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Journal of the Neurological Sciences ; 429, 2021.
Article in English | EMBASE | ID: covidwho-1466699


Background and aims: Miller Fisher Syndrome (MFS) is an uncommon variant of the spectrum of Guillain Barré Syndrome (GBS). MFS relapses are rare and often described after long asymptomatic intervals. GBS-MFS spectrum has been reported in association with SARS-COV2 infection. We present a SARS-COV2 associated GBS-MFS relapse. Methods: We detail patient's characteristics and compare with previous reports. Results: A 60-year-old man, diagnosed with GBS-MFS in March 2020, was admitted at Emergency Department in February 2021 with incomplete asymmetric ophthalmoplegia, ataxia, areflexia, four limbs weakness and paraesthesia and mild bifrontal oppressive headache. CSF analysis was unremarkable. Nerve conduction studies on day 7 showed a motor demyelinating polyneuropathy. Serum anti-GQ1b IgG antibodies were negative. Molecular SARS-COV2 test was positive although he was asymptomatic, except for mild fever three days after onset, at the same time with neurological symptoms worsening. Blood tests revealed mild leukopenia and CRP elevation. He was treated with intravenous low dose dexamethasone, subcutaneous enoxaparin for 10 days and with intravenous immunoglobulins for 5 days. Neurological symptoms resolved after 20 days, concurrently nasopharyngeal swab tested negative. Compared to previous reported SARS-COV2 associated GBS-MFS, in our case neurological symptoms came first, with para-infectious rather than post-infectious immune mediated mechanism. Latency of not SARS-COV2 triggered relapses was longer (median 7 years) with usually positive anti-GQ1b IgG antibodies. Conclusions: To the best of our knowledge, this is the first GBS-MFS recurrence description during SARS-COV2 infection. Its underlying immune mechanism seems to differ from SARS-COV2 related monophasic reports, with shorter latency and probably different antibody profile than not-SARS-COV2 linked relapses.

Journal of the Neurological Sciences ; 429, 2021.
Article in English | EMBASE | ID: covidwho-1466683


Background and aims: Erenumab proved to be safe and well tolerated in a 5-year continuation of a 1-year double-blind, placebo-controlled study. Aim: to assess >48-week erenumab tolerability and safety in a real-world setting. Methods: In this long term (>48-week), multicenter (n = 15), longitudinal cohort real life study, we monitored all the adverse events emerged in consecutive adult patients with high-frequency episodic migraine (HFEM) or chronic migraine (CM) treated with monthly erenumab 70 mg or 140 mg from 20 December 2018 to 15 December 2020. Results: 442 patients (HFEM: 115;CM: 327) were treated with erenumab for >48 weeks: 209 (47.3%) patients were treated for 49–60 weeks, 132 (29.9%) for 61–72 weeks;73 (16.5%) for 73–84 weeks;21 (4.7%) for 85–100 weeks. Overall, >1 treatment emergent adverse event (TEAE) was reported by 136 (30.8%) [HFEM: 43 (37.4%);CM: 93 (28.4%)]. Most common TEAE were constipation (n = 66;14.9%), injection site erythema (n = 15;3.4%), and influenza (n = 7;1.6%). Serious adverse events (SAE) were reported by 8 patients (1.8%) and led to treatment discontinuation: severe constipation (n = 3), abdominal pain (n = 1), NSTEMI (n = 3), Covid-19 infection (n = 1). Only severe constipation was considered treatment-related SAE (0.45%). Conclusions: Conclusion: Erenumab is safe and well tolerated also in long-term treatment (>48 weeks) in real life.

Journal of the Neurological Sciences ; 429, 2021.
Article in English | EMBASE | ID: covidwho-1466657


Background and aims: The number of cases of encephalitis in COVID-19 pandemic is increasing. We describe characteristics and outcome of encephalitis in COVID-19 (COV-ENC) patients in one of the most affected regions by COVID-19 of the world, Lombardia, during the first pandemic wave. Methods: A multi-center observational study on neurological complications in COVID-19 patients was conducted by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to 20 Neurological Departments in Lombardia between February-April 2020 with COV-ENC have been included. Results: 30 COV-ENC patients had a mean age of 66.5 years and male frequency of 56.6%. Altered consciousness was characterized by confusion in 86%, coma in 30%, delirium in 37.9% and alteration of personality traits in 27.6%. Epileptic seizures occurred in 74% of cases. One third of cases had hyperproteinorrachia, one third pleocytosis/hyperproteinorrachia, and remaining third had a normal CSF. PCR for SARS-CoV-2 was negative in all tested patients. EEG was altered in 82.7% of patients. Brain CT and MRI were normal in 9 patients, and among abnormal findings 9 patients had mesial temporal lesions, one of which confirmed with PET imaging. The course was favorable in 39.2% of patients, sequelae were few in 26.6% and moderate in 19.2%, while 20% of patients died. Conclusions: The outcome tends to be worse in male patients. PCR negativity seems to confirm an autoimmune etiology more than a direct invasion of the virus. However, a temporal lobe involvement, detected in 30% of patients with COV-ENC, suggests usual sites of encephalitis due to herpes virus.