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Postinfectious neurologic syndromes: A prospective cohort study.
MedLine Citation:
PMID:  23325908     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
OBJECTIVES: Postinfectious neurologic syndromes (PINSs) of the CNS include heterogeneous disorders, sometimes relapsing. In this study, we aimed to a) describe the spectrum of PINSs; b) define predictors of outcome in PINSs; and c) assess the clinical/paraclinical features that help differentiate PINSs from multiple sclerosis (MS). METHODS: In this prospective cohort study, adult inpatients with PINSs underwent extensive diagnostic assessment and therapeutic protocols at inclusion and during a minimum 2-year follow-up. We compared them with newly diagnosed, treatment-naive patients with MS, also prospectively recruited. RESULTS: The study sample comprised 176 patients with PINSs aged 59.9 ± 17.25 years (range: 18-80 years) divided into 2 groups: group 1 (CNS syndromes, 64%)-encephalitis, encephalomyelitis, or myelitis; and group 2 (CNS + peripheral nervous system [PNS] syndromes, 36%)-encephalomyeloradiculoneuritis or myeloradiculoneuritis. We observed the patients for 24 to 170 months (median 69 months). Relapses, almost invariably involving the spinal cord, occurred in 30.5%. PNS involvement was an independent risk factor for relapses (hazard ratio 2.8). The outcome was poor in 43% of patients; risk factors included older age, greater neurologic disability at onset, higher serum-CSF albumin percentage transfer, myelitis, and PNS involvement. Steroid resistance occurred in 30% of the patients, half of whom responded favorably to IV immunoglobulins. Compared with MS, PINSs were characterized by older age, lower tendency to relapse, and distinct CSF findings. CONCLUSIONS: The category of PINSs should be revised: most of the clinical variants have a poor prognosis and are not readily classifiable on the basis of current knowledge. PNS involvement has a critical role in relapses, which seem to affect the spine only.
Authors:
Enrico Marchioni; Sabrina Ravaglia; Cristina Montomoli; Eleonora Tavazzi; Lorenzo Minoli; Fausto Baldanti; Milena Furione; Enrico Alfonsi; Roberto Bergamaschi; Alfredo Romani; Laura Piccolo; Elisabetta Zardini; Stefano Bastianello; Anna Pichiecchio; Pasquale Ferrante; Serena Delbue; Diego Franciotta; Giorgio Bono; Mauro Ceroni
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-16
Journal Detail:
Title:  Neurology     Volume:  -     ISSN:  1526-632X     ISO Abbreviation:  Neurology     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-1-17     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401060     Medline TA:  Neurology     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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