Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis

Suanprasert, Narupat; Taylor, Bruce; Klein, Christopher J.; Roforth, Matthew M.; Karam, Chafic; Keegan, B. Mark; Dyck, Peter J.

doi:10.1016/j.msard.2019.02.026

Cited by 9 publications

(5 citation statements)

References 29 publications

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“…Six of our cases had concurrent central demyelinating disease (diagnosed as coexisting multiple sclerosis, 3 with CISP-plus and 3 with CISP) with 3 previously reported. 21 One CISP-plus case had longstanding HIV being treated with anti-retroviral therapy. Two patients (one of 4 CISP-plus and one of 6 CISP tested) were positive for contactin-1/CASPR1 antibody confirmed by cell-based assay and immunofluorescence.…”

Section: Central Demyelination and Other Associationsmentioning

confidence: 99%

Expanding the Spectrum of Chronic Immune Sensory Polyradiculopathy

et al. 2021

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Objectives:Sensory loss with normal nerve conduction studies (NCS) from focal sensory root inflammatory demyelination is characteristic of chronic immune sensory polyradiculopathy (CISP). However, non-pure cases involving motor and distal sensory nerves exist (CISP-plus). We hypothesize that CISP-plus and CISP are fundamentally part of the same syndrome through comparison of clinical, neurophysiological and pathological features.Methods:CISP-plus (primary dorsal root with lesser motor and sensory nerve involvement) and CISP cases were retrospectively analyzed (1986-2019).Results:We identified 44 CISP-plus and 28 CISP cases (n=72) with 86% (38/44) of CISP-plus and 79% (22/28) of CISP patients experiencing imbalance. On examination, large fiber sensory loss was present in 98% (43/44) of CISP-plus and 96% (27/28) of CISP. Gait ataxia was evident in 93% (41/44) of CISP-plus and 79% (22/28) of CISP. Mild distal weakness was common in CISP-plus (75%, 33/44). NCS showed mild abnormalities in all CISP-plus and were normal (by definition) in all CISP. Elevated cerebral spinal fluid (CSF) protein, slowing of somatosensory evoked potentials and MRI root enhancement occurred in most CISP-plus and CISP cases. Eleven CISP-plus nerve biopsies showed loss of large myelinated fibers and onion-bulb formation most prominent in rootlet biopsies. Immunotherapy resulted in marked improvement of gait ataxia in 84% (27/32) of CISP-plus and 93% (14/15) of CISP cases with return to normal neurological examination in half (25/46).Conclusion:The recognition of CISP-plus expands the spectrum of CIDP by combining CISP-plus (predominant sensory polyradiculopathy with mild motor and sensory nerve involvement) with pure-CISP (focal sensory polyradiculopathy) together as proximal sensory CIDP.

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Section: Central Demyelination and Other Associationsmentioning

confidence: 99%

Expanding the Spectrum of Chronic Immune Sensory Polyradiculopathy

et al. 2021

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“…With the help of NCS, neuronal damage can be demonstrated objectively in patients with suspicious neuropathy. Peripheral neuropathy in MS could be divided into two categories as MS with chronic inflammatory demyelinating polyradiculoneuropathy (MS-CIDP, 21%) and MS with other non-inflammatory polyneuropathies (mainly axonal, 79%) 10 . MS CIDP may be the coexistence of two different diseases; however, there are different opinions on this issue.…”

Section: Discussionmentioning

confidence: 99%

Neuropathy in multiple sclerosis patients treated with teriflunomide

Suzan

Bulut

Şahbaz

2023

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: Teriflunomide is an oral medication approved for the treatment of patients with multiple sclerosis. The primary effect of teriflunomide is to reduce de novo pyrimidine synthesis by inhibiting mitochondrial dihydroorotate dehydrogenase, thereby causing cell-cycle arrest. We aimed to investigate the occurrence of peripheral neuropathy, a rare side effect of teriflunomide, in patients receiving teriflunomide. METHODS: Multiple sclerosis patients receiving teriflunomide (n=42) or other disease modifying therapies (n=18) and healthy controls (n=25) were enrolled in this cross-sectional study between January 2020 and 2021. The mean duration of teriflunomide treatment was 26 months (ranging from 6 to 54 months). All participants underwent neurological examination and nerve conduction studies of tibial, peroneal, sural, superficial peroneal, median, and ulnar nerves by using surface recording bar and bipolar stimulating electrodes. RESULTS: The mean superficial peroneal nerve distal latency and conduction velocity were significantly slower, and the mean superficial peroneal nerve action potential amplitude was lower in patients using teriflunomide (2.50 ms, p<0.001; 47.35 m/s, p=0.030; and 11.05 μV, p<0.001, respectively). The mean peroneal motor nerve distal latency was significantly longer and amplitude was lower in teriflunomide patients (3.68 ms, p<0.001, and 5.25 mV, p=0.009, respectively). During the study period, treatment switching to another disease-modifying therapy was planned in 10 patients, and all neuropathic complaints were reversed after switching. CONCLUSION: Teriflunomide has the potential to cause peripheral neuropathy. The awareness of peripheral neuropathy, questioning the symptoms, and if suspected, evaluation with electromyography and switching the therapy in patients under teriflunomide treatment are crucial.

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“…The condition of demyelination present in the central and peripheral nervous system is also known as combined central and peripheral demyelinating disease (CCPD) with a large heterogeneity of clinical presentation and disease course. 7 , 8 One case of successful treatment of CCPD with rituximab has been published so far. 9 Contrary to most case reports about CCPD our patient did not simultaneously develop peripheral and central demyelination so that both CIDP and MS were independently diagnosed at different time points.…”

Section: Discussionmentioning

confidence: 99%

Recovery of Chronic Inflammatory Demyelinating Polyneuropathy on Treatment With Ocrelizumab in a Patient With Co-Existing Multiple Sclerosis

Auer

Hegen

Hotter

et al. 2022

J Cent Nerv Syst Dis

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The chimeric anti-CD20 antibody rituximab has demonstrated good efficacy as an off-label treatment in chronic inflammatory demyelinating polyneuropathy (CIDP), while the humanized anti-CD20 antibody ocrelizumab has been approved for treatment of multiple sclerosis (MS), whereas there is no evidence for its use in CIDP so far. We present a patient suffering from CIDP and MS, both refractory to standard treatment and both showing marked improvement on ocrelizumab. To the best of our knowledge, this is a unique report of CIDP with an almost full electrophysiological recovery on ocrelizumab which could be considered as a potential treatment option for refractory CIDP.

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Polyneuropathies and chronic inflammatory demyelinating polyradiculoneuropathy in multiple sclerosis

Cited by 9 publications

References 29 publications

Expanding the Spectrum of Chronic Immune Sensory Polyradiculopathy

Expanding the Spectrum of Chronic Immune Sensory Polyradiculopathy

Neuropathy in multiple sclerosis patients treated with teriflunomide

Recovery of Chronic Inflammatory Demyelinating Polyneuropathy on Treatment With Ocrelizumab in a Patient With Co-Existing Multiple Sclerosis

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