Updated Diagnostic Criteria for Paraneoplastic Neurologic Syndromes

The contemporary diagnosis of paraneoplastic neurologic syndromes (PNSs) requires an increasing understanding of their clinical, immunologic, and oncologic heterogeneity. The 2004 PNS criteria are partially outdated due to advances in PNS research in the last 16 years leading to the identification of new phenotypes and antibodies that have transformed the diagnostic approach to PNS. Here, we propose updated diagnostic criteria for PNS.A panel of experts developed by consensus a modified set of diagnostic PNS criteria for clinical decision making and research purposes. The panel reappraised the 2004 criteria alongside new knowledge on PNS obtained from published and unpublished data generated by the different laboratories involved in the project.The panel proposed to substitute "classical syndromes" with the term "high-risk phenotypes" for cancer and introduce the concept of "intermediate-risk phenotypes." The term "onconeural antibody" was replaced by "high risk" (>70% associated with cancer) and "intermediate risk" (30%-70% associated with cancer) antibodies. The panel classified 3 levels of evidence for PNS: definite, probable, and possible. Each level can be reached by using the PNS-Care Score, which combines clinical phenotype, antibody type, the presence or absence of cancer, and time of follow-up. With the exception of opsoclonus-myoclonus, the diagnosis of definite PNS requires the presence of high- or intermediate-risk antibodies. Specific recommendations for similar syndromes triggered by immune checkpoint inhibitors are also provided.The proposed criteria and recommendations should be used to enhance the clinical care of patients with PNS and to encourage standardization of research initiatives addressing PNS.Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology

Immune and Genetic Signatures of Breast Carcinomas Triggering Anti-Yo–Associated Paraneoplastic Cerebellar Degeneration

International audienceBackground and Objectives Paraneoplastic cerebellar degeneration (PCD) with anti-Yo antibodies is a cancer-related autoimmune disease directed against neural antigens expressed by tumor cells. A putative trigger of the immune tolerance breakdown is genetic alteration of Yo antigens. We aimed to identify the tumors' genetic and immune specificities involved in Yo-PCD pathogenesis. Methods Using clinicopathologic data, immunofluorescence (IF) imaging, and whole-transcriptome analysis, 22 breast cancers (BCs) associated with Yo-PCD were characterized in terms of oncologic characteristics, genetic alteration of Yo antigens, differential gene expression profiles, and morphofunctional specificities of their in situ antitumor immunity by comparing them with matched control BCs. Results Yo-PCD BCs were invasive carcinoma of no special type, which early metastasized to lymph nodes. They overexpressed human epidermal growth factor receptor 2 (HER2) but were hormone receptor negative. All Yo-PCD BCs carried at least 1 genetic alteration (variation or gain in copy number) on CDR2L, encoding the main Yo antigen that was found aberrantly overexpressed in Yo-PCD BCs. Analysis of the differentially expressed genes found 615 upregulated and 54 downregulated genes in Yo-PCD BCs compared with HER2-driven control BCs without PCD. Ontology enrichment analysis found significantly upregulated adaptive immune response pathways in Yo-PCD BCs. IF imaging confirmed an intense immune infiltration with an overwhelming predominance of immunoglobulin G-plasma cells. Discussion These data confirm the role of genetic alterations of Yo antigens in triggering the immune tolerance breakdown but also outline a specific biomolecular profile in Yo-PCD BCs, suggesting a cancer-specific pathogenesis

Hypertrophic Olivary Degeneration and Palatal or Oculopalatal Tremor

Hypertrophic degeneration of the inferior olive is mainly observed in patients developing palatal tremor (PT) or oculopalatal tremor (OPT). This syndrome manifests as a synchronous tremor of the palate (PT) and/or eyes (OPT) that may also involve other muscles from the branchial arches. It is associated with hypertrophic inferior olivary degeneration that is characterized by enlarged and vacuolated neurons, increased number and size of astrocytes, severe fibrillary gliosis, and demyelination. It appears on MRI as an increased T2/FLAIR signal intensity and enlargement of the inferior olive. There are two main conditions in which hypertrophic degeneration of the inferior olive occurs. The most frequent, studied, and reported condition is the development of PT/OPT and hypertrophic degeneration of the inferior olive in the weeks or months following a structural brainstem or cerebellar lesion. This “symptomatic” condition requires a destructive lesion in the Guillain–Mollaret pathway, which spans from the contralateral dentate nucleus via the brachium conjunctivum and the ipsilateral central tegmental tract innervating the inferior olive. The most frequent etiologies of destructive lesion are stroke (hemorrhagic more often than ischemic), brain trauma, brainstem tumors, and surgical or gamma knife treatment of brainstem cavernoma. The most accepted explanation for this symptomatic PT/OPT is that denervated olivary neurons released from inhibitory inputs enlarge and develop sustained synchronized oscillations. The cerebellum then modulates/accentuates this signal resulting in abnormal motor output in the branchial arches. In a second condition, PT/OPT and progressive cerebellar ataxia occurs in patients without structural brainstem or cerebellar lesion, other than cerebellar atrophy. This syndrome of progressive ataxia and palatal tremor may be sporadic or familial. In the familial form, where hypertrophic degeneration of the inferior olive may not occur (or not reported), the main reported etiologies are Alexander disease, polymerase gamma mutation, and spinocerebellar ataxia type 20. Whether or not these are associated with specific degeneration of the dentato–olivary pathway remain to be determined. The most symptomatic consequence of OPT is eye oscillations. Therapeutic trials suggest gabapentin or memantine as valuable drugs to treat eye oscillations in OPT

Early phagocytic response in experimental ischemia in mice : mRI and histology study

La réaction inflammatoire post-ischémique est dominée par les cellules mononuclées phagocytaires : la microglie, cellules immunocompétentes du parenchyme cérébral, et les macrophages dérivant du sang et infiltrant le tissu cérébral lésé. L’imagerie cellulaire par IRM avec injection de nanoparticules superparamagnétiques d’oxydes de fer (USPIO) a contribué à la description dynamique de cette infiltration macrophagique tardive. Cependant, la séquence spatio-temporelle de l’activation microgliale et du recrutement macrophagique, intriqués avec des altérations de la barrière hématoencéphalique au cours des premières heures post-ischémie, reste mal élucidée. Nous avons tenté de mieux comprendre la relation entre les signaux IRM après injection d’USPIO et la réaction phagocytaire aux temps précoces post-ischémie dans un modèle d’accident vasculaire cérébral chez la souris. Nos résultats suggèrent que les modifications précoces de signal après injection d’USPIO reflètent principalement des mécanismes non spécifiques d’entrée des particules dans le tissu lésé. Pour étudier les interactions entre les cellules neurales et les macrophages périphériques au cours de la réaction inflammatoire post-ischémique précoce, nous avons développé un modèle in vivo d’ischémie globale chez la souris et un modèle in vitro d’hypoxie sur cultures organotypiques d’hippocampe. Ce dernier modèle nous a permis d’analyser les effets de co-cultures macrophagiques sur la survie des cellules neurales au sein du parenchyme cérébral ischémié et d’analyser les profils d’expressions cytokiniques impliqués dans ces interactions à médiation humorale. Nous avons observé un effet neuroprotecteur sur la perte neurale post-hypoxique des co-cultures macrophagiques. Cet effet à médiation humorale est associé à un profil d’activation macrophagique de type alternatif (M2).Clinical outcome in cerebral ischemia may be influenced by innate immune cells of myeloid lineage : central nervous system (CNS)-infiltrating peripheral macrophages and CNS-resident microglia. Noninvasive monitoring of these cells may improve the understanding of postischemic inflammation. Accumulation of Ultrasmall Superparamagnetic Particles of Iron Oxide (USPIO) has been observed in infarcted areas at the subacute stage of experimental stroke. However, the exact route of USPIO uptake and early brain distribution remain elusive, hampering the interpretation of USPIO-relatedsignals. Therefore, we compared MRI signal changes after intravenous USPIO injection with the histological distribution of iron particles and macrophagic cells 6 to 24 hours after permanent middle cerebral artery occlusion in mice. Our results suggest that in this model, early USPIO-related MR signal changes are mainly related to passive diffusion of free USPIO through a damaged blood-brain barrier and to intravascular trapping rather than peripheral phagocyte infiltration. To understand the complex interactions between microglia, hypoxic neurons and CNS-infiltrating macrophages, we setup an in vitro model where primary macrophages were co-cultured with hippocampal slices submitted to hypoxia and glucose deprivation (OGD). Our results indicate that under these experimental conditions, cultured macrophages engage in a M2 activation pattern and afford partial protection from OGD-induced neuronal loss through paracrine mechanisms. We also conclude that microglia is susceptible to hypoxia-induced cell death in vitro and in viv

Une apraxie oculomotrice primaire progressive révélatrice d'une dégénérescence lobaire fronto-temporale

LYON1-BU Santé (693882101) / SudocSudocFranceF

Balint syndrome in anti-NMDA receptor encephalitis

International audienc