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PubMed2003

Self-inflicted tourniquet paralysis mimicking acute demyelinating polyneuropathy.

Tourniquet paralysis is an uncommon complication of surgery, and self-inflicted tourniquet paralysis has never been documented to our knowledge. We report a patient with bilateral self-induced tourniquet paralysis of the lower extremities, whose symptoms were initially attributed to an acute demyelinating sensorimotor polyneuropathy based on clinical presentation and electrodiagnostic study. After investigations failed to reveal a cause, he was found to have placed tourniquets on his legs because of a rare obsession with limb amputation known as apotemnophilia. Significant spontaneous partial resolution of clinical symptoms was noted after 6 weeks. Electrophysiologic evidence of segmental demyelination of multiple motor nerves localized to the same region may help to distinguish this condition from other forms of acute demyelinating polyneuropathy.

Acute Disease↗
PubMed2005

Differential diagnosis of chronic dysimmune demyelinating polyneuropathies with and without anti-MAG antibodies.

The distinction between chronic demyelinating polyneuropathies associated with IgM paraproteinemia and anti-myelin-associated glycoprotein (MAG) antibodies (MAG-PN) and chronic inflammatory demyelinating polyneuropathies (CIDPs) relies on the anti-MAG antibodies assay. The aim of the study was to identify clinical and electrophysiological features suggesting a diagnosis of MAG-PN. Fourteen patients with MAG-PN and 35 with CIDP were included, and a discriminant analysis was performed to identify the clinical and electrophysiological features suggestive of MAG-PN. Pure sensory clinical phenotype, low median and ulnar terminal latency index, and absence of M responses in the lower limbs were significantly associated with the diagnosis of MAG-PN, and indicate a moderate to large increase in probability of this diagnosis in patients with chronic dysimmune demyelinating polyneuropathies.

Adult↗
PubMed2006

Dispersion of compound muscle action potential in hereditary neuropathies and chronic inflammatory demyelinating polyneuropathy.

Distal compound muscle action potential (DCMAP) dispersion, defined as a DCMAP duration > or = 9 ms, and proximal-distal (P-D) CMAP dispersion are considered useful in the electrodiagnosis of chronic inflammatory demyelinating polyneuropathy (CIDP). Distal and P-D CMAP dispersion have not been fully studied in hereditary neuropathies, and it is not known whether these measures distinguish hereditary from acquired demyelination. We compared DCMAP duration and P-D CMAP dispersion in 91 genetically characterized hereditary neuropathies and 33 subjects with CIDP. DCMAP dispersion was more frequent in nerves affected by CIDP (41.5%) than in Charcot-Marie-Tooth disease (CMT)1A (24.4%), CMT1B (7.4%), hereditary neuropathy with liability to pressure palsies (HNPP) (10.5%), or CMTX (9.8%). P-D CMAP dispersion was more frequent in CIDP (27.7% of nerves) than in hereditary neuropathies (16.3%) when applying American Academy of Neurology (AAN) criteria; however, its frequency was similar in CIDP and the hereditary neuropathies using the more restrictive criteria of the American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM). Although dispersion is more common in CIDP than in the hereditary neuropathies, DCMAP and P-D dispersion occur in at least one motor nerve in a significant proportion of hereditary neuropathies, and cannot be used in isolation to distinguish acquired from hereditary demyelination.

Action Potentials↗
PubMed1983

Multiple sclerosis and hypertrophic demyelinating peripheral neuropathy.

A combination of multiple sclerosis (MS) and hypertrophic demyelinating neuropathy has been reported in a few autopsy studies. We are reporting a unique case of such a combination, which was proved by the sural nerve biopsy. A patient with classical MS on history and findings had areflexia and sensory abnormalities in stocking distribution. The nerve conduction study showed marked abnormalities indicative of demyelinating neuropathy, and sural nerve biopsy was typical of hypertrophic demyelinating neuropathy.

Adult↗
PubMed1989

The single-fiber EMG in chronic demyelinating neuropathy.

Various parameters of single- fiber electromyography (SFEMG) were studied in 19 patients with electrophysiologically and histologically proven chronic demyelinating neuropathy. The mean duration of disease at the time of testing was four years. Motor nerve conduction in the median nerve was abnormal in all patients, whereas sensory nerve conduction was abnormal in all but one. Needle EMG in the extensor digitorum communis (EDC) muscle showed rare fibrillations and fasciculations and some abnormal motor unit potentials in most of patients. SFEMG in the EDC muscle showed an increased fiber density in seven cases (37%) and minimally abnormal jitter in 14 cases (74%). Single-fiber action potentials were stable, whereas blocking was rare. Fiber density was significantly increased in patients with fibrillation in the conventional needle EMG. Our study showed that the SFEMG is mildly abnormal in many patients with demyelinating neuropathy and that this test is useful in detecting and quantitating axonal degeneration in demyelinating neuropathy.

Adult↗
PubMed1991

Comparison of electrodiagnostic criteria for primary demyelination in chronic polyneuropathy.

Three sets of electrodiagnostic criteria for establishing primary demyelination in chronic polyneuropathy are evaluated. Sensitivity is assessed in 70 patients with clinically established chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). The criteria use different abnormal values, one adjusts for the effects of axonal loss, while another relies only on conduction velocity. However, even when consideration is given to sufficient number of nerves tested, there is no significant difference (P = 0.37) in diagnostic sensitivity among them, with 48% to 64% of CIDP patients fulfilling criteria for primary demyelination. Specificity is assessed by applying the criteria to 47 patients with motor neuron disease and 63 patients with diabetic polyneuropathy. No patients meet any of the criteria. Further analysis shows that as sensitivity increases specificity decreases, because of overlapping distributions of nerve conduction abnormalities in these neuropathic disorders. A sensitivity of approximately 66% is a practical limit for electrodiagnostic criteria in CIDP.

Demyelinating Diseases↗
PubMed1993

Thermal sensitivity in demyelinating neuropathy.

An 8-year-old girl with demyelinating peripheral neuropathy was observed to get markedly weak coincident with a febrile illness. With return of body temperature to normal over 24 hours, her strength improved back to baseline. Subsequently, we studied the effect of temperature on CMAP amplitude of two motor nerves in the patient and two control subjects. Both temperature, measured orally, was raised by immersing the subjects in hot water and lowered by passive cooling. With increase in temperature to 39.5 degrees C, the CMAP amplitudes were reduced by 80% in the patient's nerves compared to only 48% in the control nerves. These changes recovered with cooling to 36.9 degrees C. We conclude that demyelinated peripheral nerves are more susceptible to temperature-induced impulse blocking than healthy nerves and provide the first published evidence of the clinical consequences of this phenomenon in a demyelinating disease other than multiple sclerosis.

Action Potentials↗
PubMed1993

Antigalactocerebroside antibody increases demyelination in adoptive transfer experimental allergic neuritis.

There is suggestive but inconclusive evidence for a contribution of T cells and antimyelin antibodies to the pathogenesis of the Guillain-Barré polyneuropathy. We have studied the potential synergism of cellular and humoral immunity in the adoptive transfer model of EAN. EAN was induced in Lewis rats by injecting varying doses of P2 peptide (SP26)-sensitized T lymphocytes. Disease severity was dose-dependent. The addition of intravenous GC-AB to a subclinical dose of SP26-sensitized T cells resulted in overt clinical disease and markedly enhanced demyelination. Intravenous injection of antibody alone had no effect. We conclude that activated neuritogenic T cells, while entering into peripheral nerves, alter the blood-nerve barrier, which gives circulating demyelinating antibodies access to the endoneurium. The observations support the concept of a synergistic role of T-cell autoimmunity and humoral responses in the inflammatory demyelination of Lewis rat EAN.

Animals↗
PubMed1994

Tendon-reflex testing in chronic demyelinating polyneuropathy.

We studied the tendon reflex (T-reflex) in 26 patients with acquired chronic demyelinating polyneuropathy (CDN), including 22 with chronic inflammatory demyelinating polyneuropathy (CIDP). In 7 patients reflexes were brisk or normal on clinical testing. The height adjusted T-reflex was abnormal in 25 (96%) cases, including 6 of 7 patients with brisk or normal reflexes on clinical testing. Mean latency (P < 0.01) and duration (P < 0.05) of the ankle and patellar tendon reflexes were significantly prolonged in the CIDP patients when compared to the controls. Mean latency in the CIDP patients was 152% of normal means. In 7 CIDP patients, the T-reflex latencies were prolonged beyond 150% of normal means. Thus, the T-reflex test is abnormal in a majority of patients with CDN, even in the presence of well-preserved clinical reflexes, and the T-reflex latency is a useful indicator of the presence of a demyelinating peripheral neuropathy in some patients.

Adult↗
PubMed1994

Nerve root hypertrophy in chronic inflammatory demyelinating polyneuropathy.

A patient with chronic inflammatory demyelinating polyneuropathy (CIDP) and central demyelinating disease is described in whom striking nodular filling defects on multiple lumbar-sacral nerve roots, mimicking neurofibromata, were observed at myelography and magnetic resonance imaging. We suggest that these lesions are secondary to recurrent segmental demyelination and remyelination and that the differential diagnosis of this radiological feature should include CIDP.

Chronic Disease↗
PubMed1994

Multifocal cytomegalovirus demyelinative polyneuropathy associated with AIDS.

A 47-year-old man with acquired immunodeficiency syndrome presented 3 months antemortem with the onset of lower extremity sensory abnormalities. A progressive course of multifocal weakness and sensory disturbances ensued. Electrophysiologic studies revealed a generalized asymmetric demyelinating polyneuropathy with secondary axonal loss. The patient was sequentially treated with plasmapheresis, high dose corticosteroids, intravenous immune globulin, and ganciclovir. His neuropathy progressed, and he died of a fulminant bronchopneumonia. At autopsy the patient had a multifocal cytomegalovirus polyradiculoneuropathy, with both demyelinative and necrotizing features. While cytomegalovirus may be associated with a variety of peripheral nerve syndromes, its clinical presentation as a primary demyelinating polyneuropathy is unusual. Its importance vis-à-vis potential therapy for AIDS-associated neuropathies is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Mixed nerve action potentials in acquired demyelinating polyneuropathy.

Uncertainty about motor and sensory contributions in abnormal nerves has limited the use of mixed nerve action potentials (MNAPs). We recorded MNAPs in 21 patients with an acquired demyelinating neuropathy, 18 age-matched control subjects, and 10 patients with an axonal polyneuropathy. Bipolar and unipolar recordings from median and ulnar nerves were made above the elbow after electrical stimulation of the nerves at the wrist. Antidromic digital sensory action potentials and motor conduction velocity were also recorded for both nerves. In 19 median and 12 ulnar nerves from demyelinating polyneuropathy patients, compared with control subjects, MNAP amplitudes were significantly reduced (mean, 6 microV vs. 31 microV), MNAP velocities were mildly reduced (mean, 50 m/s vs. 62 m/s), motor conduction velocities were significantly reduced (mean, 33 m/s vs. 57 m/s), and MNAPs were significantly dispersed, with markedly prolonged rise times (mean 2.0 ms vs. 1.0 ms). Compared with the axonal polyneuropathy group, MNAP amplitudes from the median nerve were similarly reduced (mean, 8 microV vs. 9 microV), MNAP velocities were only slightly slower (mean, 52 m/s vs. 58 m/s), but the rise times were significantly prolonged (mean, 2.0 ms vs 1.2 ms). We conclude that, in acquired demyelinating neuropathies, the onset and, in some cases, the whole MNAP is from afferent fibers, which can be abnormally dispersed, and that, over the same segment MNAP velocity is less affected than motor conduction velocity.

Action Potentials↗
PubMed2005

MR properties of excised neural tissue following experimentally induced demyelination.

Changes in the magnetic resonance (MR) parameters of demyelinated neural tissue were measured in vitro using an experimental animal model. A tellurium (Te) diet was applied to weanling rats to induce the demyelination process in the sciatic nerve. The quantitative MR parameters, such as T(1), T(2) relaxation time constants and magnetization transfer (MT) were measured each day after applying the Te diet (up to 7 days) and were found to be substantially different from those of normal nerves. An increase in the average T(1) and T(2) was observed along with a decrease in the MT ratio (MTR) and the quantitative MT parameter M(0B), which describes the semisolid pool of protons. Most of the MR parameters correlated very well with the myelin fraction of neural tissue evaluated by quantitative histopathology. The T(2) relaxation spectrum provided the most efficient quantitative assessment of changes in neural tissue microstructure and its analysis resulted in a powerful tool to distinguish the processes of demyelination and inflammation. In comparison, the MT measurements were less successful.

Animals↗
PubMed1994

Coronavirus-induced demyelination occurs in the presence of virus-specific cytotoxic T cells.

C57BI/6, but not BALB/c, mice infected with mouse hepatitis virus strain JHM (MHV-JHM) develop a late onset, symptomatic demyelinating encephalomyelitis. In this report, we characterized anti-viral cytotoxic T cells in the central nervous system and spleen during the acute and chronic stages of the MHV infection. The data show that C57BI/6 mice display a cytotoxic T cell (CTL) response to the surface (S) glycoprotein and this response can be demonstrated in lymphocytes isolated from the brains and spinal cords of mice both acutely and persistently infected with MHV-JHM. Thus, the anti-S CTL activity present in the central nervous system of chronically infected animals is not sufficient to prevent the demyelinating process. BALB/c mice have been shown previously to mount a CTL response against the nucleocapsid (N) protein (Stohlman et al., 1992). Since C57BI/6 mice do not mount a response to the N protein, the role of the N-specific response in preventing the late onset disease was assessed using B10.A(18R) mice, recombinant in the H-2 locus. These mice contain the d alleles of the D and L loci and exhibit a CTL response against the N protein. However, unlike the BALB/c mice, these animals develop the late onset symptomatic disease. These results suggest that the N-specific response is partially protective against the development of the demyelinating disease, but that additional factors are also likely to be involved.

Acute Disease↗
PubMed1998

The C12 mutant of MHV-A59 is very weakly demyelinating and has five amino acid substitutions restricted to the spike and replicase genes.

C12, an attenuated, fusion defective, very weakly hepatotropic mutant of MHV-A59 has been further characterized. Analysis of C12 in vivo in C57BL/6 mice has shown that despite the fact that this virus replicates in the brain to titers at least as high as wild type and causes acute encephalitis similar to wild type, this virus causes minimal demyelination. Thus acute encephalitis is not sufficient for induction of demyelination by wild type MHV-A59. We have previously shown that C12 has two amino acid substitutions relative to wild type virus in the spike gene, Q159L (in the receptor binding domain of S1) and H716D (in the signal sequence for cleavage of S). We have now sequenced the rest of the 31 kb genome of C12 and compared it to wild type virus. Only three additional amino acids substitutions were found, all within the replicase gene, one in the predicted papain like proteinase (PLP)-2 domain and one in the predicted helicase domain. Thus, determinants of virulence, hepatotropism, and demyelination may map to the replicase gene as well as to the spike gene.

Amino Acid Substitution↗
PubMed1984

Immunological expression of gangliosides in multiple sclerosis and in a demyelinating model disease in rabbits.

Accumulating evidence suggests that the process of demyelination in MS might involve an autoimmune response to one or more myelin components. A combination of myelin basic protein and myelin haptens was considered as possibly enhancing a cellular or humoral autoimmune reaction in MS. In line with this motion we have used an in-vitro E-rosette assay that correlates with in-vivo delayed hypersensitivity to demonstrate specific immunologic sensitivity of lymphocytes from MS patients to polysialogangliosides. A recent report that only lymphocytes from patients in relapse, but not in remission, are primed by gangliosides, underscores the relevance of the antigenic expression of gangliosides during the active pathological phase of the disease. The antigenic capacity of gangliosides to induce upon immunization a neurological disorder featured by demyelination in the CNS was demonstrated in rabbits. This and previous reports on the induction of peripheral demyelination in rabbits immunized with gangliosides will be further analyzed to gain insight on the possible role of these myelin lipid components as targets for an autoimmune mechanism in MS.

Adult↗
PubMed1978

Neutral proteinases secreted by macrophages degrade basic protein: a possible mechanism of inflammatory demyelination.

In the inflammatory demyelinating diseases, such as multiple sclerosis, Landry-Guillain-Barré syndrome and experimental allergic encephalomyelitis, demyelination occurs in the vicinity of infiltrating mononuclear cells. Although the histopathology is characteristic of each disease, the general observation that myelin destruction in inflammatory lesions begins prior to phagocytosis suggests a common mechanism for myelinolysis in these diseases. Recent studies show that stimulated macrophages secrete several neutral proteinases, including plasminogen (Plg) activator. We have tested the possibility that these proteinases could, directly or indirectly, initiate myelin destruction. Isolated brain myelin was incubated with supernatant media from cultures of stimulated mouse peritoneal macrophages in the presence and absence of Plg. Cell supernatants alone caused some degradation of basic protein (BP) in myelin. The amount degraded was considerably enhanced in the presence of Plg. The other myelin proteins remained essentially intact. While the Plg-independent proteolytic activity in the supernatants was abolished by EDTA, known to inhibit the neutral proteinases, the Plg-dependent hydrolysis was inhibited by p-nitrophenylguanidinobenzoate, an inhibitor of Plg activator and plasmin. These results suggested that the Plg activator secreted by the macrophages generated plasmin, which selectively degraded BP. This interpretation was confirmed by the observation that urokinase, a Plg activator, plus Plg was effective in degrading BP in myelin. We propose that the action of neutral proteinases released by stimulated macrophages, and its amplification by the Plg-plasmin system, may play a significant role in several inflammatory demyelinating diseases; and that the relative specificity of these reactions for myelin lies in the extreme susceptibility of BP to proteolysis.

Animals↗
PubMed1978

Virus infection in demyelinating diseases.

Several animal and human demyelinating diseases of the central nervous system (CNS) are associated with RNA or DNA viruses. These viruses infect CNS cells lytically or persistently. They mainly belong to the group of envelope viruses which derive their envelope partly from the host cell membrane. The process of virus release may result in the appearance of new antigens of virus-infected cells or the incorporation of cell membrane material into the viral envelope. These changes may lead to an immune response which selectively injures the CNS. These alterations of host cell membranes and host cell functions, together with the immune mechanism, are central to many of the hypotheses regarding virus-induced demyelination. The role of virus infection in progressive multifocal leukoencephalopathy, subacute sclerosing panencephalitis, visna and mouse hepatitis virus infections, is discussed in relation to the demyelinating process of these diseases.

Animals↗