encephalopathy syndrome in childhood. Dev Med Child Neurol 2002; 44: Suleiman J, Brenner T, Gill D, et al. Immune-mediated steroid-responsive epileptic spasms and epileptic encephalopathy associated with VGKC-complex antibodies. Dev Med Child Neurol 2011; 53: Alper G, Heyman R, Wang L. Multiple sclerosis and acute disseminated encephalomyelitis diagnosed in children after long-term follow-up: comparison of presenting features. Dev Med Child Neurol 2009; 51: Freedman MS, Thompson EJ, Deisenhammer F, et al. Recommended standard of cerebrospinal fluid analysis in the diagnosis of multiple sclerosis: a consensus statement. Arch Neurol 2005; 62: Kostulas V, Eeg-Olofsson O, Olsson T, Link H. Demonstration in children of oligoclonal IgG bands in unconcentrated CSF using agarose isoelectric focusing and immunolabeling. Pediatr Neurol 1986; 2: Link H, Huang YM. Oligoclonal bands in multiple sclerosis cerebrospinal fluid: an update on methodology and clinical usefulness. J Neuroimmunol 2006; 180: Mayringer I, Timeltaler B, Deisenhammer F. Correlation between the IgG index, oligoclonal bands in CSF, and the diagnosis of demyelinating diseases. Eur J Neurol 2005; 12: Banwell B, Bar-Or A, Arnold DL, et al. Clinical, environmental, and genetic determinants of multiple sclerosis in children with acute demyelination: a prospective national cohort study. Lancet Neurol 2011; 10: Tenembaum S, Chamoles N, Fejerman N. Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients. Neurology 2002; 59: Pranzatelli MR, Slev PR, Tate ED, Travelstead AL, Colliver JA, Joseph SA. Cerebrospinal fluid oligoclonal bands in childhood opsoclonus myoclonus. Paediatr Neurol 2011; 45: Granerod J, Cunningham R, Zuckerman M, et al. Causality in acute encephalitis: defining aetiologies. Epidemiol Infect 2010; 138: Irani SR, Vincent A. Autoimmune encephalitis new awareness, challenging questions. Discov Med 2011; 11: Vincent A, Bien CG, Irani SR, Waters P. Autoantibodies associated with diseases of the CNS: new developments and future challenges. Lancet Neurol 2011; 10: Dale RC, Brilot F, Banwell B. Pediatric central nervous system inflammatory demyelination: acute disseminated encephalomyelitis, clinically isolated syndromes, neuromyelitis optica, and multiple sclerosis. Curr Opin Neurol 2009; 22: Dale RC, de Sousa C, Chong WK, Cox TC, Harding B, Neville BG. Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children. Brain 2000; 123: Franciotta D, Columba-Cabezas S, Andreoni L, et al. Oligoclonal IgG band patterns in inflammatory demyelinating human and mouse diseases. J Neuroimmunol 2008; 200: Bien CG, Granata T, Antozzi C, et al. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain 2005; 128: Connolly AM, Dodson WE, Prensky AL, Rust RS. Course and outcome of acute cerebellar ataxia. Ann Neurol 1994; 35: Intrathecal and Mirrored OCBs in Paediatric Neurology Adriane Sinclair et al. 75
Contents 1 Immunology for the Non-immunologist 2 Neurology for the Non-neurologist 3 Neuroimmunology for the Non-neuroimmunologist
1 Immunology for the Non-immunologist... 1 1 The Beginnings of Immunology... 1 2 The Components of the Healthy Immune Response... 2 2.1 White Blood Cells... 4 2.2 Molecules... 8 References... 13 2 Neurology
More informationCOPYRIGHT 2012 THE TRANSVERSE MYELITIS ASSOCIATION. ALL RIGHTS RESERVED
The Transverse Myelitis Association...advocating for those with acute disseminated encephalomyelitis, neuromyelitis optica, optic neuritis and transverse myelitis ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM)
More informationPediatric acute demyelinating encephalomyelitis in Denmark: a nationwide population-based study
Pediatric acute demyelinating encephalomyelitis in Denmark: a nationwide population-based study Magnus Spangsberg Boesen November, 2016 Supervisors: P. Born, P. Uldall, M. Blinkenberg, M. Magyari, F. Sellebjerg
More informationAutoimmune Encephalitis
Evaluation Approach for Suspected Autoimmune Encephalitis M.R ASHRAFI PROFESSOR OF PEDIATRIC NEUROLOGY CHILDREN S MEDICAL CENTER PEDIATRIC CENTER OF EXCELLENCE TEHRAN UNIVERSITY OF MEDICAL SCIENCES TEHRAN
More informationMULTIPLE SCLEROSIS PROFILE
MULTIPLE SCLEROSIS PROFILE What is Multiple Sclerosis? Multiple sclerosis (MS) is a chronic, inflammatory disease of unknown etiology that involves an immune-mediated attack on the central nervous system
More informationActualização no diagnóstico e tratamento das doenças desmielinizantes na infância. Silvia Tenembaum
Actualização no diagnóstico e tratamento das doenças desmielinizantes na infância Silvia Tenembaum Acquired CNS inflammatory/demyelinating disorders: Background information More frequent in children than
More informationAutoimmune epilepsies:
Autoimmune epilepsies: Syndromes and Immunotherapies Sarosh R Irani Associate Professor, Wellcome Trust Intermediate Fellow and Honorary Consultant Neurologist Nuffield Department of Clinical Neurosciences,
More informationThe Neurology of HIV Infection. Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University
The Neurology of HIV Infection Carolyn Barley Britton, MD, MS Associate Professor of Clinical Neurology Columbia University HIV/AIDS Epidemiology World-wide pandemic, 40 million affected U.S.- Disproportionate
More informationRole of MRI in acute disseminated encephalomyelitis
Original Research Article Role of MRI in acute disseminated encephalomyelitis Shashvat Modiya 1*, Jayesh Shah 2, C. Raychaudhuri 3 1 1 st year resident, 2 Associate Professor, 3 HOD and Professor Department
More informationNEWER TESTS IN NEUROLOGY DR RAJESH V BENDRE HOD, IMMUNOCHEMISTRY METROPOLIS, MUMBAI
NEWER TESTS IN NEUROLOGY DR RAJESH V BENDRE HOD, IMMUNOCHEMISTRY METROPOLIS, MUMBAI The Central Nervous System was considered an Immunological Privileged Site Blood brain barrier (BBB) Proapoptotic molecules
More informationContents 1 Normal Histology and Commonly Used Stains 2 Basic Pathologic Reactions
Contents 1 Normal Histology and Commonly Used Stains.... 1 1.1 Cells of the Nervous System... 1 1.1.1 Neurons... 1 1.1.2 Astrocytes.... 2 1.1.3 Oligodendrocytes... 5 1.1.4 Schwann Cells... 5 1.1.5 Ependyma....
More informationMRI and differential diagnosis in patients suspected of having MS
Andrea Falini Italy MRI and differential diagnosis in patients suspected of having MS IMPROVING THE PATIENT S LIFE THROUGH MEDICAL EDUCATION www.excemed.org Outline of presentation - Diagnostic criteria
More informationInfection-Associated Neurological Syndromes
Infection-Associated Neurological Syndromes Anand P, MD PhD Medical Director, BloodCenter of Wisconsin Assistant Professor, Medical College of Wisconsin ASFA Annual Meeting San Antonio, TX, May 8th, 2015
More informationAnalysis of prognostic significance of clinical and paraclinical indices in case of different types of acute disseminated encephalomyelitis course.
1 2 Analysis of prognostic significance of clinical and paraclinical indices in case of different types of acute disseminated encephalomyelitis course. 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
More informationAND RELAPSING REMITTING COURSES
original research THE VALUE OF INTRATHECAL MRZ REACTION AND OLIGOCLONAL IgG BANDS FOR DISCRIMINATION BETWEEN THE PRIMARY PROGRESSIVE AND RELAPSING REMITTING COURSES OF MULTIPLE SCLEROSIS Štourač P. 1,
More informationHeterogeneity of Demyelinating Disease: Definitions and Overlap Overview
Heterogeneity of Demyelinating Disease: Definitions and Overlap Overview Brian Weinshenker, MD, FRCP(C) Disclosures Royalties related to patent for discovery of NMO-IgG licensed to RSR Ltd; Oxford University
More informationLancet Neurology 2016 Apr; 15(4): The estimated incidence is 5-10 patients per inhabitants per year.
Lancet Neurology 2016 Apr; 15(4):391-404 Position Paper 1 A clinical approach to diagnosis of autoimmune encephalitis Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, Cortese I, Dale RC,
More informationRSR RSR RSR RSR RSR. ElisaRSR AQP4 Ab RSR. Aquaporin-4 Autoantibody Assay Kit
To aid diagnosis of Neuromyelitis Optica (NMO) and NMO spectrum disorder (NMOSD) To confirm diagnosis before initial treatment of patients with demyelinating inflammatory disease NMO, NMOSD and AQP4 Elisa
More informationNeuroimmunology testing services
Neuroimmunology testing services Neuroimmunology Quest Diagnostics is your source for neuroimmunological testing with expanded offerings for several autoimmune neurological disorders Neuroimmunology is
More informationAUTOIMMUNE ENCEPHALITIS
AUTOIMMUNE ENCEPHALITIS Shruti Agnihotri, MD Assistant Professor Department of Neurology, UAB August 12, 2017 DISCLOSURES No financial disclosure Evolving evidence Page 2 OBJECTIVES Review the types of
More informationNeuroimmunology testing services
Neuroimmunology testing services Neuroimmunology Quest Diagnostics is your source for neuroimmunological testing with expanded offerings for several autoimmune neurological disorders Neuroimmunology is
More informationAppendix 2 (as supplied by the authors): ICD codes to identify high-risk children
Appendix 2 (as supplied by the authors): ICD codes to identify high-risk children ICD-9 codes to identify high risk children in physician claims database Category of condition Condition ICD-9 code Bacterial
More informationEncephalitis. HSV Encephalitis. Encephalitis. Viral CNS Infection. WNV Encephalitis GRAY MATTER. Zoran Rumboldt
Encephalitis Viral CNS Infection Hematogenous dissemination ( along peripheral nerves ) Zoran Rumboldt University of Rijeka Medical University of South Carolina Telemedicine Clinic MarinMed Clinic Many
More informationChild Neurology Elective PL1 Rotation
PL1 Rotation The neurology elective is available to first year residents in either a 2 or 4 week block rotation. The experience will include performing inpatient consultations, attending outpatient clinics
More informationAutoimmune encephalopathieslatest. Prof Belinda Lennox Department of Psychiatry, University of Oxford
Autoimmune encephalopathieslatest advances Prof Belinda Lennox Department of Psychiatry, University of Oxford Belinda.lennox@psych.ox.ac.uk RCP Advanced Medicine 20 th June 2016 Declarations of Interest
More informationEncephalitis following Purified Chick-Embryo Cell Anti-Rabies Vaccination
CASE REPORT JIACM 2003; 4(3): 251-9 Encephalitis following Purified Chick-Embryo Cell Anti-Rabies Vaccination NS Neki*, Ashok Khurana**, Ashok Duggal*** Abstract A case of encephalitis following purified
More informationParaparesis. Differential Diagnosis. Ran brauner, Tel Aviv university
Paraparesis Differential Diagnosis Ran brauner, Tel Aviv university Definition Loss of motor power to both legs Paraparesis (paraplegia) refers to partial (- paresis) or complete (-plegia) loss of voluntary
More informationDisease of Myelin. Reid R. Heffner, MD Distinguished Teaching Professor Emeritus Department of Pathology and Anatomy January 9, 2019
Disease of Myelin Reid R. Heffner, MD Distinguished Teaching Professor Emeritus Department of Pathology and Anatomy January 9, 2019 1 I HAVE NO CONFLICTS OF INTEREST OR DISCLOSURES TO DECLARE. I HAVE NO
More informationCentral nervous system
Central nervous system By Dr. Mohsen Dashti Clinical Medicine & Pathology 316 7 th Lecture Lecture outline Review of structure & function. Symptoms, signs & tests. Specific diseases. Review of structure
More informationPRIMARY DISEASES OF MYELIN. By: Shifaa Al Qa qa
PRIMARY DISEASES OF MYELIN By: Shifaa Al Qa qa Most diseases of myelin are primarily white matter disorders??? Myelinated axons most diseases of CNS myelin do not involve the peripheral nerves to any significant
More informationUnraveling the Mystery of MS Differential Diagnosis
Unraveling the Mystery of MS Differential Diagnosis Aliza Ben-Zacharia, ANP Ann Marie Rooney-Crino, ANP The Corinne Goldsmith Dickinson Center for Multiple Sclerosis The Mount Sinai Medical Center MS or
More informationCNS pathology Third year medical students. Dr Heyam Awad 2018 Lecture 4: Myelin diseases of the CNS
CNS pathology Third year medical students Dr Heyam Awad 2018 Lecture 4: Myelin diseases of the CNS ILOS 1. to understand differences and similarities between diseases of myelin in CNS and PNS. 2. to understand
More informationSeema Sikka, MD January 18, 2014 TRANSVERSE MYELITIS: A CLINICAL OVERVIEW
Seema Sikka, MD January 18, 2014 TRANSVERSE MYELITIS: A CLINICAL OVERVIEW DISCLOSURES I have no industry relationships to disclose. I will not discuss off-label use. OBJECTIVES: TRANSVERSE MYELITIS Review
More informationAccepted Manuscript. Acute disseminated encephalomyelitis in an older adult following prostate resection. B. Ceronie, O.C.
Accepted Manuscript Acute disseminated encephalomyelitis in an older adult following prostate resection B. Ceronie, O.C. Cockerell PII: S2405-6502(18)30038-8 DOI: https://doi.org/10.1016/j.ensci.2018.11.006
More informationClinical Information on West Nile Virus (WNV) Infection
Clinical Information on West Nile Virus (WNV) Infection Introduction In 1999, West Nile Virus (WNV), an Old World flavivirus, producing a spectrum of disease including severe meningoencephalitis, appeared
More informationAcute neurological syndromes
Acute neurological syndromes Assoc.Prof. Murat Sayan Kocaeli Üniversitesi, Rutin PCR Lab. Sorumlu Öğt.Üyesi Yakın Doğu Üniversitesi, DESAM Kurucu Öğrt. Üyesi sayanmurat@hotmail.com 0533 6479020 Medical
More informationRESOURCES. Subacute Sclerosing Panencephalitis in Perspective. W. Walop. Can measles vaccine cause MIBE?
Subacute Sclerosing Panencephalitis in Perspective W. Walop Three different forms of infections in the central nervous system have been associated with the measles virus: acute postinfectious encephalitis,
More informationPMH: No medications; Immunizations UTD No hospitalizations or surgeries Speech Delay. Birth Hx: 24 WGA, NICU x6 months
HPI: 6 months of weakness and parathesias- originally in both feet x 2-3 months, then resolved. Now with parathesias and weakness in fingers x 1 week. Seen by podiatrist and given custom in-soles 1 month
More informationMYELITIS. A Mochan Neurology
MYELITIS A Mochan Neurology ATM MS LETM NMOSD ATM LETM MS NMOSD Acute Transverse Myelitis Longitudinally Extensive Transverse Myelitis Multiple Sclerosis Neuromyelitis Optica Spectrum Disorders ATM ADEM
More informationEpilepsy in the Primary School Aged Child
Epilepsy in Primary School Aged Child Deepak Gill Department of Neurology and Neurosurgery The Children s Hospital at Westmead CHERI Research Forum 15 July 2005 Overview The School Age Child and Epilepsy
More informationNeurology Clerkship Learning Objectives
Neurology Clerkship Learning Objectives Clinical skills Perform a neurological screening examination of the cranial nerves, motor system, reflexes, and sensory system under the observation and guidance
More informationAcute Ataxia Acute. Ataxia. Not defined by consensus. Ryan and Engle (2003) evolution time < 72 hours
Acute Ataxia Eugen Boltshauser Emeritus Department of Pediatric Neurology Children s Hospital Zürich EPNS Training Course March 2015 Budapest Acute Not defined by consensus Ryan and Engle (2003) evolution
More informationTitle: Recurrent myelitis after allogeneic stem cell transplantation. Report of two cases.
Author's response to reviews Title: Recurrent myelitis after allogeneic stem cell transplantation. Report of two cases. Authors: Martin Voss (Martin.Voss@kgu.de) Felix Bischof (Felix.Bischof@uni-tuebingen.de)
More informationThe Role of Assay of Free Immunoglobulin Light Chains in the Diagnosis of the Onset of Multiple Sclerosis
DOI 10.1007/s11055-018-0617-1 Neuroscience and Behavioral Physiology, Vol. 48, No. 6, July, 2018 The Role of Assay of Free Immunoglobulin Light Chains in the Diagnosis of the Onset of Multiple Sclerosis
More informationNew Insights on Optic Neuritis in Young People
Cronicon OPEN ACCESS EC OPHTHALMOLOGY Case Study New Insights on Optic Neuritis in Young People Sergio Carmona 1, Sandra Barbosa 1 and Maria Laura Ortube 2 * 1 Department of Neuro-ophthalmology, Hospital
More informationEpilepsy Syndromes: Where does Dravet Syndrome fit in?
Epilepsy Syndromes: Where does Dravet Syndrome fit in? Scott Demarest MD Assistant Professor, Departments of Pediatrics and Neurology University of Colorado School of Medicine Children's Hospital Colorado
More informationMagnetic Resonance Imaging of Neuromyelitis Optica (Devic s Syndrome)
J Radiol Sci 2012; 37: 45-50 Magnetic Resonance Imaging of Neuromyelitis Optica (Devic s Syndrome) Chien-Chuan Huang Tai-Yuan Chen Tai-Ching Wu Yu-Kun Tsui Te-Chang Wu Wen-Sheng Tzeng Chien-Jen Lin Department
More informationMultiple Sclerosis vs Acute Disseminated Encephalomyelitis in Childhood
Multiple Sclerosis vs Acute Disseminated Encephalomyelitis in Childhood Steven David Brass, MD, Zografos Caramanos, BA, Carlos Santos, MD, Marie-Emmanuelle Dilenge, MD, Yves Lapierre, MD, and Bernard Rosenblatt,
More informationICD-9 to ICD-10 Conversion of Epilepsy
ICD-9-CM 345.00 Generalized nonconvulsive epilepsy, without mention of ICD-10-CM G40.A01 Absence epileptic syndrome, not intractable, with status G40.A09 Absence epileptic syndrome, not intractable, without
More informationدمانس های اتوایمون دکتر رضائی طلب نورولوژیست آذر 95
دمانس های اتوایمون دکتر رضائی طلب نورولوژیست آذر 95 Definition: Dementia According the DSM-5, dementia is defined as significant acquired cognitive impairment in one or more cognitive domains (eg, learning
More informationAcute disseminated encephalomyelitis (ADEM) is a
Russell C. Dale, MBChB, MRCP Acute disseminated encephalomyelitis (ADEM) is a monophasic inflammatory disorder of the central nervous system (CNS). Unlike viral encephalitis, microorganisms do not invade
More informationAlberta Health Public Health Notifiable Disease Management Guidelines December Subacute Sclerosing Panencephalitis (SSPE)
December 2015 Subacute Sclerosing Panencephalitis (SSPE) Revision Dates Case Definition Reporting Requirements Remainder of the Guideline (i.e., Etiology to References sections inclusive) Case Definition
More informationDemyelinating Diseases of the Brain
Department of Radiology University of California San Diego Demyelinating Diseases of the Brain John R. Hesselink, M.D. T1-Weighted Images Normal White Matter Contents Axons with envelope of myelin Neuroglia
More informationInteractive Cases: Demyelinating Diseases and Mimics. Disclosures. Case 1 25 yo F with nystagmus; look for tumor 4/14/2017
Interactive Cases: Demyelinating Diseases and Mimics Disclosures None Brad Wright, MD 27 March 2017 Case 1 25 yo F with nystagmus; look for tumor What do you suspect? A. Demyelinating disease B. Malignancy
More informationThe University of Arizona Pediatric Residency Program. Primary Goals for Rotation. Neurology
The University of Arizona Pediatric Residency Program Primary Goals for Rotation Neurology 1. GOAL: Understand the role of the pediatrician in preventing neurological diseases, and in counseling and screening
More informationANTIBODIES TO HERPES-SIMPLEX VIRUS IN THE CEREBROSPINAL FLUID OF PATIENTS WITH HER- PETIC ENCEPHALITIS
ANTIBODIES TO HERPES-SIMPLEX VIRUS IN THE CEREBROSPINAL FLUID OF PATIENTS WITH HER- PETIC ENCEPHALITIS F. 0. MACCALLUM, I. J. CHINN AND J. V. T. GOSTLMG Virology Laboratory, Radclife Infirmary, Oxford
More informationEpilepsy in children with cerebral palsy
Seizure 2003; 12: 110 114 doi:10.1016/s1059 1311(02)00255-8 Epilepsy in children with cerebral palsy A.K. GURURAJ, L. SZTRIHA, A. BENER,A.DAWODU & V. EAPEN Departments of Paediatrics, Community Medicine
More informationDifferential diagnose of cerebral infections. Peter Uldall Rigshospitalet
Differential diagnose of cerebral infections Peter Uldall Rigshospitalet Encephalitis Definition: Inflammation of the brain parachyma Markers: Inflammatory cells of CNS MRI Aetiology: 1) Infectious agents
More informationFebrile seizures. Olivier Dulac. Hôpital Necker-Enfants Malades, Université Paris V, INSERM U663
Febrile seizures Olivier Dulac Hôpital Necker-Enfants Malades, Université Paris V, INSERM U663 olivier.dulac@nck.aphp.fr Definition Seizures precipitated by fever that is not due to an intracranial infection
More informationWingerchuk et al, Neurol, 2006
Current Understanding of Neuromyelitis Optica Jacqueline A. Leavitt, M.D. Mayo Clinic Rochester, MN I have no financial disclosures 46 y/o F Pain in R temple worse with head movements, resolved in days
More informationMRI in Differential Diagnosis. CMSC, June 2, Jill Conway, MD, MA, MSCE
MRI in Differential Diagnosis CMSC, June 2, 2016 Jill Conway, MD, MA, MSCE Director, Carolinas MS Center Clerkship Director, UNCSOM-Charlotte Campus Charlotte, NC Disclosures Speaking, consulting, and/or
More informationHippocampal Sclerosis in LGI1 and CSPR2 Positive Limbic Encephalopathy: Case Report
Hippocampal Sclerosis in LGI1 and CSPR2 Positive Limbic Encephalopathy: Ammar Taha Abdulaziz 1, Le Zhang 1, Dong Zhou 2, JinMei Li 3, Abstract Background: Limbic encephalopathy (LE) is a sub-acute neuropsychiatric
More informationCNS demyelination and quadrivalent HPV vaccination
SHORT REPORT Multiple Sclerosis 2009; 15: 116 119 CNS demyelination and quadrivalent HPV vaccination I Sutton 1,2, R Lahoria 3, IL Tan 1, P Clouston 4 and MH Barnett 2,3 Vaccination is generally considered
More informationJNNP Online First, published on November 22, 2012 as /jnnp Neuro-inflammation
1 Department of Clinical Neurology, John Radcliffe Hospital, University of Oxford, Oxford, UK 2 Department of Paediatric Neurology, Birmingham Children s Hospital, Birmingham, UK 3 Department of Paediatric
More informationChildhood Post-infectious Autoimmune Encephalitis. PANDA problems. Michael Daines, M.D. Pediatric Allergy-Immunology
Childhood Post-infectious Autoimmune Encephalitis PANDA problems Michael Daines, M.D. Pediatric Allergy-Immunology Terms PANDAS Pediatric Autoimmune Neuropsychiatric Disorders Associated with Strep PANS
More informationEpilepsy and EEG in Clinical Practice
Mayo School of Professional Development Epilepsy and EEG in Clinical Practice November 10-12, 2016 Hard Rock Hotel at Universal Orlando Orlando, FL Course Directors Jeffrey Britton, MD and William Tatum,
More informationAppendix I (a) Human Surveillance Case Definition (Revised July 4, 2005)
Section A: Case Definitions Appendix I (a) Human Surveillance Case Definition (Revised July 4, 2005) The current Case Definitions were drafted with available information at the time of writing. Case Definitions
More informationAcquired and genetic channelopathies: in vivo assessment of
Kuwabara, p1 Experimental Neurology, Commentary Commentary on: Park SB, et al. Axonal dysfunction with voltage gated potassium channel complex antibodies. Experimental Neurology 261(2014) 337-342 Acquired
More informationWho Gets Epilepsy? Etiologies and Risk Factors for Seizures. David Spencer, MD Professor of Neurology Director, OHSU Epilepsy Center Portland, OR
Who Gets Epilepsy? Etiologies and Risk Factors for Seizures David Spencer, MD Professor of Neurology Director, OHSU Epilepsy Center Portland, OR Epidemiology Risk Factors Febrile seizures CNS infection
More informationNeurological update: MOG antibody disease
https://doi.org/10.1007/s00415-018-9122-2 NEUROLOGICAL UPDATE Neurological update: MOG antibody disease Ray Wynford Thomas 1,2 Anu Jacob 3 Valentina Tomassini 1,2,4 Received: 17 August 2018 / Revised:
More informationEPILEPSY. Elaine Wirrell
EPILEPSY Elaine Wirrell Seizures are amongst the most common of neurological disorders in the pediatric age range. The incidence of new-onset epilepsy in children is approximately 40 per 100,000 per year
More informationNeurology. Access Center 24/7 access for referring physicians (866) 353-KIDS (5437)
Neurology The Neurology practice at Valley Children s provides diagnostic services, medical treatment, and followup care to infants, children, and adolescents who have suspected or confirmed neurological
More information5/8/2017. Nothing to disclose Objectives
Brooke Surran, MD Eastern Maine Medical Center Pediatric Neurology Nothing to disclose Objectives Recognize the clinical features of ROHHAD Understand progression of ROHHAD and possible treatments Understand
More informationAcute Ataxia Acute. Ataxia. Sensory versus cerebellar ataxia. Overview
Acute Ataxia Eugen Boltshauser Emeritus Department of Pediatric Neurology Children s Hospital Zürich EPNS Training Course May 2018 Alicante Overview General remarks terminology Clinical examination Additional
More informationEEG in Epileptic Syndrome
EEG in Epileptic Syndrome Surachai Likasitwattanakul, M.D. Division of Neurology, Department of Pediatrics Faculty of Medicine, Siriraj Hospital Mahidol University Epileptic syndrome Electroclinical syndrome
More informationAntibodies Main associated neurological syndromes Cancer. Subacute cerebellar ataxia. Ma2-Ab Limbic encephalitis Testicular
Auto-antibodies Antibodies Main associated neurological syndromes Cancer Hu-Ab Yo-Ab CV2-Ab Ri-Ab amphiphysin-ab Sensory neuronopathy Encephalomyelitis Chronic gastrointestinal pseudoobstruction Cerebellar
More informationEpilepsy. Presented By: Stan Andrisse
Epilepsy Presented By: Stan Andrisse What Is Epilepsy Chronic Neurological Disorder Characterized by seizures Young children or elderly Developing countries Famous Cases Socrates Muhammad Aristotle Joan
More informationEPILEPSY AND AUTOIMMUNE ENCEPHALITIS
EPILEPSY AND AUTOIMMUNE ENCEPHALITIS Maarten J Titulaer, MD PhD Erasmus Medical Center, Erasmus University Rotterdam, THE NETHERLANDS Contents Introduction VGKC-complex antibodies o anti-lgi1 encephalitis
More informationSUSPECTED MECHANISMS INVOLVED IN MS AND PUTATIVE INTERACTIONS WITH HEPATITIS B VACCINE IN MS
SUSPECTED MECHANISMS INVOLVED IN MS AND PUTATIVE INTERACTIONS WITH HEPATITIS B VACCINE IN MS Emmanuelle Waubant, M.D. Olaf Stüve, M.D., PhD UCSF MS Center, San Francisco March 11, 2002 EPIDEMIOLOGY OF
More informationProvide specific counseling to parents and patients with neurological disorders, addressing:
Neurology Description: The Pediatric Neurology elective will give the resident the opportunity to learn how to obtain an appropriate history and perform a complete neurologic exam. Four to five half days
More informationMovement disorders in childhood: assessment and diagnosis. Lucinda Carr
Movement disorders in childhood: assessment and diagnosis Lucinda Carr Movement disorders in childhood: Assessment Classification Causes Diagnosis Presentation of movement disorders in childhood: Concerns
More informationResearch Article Optic Nerve and Spinal Cord Are the Major Lesions in Each Relapse of Japanese Multiple Sclerosis
International Scholarly Research Network ISRN Neurology Volume 211, Article ID 9476, 4 pages doi:1.542/211/9476 Research Article Optic Nerve and Spinal Cord Are the Major Lesions in Each Relapse of Japanese
More informationSituaciones estresantes en el lupus
Situaciones estresantes en el lupus Munther A Khamashta MD FRCP PhD Director: Lupus Research Unit Barcelona, Noviembre 2008 What is Lupus? Lupus is a neurological disease and sometimes affects other organs
More informationEpilepsy Surgery: A Pediatric Neurologist s Perspective
Epilepsy Surgery: A Pediatric Neurologist s Perspective Juliann M. Paolicchi, MD, MA Associate Professor of Neurology and Pediatrics Director, Pediatric Neurology Director, Pediatric Epilepsy and EEG Vanderbilt
More informationS (18) doi: /j.ensci Reference: ENSCI 122
Accepted Manuscript A case of cerebellar ataxia associated with VZV infection Hirofumi Matsuyama, Takekazu Ohi PII: S2405-6502(18)30012-1 DOI: doi:10.1016/j.ensci.2018.04.003 Reference: ENSCI 122 To appear
More informationInitial symptom or syndrome: (1) FOCAL WEAKNESS OR NUMBNESS
View the referenced DVD patient cases, especially if few hospital or clinic patients are encountered for any one symptom or syndrome. The DVD patient cases are referenced by initial symptom or syndrome
More informationDiagnosing Epilepsy in Children and Adolescents
2019 Annual Epilepsy Pediatric Patient Care Conference Diagnosing Epilepsy in Children and Adolescents Korwyn Williams, MD, PhD Staff Epileptologist, BNI at PCH Clinical Assistant Professor, Department
More informationSubspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level
Subspecialty Rotation: Child Neurology at SUNY (KCHC and UHB) Residents: Pediatric residents at the PL1, PL2, PL3 level Prerequisites: Any prior pediatric rotations and experience Primary Goals for this
More informationClassification of Epilepsy: What s new? A/Professor Annie Bye
Classification of Epilepsy: What s new? A/Professor Annie Bye The following material on the new epilepsy classification is based on the following 3 papers: Scheffer et al. ILAE classification of the epilepsies:
More informationMANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN
MANAGEMENT OF SUSPECTED VIRAL ENCEPHALITIS IN CHILDREN OVERVIEW 1980s: dramatically improved by aciclovir HSV encephalitis in adults Delays treatment(> 48h after hospital admission): associated with a
More informationFailure to wake. Robin S. Howard
Failure to wake Robin S. Howard National Hospital for Neurology and Neurosurgery, Queen Square St. Thomas Hospital, Guys & St. Thomas NHS (Foundation) Trust Royal College of Physicians - November 2017
More informationOntario Acquired Brain Injury (ABI) Dataset Project Phase III. Highlights: Numbers of Episodes of Care and Causes of Brain Injury
Ontario Acquired Brain Injury (ABI) Dataset Project Phase III Highlights: Numbers of Episodes of Care and Causes of Brain Injury Acquired Brain Injury (ABI), which includes brain injury from traumatic
More informationEEG IN FOCAL ENCEPHALOPATHIES: CEREBROVASCULAR DISEASE, NEOPLASMS, AND INFECTIONS
246 Figure 8.7: FIRDA. The patient has a history of nonspecific cognitive decline and multiple small WM changes on imaging. oligodendrocytic tumors of the cerebral hemispheres (11,12). Electroencephalogram
More informationBrainstorming the Case: An unusual presentation of autoimmune encephalitis
Brainstorming the Case: An unusual presentation of autoimmune encephalitis Alyssa Tilly, MD, LeeAnne Flygt, MD, MA, Ashley Sutton, MD UNC Chapel Hill Department of Pediatrics Disclosure of Financial Relationships
More informationClinical Commissioning Policy Proposition: Intravenous immunoglobulin for acute disseminated encephalomyelitis and autoimmune encephalitis
Clinical Commissioning Policy Proposition: Intravenous immunoglobulin for acute disseminated encephalomyelitis and autoimmune encephalitis Reference: NHS England F06X05/01 First published: March 2016 Prepared
More informationReferences 1. Feng S et al. Journal of Thoracic Oncology 2017; 12: Spain L et al. Annals of Oncology 2017; 28:
Maulik Shah, MD February 15, 2019 Patient Presentation: Progressive Sensory Disturbance In early 2018, this 57 year old man was sent to the Emergency Department after complaining in the oncology clinic
More informationAutologous Hematopoietic Stem Cell Transplantation for the Treatment of Neuromyelitis Optica in Singapore
Case Reports 26 Autologous Hematopoietic Stem Cell Transplantation for the Treatment of Neuromyelitis Optica in Singapore Koh Yeow Hoay, Pavanni Ratnagopal Abstract Introduction: Neuromyelitis optica (NMO)
More informationBlood Brain Barrier Disruption is More Severe in Neuromyelitis Optica than in Multiple Sclerosis and Correlates with Clinical Disability
The Journal of International Medical Research 2012; 40: 1483 1491 Blood Brain Barrier Disruption is More Severe in Neuromyelitis Optica than in Multiple Sclerosis and Correlates with Clinical Disability
More information