Copper deficiency myelopathy: A report of two cases

Context Copper deficiency myelopathy represents an often underdiagnosed, acquired neurological syndrome, clinically characterized by posterior column dysfunction. The main causes of copper deficiency are bariatric surgery, increased consumption of zinc, and malabsorption. However, even after a careful history taking and extensive laboratory researches, the etiology of copper deficiency remains undetermined in a significant percentage of cases. Patients affected by copper deficiency myelopathy usually present with sensory ataxia due to dorsal column dysfunction and sometimes with mild leg spasticity. In such patients, spinal cord magnetic resonance imaging (MRI) may show hyperintense lesions in T2-weighted sequences involving the posterior columns of cervical and thoracic cord. These MRI findings are not distinguishable from those of subacute combined degeneration associated with vitamin B12 deficiency. Findings Here, we describe two patients with gait ataxia and sensory symptoms in which a diagnosis of copper deficiency myelopathy was made. Both patients showed a significant clinical, neuroradiological, and neurophysiological improvement after proper supplementation therapy. Conclusion The patients herein described underline the importance to include serum copper and ceruloplasmin levels as part of the myelopathy diagnostic workup, especially in the cases of otherwise unexplained subacute myelopathy involving the posterior columns. Since copper deficiency myelopathy is a progressive syndrome, early diagnosis is mandatory in order to promptly provide a proper supplementation therapy and, thus, prevent an irreversible neurological damage

Nusinersen in pediatric and adult patients with type III spinal muscular atrophy

none32Objective: We report longitudinal data from 144 type III SMA pediatric and adult patients treated with nusinersen as part of an international effort. Methods: Patients were assessed using Hammersmith Functional Motor Scale Expanded (HFMSE), Revised Upper Limb Module (RULM), and 6-Minute Walk Test (6MWT) with a mean follow-up of 1.83 years after nusinersen treatment. Results: Over 75% of the 144 patients had a 12-month follow-up. There was an increase in the mean scores from baseline to 12 months on both HFMSE (1.18 points, p = 0.004) and RULM scores (0.58 points, p = 0.014) but not on the 6MWT (mean difference = 6.65 m, p = 0.33). When the 12-month HFMSE changes in the treated cohort were compared to an external cohort of untreated patients, in all untreated patients older than 7 years, the mean changes were always negative, while always positive in the treated ones. To reduce a selection bias, we also used a multivariable analysis. On the HFMSE scale, age, gender, baseline value, and functional status contributed significantly to the changes, while the number of SMN2 copies did not contribute. The effect of these variables was less obvious on the RULM and 6MWT. Interpretation: Our results expand the available data on the effect of Nusinersen on type III patients, so far mostly limited to data from adult type III patients.mixedPera M.C.; Coratti G.; Bovis F.; Pane M.; Pasternak A.; Montes J.; Sansone V.A.; Dunaway Young S.; Duong T.; Messina S.; Mizzoni I.; D'Amico A.; Civitello M.; Glanzman A.M.; Bruno C.; Salmin F.; Morando S.; De Sanctis R.; Sframeli M.; Antonaci L.; Frongia A.L.; Rohwer A.; Scoto M.; De Vivo D.C.; Darras B.T.; Day J.; Martens W.; Patanella K.A.; Bertini E.; Muntoni F.; Finkel R.; Mercuri E.Pera, M. C.; Coratti, G.; Bovis, F.; Pane, M.; Pasternak, A.; Montes, J.; Sansone, V. A.; Dunaway Young, S.; Duong, T.; Messina, S.; Mizzoni, I.; D'Amico, A.; Civitello, M.; Glanzman, A. M.; Bruno, C.; Salmin, F.; Morando, S.; De Sanctis, R.; Sframeli, M.; Antonaci, L.; Frongia, A. L.; Rohwer, A.; Scoto, M.; De Vivo, D. C.; Darras, B. T.; Day, J.; Martens, W.; Patanella, K. A.; Bertini, E.; Muntoni, F.; Finkel, R.; Mercuri, E