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1.
Acta Neurol Belg ; 121(1): 219-223, 2021 Feb.
Article in English | MEDLINE | ID: mdl-32931000

ABSTRACT

We wanted to explore possible differences in disease presentation, frequency, and age of onset of dementia with Lewy bodies (DLB) between first-generation immigrants (FGI) and patients born in Belgium (PBIB). We conducted a retrospective study on all patients of our Memory Clinic between June 1, 2010 and January 31, 2020. A synucleinopathy was diagnosed in 150 of 2702 patients (5.5%): 91 received a diagnosis of DLB (3.4%). FGI were two times more likely to receive a diagnosis of DLB, due to a higher prevalence in North-Africans and Latin-Americans. Visual hallucinations were less frequent in North-Africans than in other immigrants. FGI were younger than PBIB and reported more often parasomnia. Our data suggest a higher risk for DLB in certain immigrant groups. Especially for North-African patients, a genetic factor can be suspected, namely mutations in Leucine-rich repeat kinase 2 (LRRK2). Memory clinics with a high rate of FGI may provide interesting data and insights into the prevalence of DLB, genetic and environmental differences.


Subject(s)
Emigrants and Immigrants/psychology , Lewy Body Disease/ethnology , Lewy Body Disease/psychology , Memory Disorders/ethnology , Memory Disorders/psychology , Outpatient Clinics, Hospital , Africa, Northern/ethnology , Aged , Aged, 80 and over , Belgium/ethnology , Europe/ethnology , Female , Humans , Latin America/ethnology , Lewy Body Disease/diagnosis , Male , Memory Disorders/diagnosis , Middle Aged , Retrospective Studies
2.
Alzheimer Dis Assoc Disord ; 35(3): 269-270, 2021.
Article in English | MEDLINE | ID: mdl-32809984

ABSTRACT

We describe a case of dementia with Lewy bodies immediately following encephalitis due to West Nile virus (WNV). The patient had rapid eye movement-sleep behavior disorder and constipation before the onset of encephalitis, which suggests that he would have ultimately developed dementia with Lewy bodies even without WNV infection. Our case illustrates the interactions between α-synuclein and WNV, as observed in mouse models, wherein synuclein expression augments after WNV infection and protects neurons against the virus.


Subject(s)
Clonazepam/therapeutic use , Cognitive Dysfunction , Encephalitis/complications , GABA Modulators/therapeutic use , Lewy Body Disease , West Nile Fever/complications , Aged , Confusion/etiology , Fever/etiology , Humans , Lewy Body Disease/diagnosis , Lewy Body Disease/drug therapy , Male , Republic of North Macedonia , West Nile virus/isolation & purification
4.
Retina ; 40(3): 581-590, 2020 Mar.
Article in English | MEDLINE | ID: mdl-30707148

ABSTRACT

PURPOSE: To evaluate the effect of tumor necrosis factor (TNF) inhibitor therapy on ocular relapses in patients with Susac syndrome. METHODS: Multicenter retrospective cohort study of patients diagnosed with Susac syndrome according to classical clinical criteria. We evaluated the disease activity before and after introduction of anti-TNF therapy and its value as a steroid-sparing agent. RESULTS: Five patients were included. All were initially treated with a combination of corticosteroids and classical immunosuppressive drugs. Infliximab was started in three patients, and adalimumab was started in two patients. Patients had on average 5 ocular relapses during a mean follow-up time of 2.59 years before introducing a TNF inhibitor, corresponding with on average 1.93 relapses per year. After the introduction of an anti-TNF agent, this number was reduced by factor 5.51 to an average of 0.35 relapses per year for a mean follow-up of 2.86 years (P = 0.10). Before anti-TNF introduction ocular relapses occurred at a mean daily dose of 34 mg of prednisone, whereas with anti-TNF treatment, corticosteroid administration could be completely stopped in four patients with one patient still needing 5 mg daily (P = 0.10). Infliximab and adalimumab generally were well tolerated, and no serious adverse events were reported. CONCLUSION: Although not statistically significant, our results suggest that anti-TNF therapy can be a valuable option for the treatment of ocular Susac syndrome and may especially be considered in those patients unresponsive to more conventional immunosuppressive treatment.


Subject(s)
Adalimumab/therapeutic use , Infliximab/therapeutic use , Prednisone/therapeutic use , Retina/pathology , Susac Syndrome/drug therapy , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Adolescent , Adult , Antirheumatic Agents/therapeutic use , Dose-Response Relationship, Drug , Drug Therapy, Combination , Female , Fluorescein Angiography/methods , Follow-Up Studies , Fundus Oculi , Glucocorticoids/therapeutic use , Humans , Male , Retrospective Studies , Susac Syndrome/diagnosis , Susac Syndrome/metabolism , Tomography, Optical Coherence/methods , Treatment Outcome , Tumor Necrosis Factor-alpha/metabolism , Young Adult
5.
Neurology ; 86(18): 1729-35, 2016 May 03.
Article in English | MEDLINE | ID: mdl-27053715

ABSTRACT

OBJECTIVE: To evaluate the efficacy and safety of zonisamide in patients with myoclonus-dystonia. METHODS: We conducted a randomized, double-blind, placebo-controlled crossover trial of zonisamide (300 mg/d) in 24 patients with myoclonus-dystonia. Each treatment period consisted of a 6-week titration phase followed by a 3-week fixed-dose phase. The periods were separated by a 5-week washout period. The co-primary outcomes were action myoclonus severity (section 4 of the Unified Myoclonus Rating Scale [UMRS 4]) and myoclonus-related functional disability (UMRS 5). Secondary outcomes included dystonia severity, assessed with the movement and disability subscales of the Burke-Fahn-Marsden-Dystonia Rating Scale (BFM), the Clinical Global Impression-Improvement scale (CGI), and safety measures. Wilcoxon signed-rank tests for paired data were used to analyze treatment effects. RESULTS: Twenty-three patients (11 men, 12 women) were analyzed in the intention-to-treat analysis. Zonisamide significantly improved both action myoclonus (median improvement [95% confidence limits] -5 [-9.25 to -1.44], p = 0.003) and myoclonus-related functional disability (median improvement [95% confidence limits] -2 [-2.58 to -2.46], p = 0.007) compared to placebo. Zonisamide also significantly improved dystonia (BFM movement) compared to placebo (median improvement [95% confidence limits] -3 [-8.46 to 0.03], p = 0.009). No difference was found between zonisamide and placebo with respect to the CGI (median improvement [95% confidence limits] -1 [-1.31 to 0.09], p = 0.1). Zonisamide was well-tolerated. CONCLUSIONS: Zonisamide is well-tolerated and effective on the motor symptoms of myoclonus-dystonia. CLASSIFICATION OF EVIDENCE: This study provides Class I evidence that zonisamide improves myoclonus and related disability in patients with myoclonus-dystonia.


Subject(s)
Central Nervous System Agents/therapeutic use , Dystonic Disorders/drug therapy , Isoxazoles/therapeutic use , Adolescent , Adult , Central Nervous System Agents/adverse effects , Central Nervous System Agents/blood , Cross-Over Studies , Disability Evaluation , Double-Blind Method , Dystonic Disorders/blood , Dystonic Disorders/genetics , Female , Humans , Isoxazoles/adverse effects , Isoxazoles/blood , Male , Sarcoglycans/genetics , Severity of Illness Index , Treatment Outcome , Young Adult , Zonisamide
6.
J Clin Neurol ; 10(2): 166-70, 2014 Apr.
Article in English | MEDLINE | ID: mdl-24829604

ABSTRACT

BACKGROUND: Inclusion-body myopathy with Paget's disease of the bone and frontotemporal dementia (IBMPFD) is a rare, late-onset autosomal disorder arising from missense mutations in a gene coding for valosin-containing protein. CASE REPORT: We report the case of a man carrying the previously described p.Arg159His mutation, who had an unusual axonal sensorimotor neuropathy as the first clinical manifestation of IBMPFD, and for whom diagnosis only became clear 8 years later when the patient developed frontotemporal dementia. CONCLUSIONS: Peripheral neuropathy is a rare manifestation of IBMPFD. This underdiagnosed disorder should be considered when a patient develops dementia or has signs of Paget's disease.

9.
Alzheimer Dis Assoc Disord ; 26(1): 96-9, 2012.
Article in English | MEDLINE | ID: mdl-21572310

ABSTRACT

We describe an exceptional clinical picture, namely, cognitive impairment of the Alzheimer disease type in a man who later developed manifestations typical of amyotrophic lateral sclerosis and who was subsequently found to have adult polyglucosan body disease (APGBD) upon postmortem neuropathologic explorations. The combined occurrence of amyotrophic lateral sclerosis and cognitive impairment of the Alzheimer disease type in APGBD has not been reported before. This case also underlines the diverse clinical presentation of this rare clinicopathologic entity (namely APGBD) and highlights the importance of recognizing the unusual association of clinical features in making the diagnosis.


Subject(s)
Alzheimer Disease/pathology , Amyotrophic Lateral Sclerosis/pathology , Cognition Disorders/pathology , Glucans/analysis , Aged , Alzheimer Disease/complications , Alzheimer Disease/diagnosis , Amyotrophic Lateral Sclerosis/complications , Amyotrophic Lateral Sclerosis/diagnosis , Cognition Disorders/complications , Cognition Disorders/diagnosis , Glucans/metabolism , Humans , Male , Neuropsychological Tests , Phenotype
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