Cane sign: sciatic neuropathy appearance in magnetic resonance imaging

We present a patient with idiopathic sciatic neuropathy with demonstrative magnetic resonance imaging findings

Identification of circulating MOG-specific B cells in patients with MOG antibodies

Objective To identify circulating myelin oligodendrocyte glycoprotein (MOG)-specific B cells in the blood of patients with MOG antibodies (Abs) and to determine whether circulating MOG-specific B cells are linked to levels and epitope specificity of serum anti-MOG-Abs. Methods We compared peripheral blood from 21 patients with MOG-Abs and 26 controls for the presence of MOG-specific B cells. We differentiated blood-derived B cells in vitro in separate culture wells to Ab-producing cells via engagement of Toll-like receptors 7 and 8. We quantified the anti-MOG reactivity with a live cell-based assay by flow cytometry. We determined the recognition of MOG epitopes with a panel of mutated variants of MOG. Results MOG-Ab-positive patients had a higher frequency of MOG-specific B cells in blood than controls, but MOG-specific B cells were only detected in about 60% of these patients. MOG-specific B cells in blood showed no correlation with anti-MOG Ab levels in serum, neither in the whole group nor in the untreated patients. Epitope analysis of MOG-Abs secreted from MOG-specific B cells cultured in different wells revealed an intraindividual heterogeneity of the anti-MOG autoimmunity. Conclusions This study shows that patients with MOG-Abs greatly differ in the abundance of circulating MOG-specific B cells, which are not linked to levels of MOG-Abs in serum suggesting different sources of MOG-Abs. Identification of MOG-specific B cells in blood could be of future relevance for selecting patients with MOG-Abs for B cell-directed therapy

Nöroloji Yoğun Bakım Ünitesindeki İnme Hastalarında Yoğun Bakım Ünitesinde Edinilmiş Güçsüzlüğün (YBÜ-EG) Multimodal İncelemesi

Intensive care unit acquired weakness (ICU-AW) is a common condition that causes difficulty in weaning from mechanical ventilation, increases morbidity and mortality. In this study, ICU-AW development in stroke patients in the intensive care unit was evaluated by electrophysiological studies, bioimpedance analysis (BIA), muscle biopsy, and mitochondrial complex activities and the correlation between these methods was investigated. Twenty-four stroke patients were included in the study. The patients were followed by serial nerve conduction studies and BIA. Muscle biopsy was performed on patients who were considered having critical illness myopathy/neuromyopathy (CINM) in electrophysiological studies. Muscle biopsy specimens were examined histochemically. Respiratory chain complex activities were analysed and compared to control group consisted of muscle tissues of patients who underwent orthopaedic surgery for various reasons. The frequency of ICU-AW was found to be 33%. Femoral motor nerve conduction, which has not been used in previous studies, was the best parameter in predicting the development of CINM. It was observed that CMAP duration remained relatively constant in the early period and started to increase later on. The muscle biopsies revealed type 2 muscle fiber atrophy. The respiratory chain complex activity analysis showed a prominent decrease in complex I similar to septic patients. This was the first study evaluating the development of ICU-AW in stroke patients by electrophysiological studies, muscle biopsy and respiratory chain complex activities together. Studying all these parameters in larger cohorts is essential for a better understanding of the pathogenesis of critical illness neuromyopathy and new treatment strategies. Keywords: intensive care unit acquired weakness, muscle biopsy, critical illness neuromyopathy, nerve conduction study, mitochondrial complex Supported by Hacettepe University (Proje ID: THD-2018-17114)Yoğun bakım ünitesinde edinilmiş güçsüzlük (YBÜ-EG) sık görülen, mekanik ventilatörden ayrılmayı güçleştiren, morbidite ve mortaliteyi artıran bir tablodur. Bu çalışmada yoğun bakım ünitesindeki inme hastalarında elektrofizyolojik incelemeler, biyoimpedans analizi (BİA), kas biyopsisi ve mitokondriyal kompleks aktiviteleri ile YBÜ-EG gelişimi değerlendirilmiş ve bu yöntemler arasındaki ilişki incelenmiştir. Çalışmaya 24 inme hastası dahil edilmiştir. Hastalar seri sinir iletim çalışmaları ve BİA ile takip edilmiştir. Elektrofizyolojik olarak kritik hastalık miyopatisi/nöromiyopatisi (KHNM) düşünülen hastalara kas biyopsisi yapılmıştır. Kas biyopsisi materyalleri histokimyasal olarak incelenmiş ve solunum zinciri kompleks aktiviteleri çeşitli nedenlerle ortopedik cerrahi geçiren hastaların kas dokuları kontrol olarak kullanılarak analiz edilmiştir. Yoğun bakım ünitesinde edinilmiş güçsüzlüğün sıklığı %33 olarak saptanmıştır. Önceki çalışmalardan farklı olarak femoral motor sinir iletimi de çalışılmış ve KHNM gelişimini kestirmede en iyi parametrelerden biri olduğu görülmüştür, BKAP sürelerinin erken dönemde görece sabit kaldığı sonrasında uzamaya başladığı gözlenmiştir. Kas biyopsilerinde tip 2 kas lifi atrofisi gözlenmiştir. Solunum zinciri kompleks aktiviteleri değerlendirildiğinde septik hastalardakine benzer şekilde özellikle kompleks I aktivitesinde azalma olduğu görülmüştür. Bu çalışma, inme hastaları özelinde YBÜ-EG gelişimini inceleyen elektrofizyolojik incelemeler, kas biyopsisi ve solunum zinciri kompleks aktivitelerinin bir arada değerlendirildiği ilk çalışmadır. Tüm bu parametrelerin daha geniş kohortlarla çalışılması kritik hastalık nöromiyopatisinin patogenezinin daha iyi anlaşılması ve tedavi stratejilerinin geliştirilmesi açısından önem arz etmektedir. Destekleyen kuruluş: Hacettepe Üniversitesi (Proje no: THD-2018-17114

Giant Cell Myositis Associated With Myasthenia Gravis And Thymoma

WoSScopu

Identification Of Circulating Mog-Specific B Cells In Patients With Mog Antibodies

Objective To identify circulating myelin oligodendrocyte glycoprotein (MOG)-specific B cells in the blood of patients with MOG antibodies (Abs) and to determine whether circulating MOG-specific B cells are linked to levels and epitope specificity of serum anti-MOG-Abs. Methods We compared peripheral blood from 21 patients with MOG-Abs and 26 controls for the presence of MOG-specific B cells. We differentiated blood-derived B cells in vitro in separate culture wells to Ab-producing cells via engagement of Toll-like receptors 7 and 8. We quantified the anti-MOG reactivity with a live cell–based assay by flow cytometry. We determined the recognition of MOG epitopes with a panel of mutated variants of MOG. Results MOG-Ab–positive patients had a higher frequency of MOG-specific B cells in blood than controls, but MOG-specific B cells were only detected in about 60% of these patients. MOG-specific B cells in blood showed no correlation with anti-MOG Ab levels in serum, neither in the whole group nor in the untreated patients. Epitope analysis of MOG-Abs secreted from MOG-specific B cells cultured in different wells revealed an intraindividual heterogeneity of the anti-MOG autoimmunity. Conclusions This study shows that patients with MOG-Abs greatly differ in the abundance of circulating MOG-specific B cells, which are not linked to levels of MOG-Abs in serum suggesting different sources of MOG-Abs. Identification of MOG-specific B cells in blood could be of future relevance for selecting patients with MOG-Abs for B cell–directed therapy.PubMedWoSScopu

Neuropathic Pain Frequency in Neurology Outpatients: A Multicenter Study

Introduction: Neuropathic pain is common, but the frequency of misdiagnosis and irrational treatment is high. The aim of this study is to evaluate the rate of neuropathic pain in neurology outpatient clinics by using valid and reliable scales and review the treatments of patients