Motor lumbosacral radiculopathy in HIV-infected patients

Abstract

BackgroundThis study is a review of the clinical findings and treatment outcome of 11 HIV-infected patients with motor lumbosacral radiculopathy.ObjectivesTo describe the clinical, laboratory, electrophysiological features and treatment outcome in HIV-infected motor lumbosacral radiculopathy which is a rare manifestation of HIV.MethodA retrospective review of HIV-infected patients with motor lumbosacral radiculopathy was performed at Inkosi Albert Luthuli Central Hospital (IALCH), Durban, South Africa between 2010 and 2015.ResultsEleven black African patients met the inclusion criteria. There were six women. The median age was 29 years, the interquartile range (IQR) was 23–41 years, the median duration of symptom progression was 6.5 months (IQR 3–7.5 months). The median CD4 count was 327 cells/µL (IQR 146–457). The cerebrospinal fluid (CSF) median polymorphocyte count was 0 cells/µL (IQR 0 cells/µL – 2 cells/µL), lymphocyte count was 16 cells/µL (IQR 1 cells/µL – 18 cells/µL), glucose level was 3.1 mmol/L (IQR 2.8 mmol/L – 3.4 mmol/L) and protein level was 1.02 g/dL (IQR 0.98 g/dL – 3.4 g/dL). All patients were treated with corticosteroid therapy. Ninety-one per cent recovered fully within 6 months of treatment, the median time for recovery was 3.4 months (IQR 1.8–5.6 months). There were no relapses during the 18-month follow-up.ConclusionHIV-infected patients with motor lumbosacral radiculopathy responded to corticosteroids, with no relapses during the 18-month follow-up period.

Nodal–paranodal antibodies in HIV‐immune mediated radiculo‐neuropathies: Clinical phenotypes and relevance

“…Additionally, they needed to fulfil the clinical, electrodiagnostic, and cerebral spinal fluid (CSF) criteria of the European Federation of Neurologic Sciences/Peripheral Nerve Society for CIDP 8 or criteria for VRR or DRG. For the purpose of the study, VRR was defined as: (a) pure motor presentation, (b) progressive disease beyond 3 months (c) VR enhancement on magnetic resonance imaging (MRI) 6 . DRG was defined as an immune‐mediated pure sensory non‐length dependent clinical presentation of longer than 3 months, absent sensory nerve action potentials (SNAPs) on electrophysiology, normal motor studies with or without abnormal blink responses or DR enhancement on MRI 9 …”

“…Patients who had acute onset disease and progressed beyond 4 weeks, were managed as CIDP with CST 5 . All patients with VRR and DRG were treated with steroids, in line with previous experience 6 . Escalation therapy included IVIG, azathioprine (AZA), plasma exchange (PLEX), and Rituximab.…”

“…For the purpose of the study, VRR was defined as: (a) pure motor presentation, (b) progressive disease beyond 3 months (c) VR enhancement on magnetic resonance imaging (MRI). 6 DRG was defined as an immune-mediated pure sensory non-length dependent clinical presentation of longer than 3 months, absent sensory nerve action potentials (SNAPs) on electrophysiology, normal motor studies with or without abnormal blink responses or DR enhancement on MRI. 9…”

“…A previous study describing CIDP and VRR, in HIV-infected patients, found that the above cohorts are highly corticosteroid (CST) responsive with shorter duration of disease, when compared with HIV-uninfected counterparts. 5,6 Some patients with autoimmune nodopathies are also steroid responsive. 3,4 NF186 and gliomedin antibodies have been described in pure motor neuropathies and NF155 in sensory ataxic neuropathies, although these serological-clinical associations are not absolute.…”

A Comparison of Clinical, Electro-Diagnostic, Laboratory, and Treatment Outcome Differences in a Cohort of HIV-Infected and HIV-Uninfected Patients With Myasthenia Gravis

“…The use of immunosuppressant drugs including azathioprine and corticosteroids in HIV-infected patients with other neuromuscular diseases has been previously described (20)(21)(22). However, the use of rescue therapy, with intravenous immunoglobulin (IVIG), plasma exchange (PLEX), or pulse IV (intravenous) cyclophosphamide for poorly controlled MG in the setting of HIV has been described in case reports only (9,10,(23)(24)(25)(26).…”