Clinicopathologic features of folate-deficiency neuropathy

Koike, Haruki; Takahashi, M; Ohyama, Ken; Hashimoto, Rina; Kawagashira, Yuichi; Iijima, Masahiro; Katsuno, Masahisa; Doi, Hiroshi; Tanaka, Fumiaki; Sobue, Gen

doi:10.1212/wnl.0000000000001343

Cited by 63 publications

(46 citation statements)

References 37 publications

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“…The density of myelinated fibres was evaluated in transverse sections using light microscopy. Toluidine-blue-stained semithin sections were assessed using a computer-assisted image analyser (Luzex FS; Nikon, Tokyo, Japan) 24 25. A fraction of the glutaraldehyde-fixed sample was processed for a teased-fibre study, and pathological conditions were assessed according to the previously described criteria 26.…”

Section: Methodsmentioning

confidence: 99%

Paranodal dissection in chronic inflammatory demyelinating polyneuropathy with anti-neurofascin-155 and anti-contactin-1 antibodies

Koike

Kadoya

Kaida

et al. 2017

J Neurol Neurosurg Psychiatry

177

198

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ObjectiveTo investigate the morphological features of chronic inflammatory demyelinating polyneuropathy (CIDP) with autoantibodies directed against paranodal junctional molecules, particularly focusing on the fine structures of the paranodes.MethodsWe assessed sural nerve biopsy specimens obtained from 9 patients with CIDP with anti-neurofascin-155 antibodies and 1 patient with anti-contactin-1 antibodies. 13 patients with CIDP without these antibodies were also examined to compare pathological findings.ResultsCharacteristic light and electron microscopy findings in transverse sections from patients with anti-neurofascin-155 and anti-contactin-1 antibodies indicated a slight reduction in myelinated fibre density, with scattered myelin ovoids, and the absence of macrophage-mediated demyelination or onion bulbs. Teased-fibre preparations revealed that segmental demyelination tended to be found in patients with relatively higher frequencies of axonal degeneration and was tandemly found at consecutive nodes of Ranvier in a single fibre. Assessment of longitudinal sections by electron microscopy revealed that detachment of terminal myelin loops from the axolemma was frequently found at the paranode in patients with anti-neurofascin-155 and anti-contactin-1 antibody-positive CIDP compared with patients with antibody-negative CIDP. Patients with anti-neurofascin-155 antibodies showed a positive correlation between the frequencies of axo–glial detachment at the paranode and axonal degeneration, as assessed by teased-fibre preparations (p<0.05).ConclusionsParanodal dissection without classical macrophage-mediated demyelination is the characteristic feature of patients with CIDP with autoantibodies to paranodal axo–glial junctional molecules.

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Section: Methodsmentioning

confidence: 99%

Paranodal dissection in chronic inflammatory demyelinating polyneuropathy with anti-neurofascin-155 and anti-contactin-1 antibodies

Koike

Kadoya

Kaida

et al. 2017

J Neurol Neurosurg Psychiatry

177

198

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“…Sensory and autonomic-predominant polyneuropathies are linked to abnormal blood-test results for diabetes [69], alcohol-related liver dysfunction [5], heavy-metal toxicity [36], deficiencies of vitamins B12 (cobalamin) and B1 (folate) [33, 60], hypothyroidism and hyperthyroidism [1, 47], paraproteinemia [74], sarcoidosis [24], and systemic autoimmune disorders including Sjögren’s syndrome (SS) [49, 55], systemic lupus erythematosus [46], and celiac [6, 8, 64]. Infectious causes include human immunodeficiency virus [62], hepatitis C [10], leprosy [38], and Lyme disease [25].…”

Section: Introductionmentioning

confidence: 99%

Diagnostic value of blood tests for occult causes of initially idiopathic small-fiber polyneuropathy

2016

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Small-fiber polyneuropathy (SFPN) causes non-specific symptoms including chronic pain, cardiovascular, gastrointestinal, and sweating complaints. Diagnosis is made from history and exam in patients with known risk factors such as diabetes, but objective test confirmation is recommended for patients without known risks. If tests confirm SFPN, and it is “initially idiopathic” (iiSFPN), screening for occult causes is standard. This study’s aim was to evaluate the 21 widely available, recommended blood tests to identify the most cost-effective ones and to learn about occult causes of iiSFPN. Records were reviewed from all 213 patients with SFPN confirmed by distal-leg skin biopsy, nerve biopsy, or autonomic-function testing in our regional center during 2013. We determined the prevalence of each abnormal blood-test result (ABTR) in the iiSFPN cohort, compared this to population averages, and measured the costs of screening subjects to obtain one ABTR. Participants were 70% female and 43.0±18.6 years old. High erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA; ≥1:160 titer) were each present in 28% of subjects. The ABTR ≥ 3× more prevalent in iiSFPN than in the total population were high ESR, high ANA, low C3, Sjögren’s and celiac autoantibodies. Together, these suggest the possibility of a specific association between iiSFPN and dysimmunity. ATR identifying diabetes, prediabetes, and hypertriglyceridemia were less common in iiSFPN than in the population and thus not associated with iiSFPN here. Reimbursement for the 6 most cost-effective iiSFPN-associated blood tests–ESR, ANA, C3, autoantibodies for Sjögren’s and celiac, plus thyroid-stimulating hormone–was $99.57/person with 45.6% sensitivity for detecting one abnormal result. Angiotensin-converting enzyme was elevated in 45% but no patients had sarcoidosis, so this test was futile here.

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“…Se encuentra en alimentos como las verduras de hoja verde, legumbres, frutos secos y granos enteros como las almendras [2]. El ácido fólico es de particular interés clínico por su relación con la anemia megaloblástica y diversos trastornos neurológicos relacionados con la carencia de la vitamina [3,4], suplencia perinatal y prevención de defectos del tubo neural [5], metabolismo de la homocisteína y su asociación con eventos vasculares cardiacos y cerebrales [6] y su relación con la disminución del riesgo a padecer diversos tipos de cáncer [7].…”

Section: Introductionunclassified

Valores séricos de ácido fólico en un grupo de pacientes mayores de 18 años de edad en un hospital de alta complejidad

et al. 2017

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ResumenObjetivo: establecer las concentraciones séricas de ácido fólico en un grupo de pacientes adultos. Métodos: medición del ácido fólico con inmunoanálisis en 1797 sujetos. Se calcularon medidas de tendencia central e índice de confianza al 95 %. Se compararon grupos etarios y sexos con pruebas no paramétricas. Resultados: la media global de ácido fólico sérico fue: 11,61 ng/ml (DE: 6,05). La media en mujeres fue de 11,87 ng/ml (DE: 6,09). La media en hombres fue de 11,31 ng/ml (DE: 6). Se reportaron los percentiles 5, 50 y 95 por sexo y edad. En el 2 % de los casos se encontró ácido fólico < 2 ng/ml (2 % de hombres y 3 % de mujeres). Discusión: las concentraciones séricas de ácido fólico son mayores en mujeres que en hombres (p = 0,024), lo que contrasta con la noción de déficit del micronutriente en el sexo femenino. Conclusiones: las cantidades descritas son un comparador adecuado para mediciones en muestras de población general.

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Clinicopathologic features of folate-deficiency neuropathy

Cited by 63 publications

References 37 publications

Paranodal dissection in chronic inflammatory demyelinating polyneuropathy with anti-neurofascin-155 and anti-contactin-1 antibodies

Paranodal dissection in chronic inflammatory demyelinating polyneuropathy with anti-neurofascin-155 and anti-contactin-1 antibodies

Diagnostic value of blood tests for occult causes of initially idiopathic small-fiber polyneuropathy

Valores séricos de ácido fólico en un grupo de pacientes mayores de 18 años de edad en un hospital de alta complejidad

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