Myositis as a neuromuscular complication of immune checkpoint inhibitors.

Immune checkpoint inhibitors (ICI) induce improved clinical outcomes associated with numerous cancers, but immune-related adverse events can occur, including neuromuscular complications. We searched for all muscle biopsies from the patient data system of University Hospitals Leuven (UZ Leuven) from January 2014 to July 2018 (n = 686) and collected clinical data of patients with a biopsy-proven ICI-related myositis and expanded the pathological examinations. We identified three cases of ICI-related myositis in patients with malignant melanoma. The clinical phenotype ranged from mild to life threatening. Two patients had a myositis-myasthenia gravis overlap syndrome and one had a co-occurring myocarditis. Pathological examination showed a necrotizing and/or inflammatory myopathy with CD4 + and CD8 + T cells and CD68 + macrophages. IgG staining was positive in all cases. PD-1 and PD-L1 reactions were negative for inhibitors of the PD-1/PD-L1 pathway (nivolumab, atezolizumab) and positive for CTLA-4 inhibitors (ipilimumab). With increasing usage of ICI, clinicians must be aware of rare but potentially serious adverse events such as myositis. Early detection by inquiring about complaints and clinical signs of weakness and monitoring the creatine phosphokinase level in serum are recommended. Our histological findings are in line with other reports. The IgG positivity suggests a local role of the ICI in the pathophysiology of the myositis. Further research must be performed to identify patients at risk and to optimize treatment of the complications.

Outcome after epilepsy surgery at the University Hospitals Leuven 1998-2012.

We performed a retrospective outcome study of 199 patients who underwent resective epilepsy surgery from 1998 to 2012 and had a minimum of one-year follow-up at the University Hospitals Leuven. Our aim was to assess seizure outcome, prognostic factors for seizure outcome and complication rate. Good seizure outcome after surgery was 38 % at 5 years and 34 % at 10 years follow-up. Good seizure outcome over the previous year at last follow-up, however, was 77 %, which could be explained by the 'running-down phenomenon', i.e. seizure freedom after initial recurrent epilepsy in 32 % of the patients, mainly after temporal lobe surgery. Good seizure outcome for at least 1 year at the last visit was 82 % for temporal and 62 % for extra-temporal lobe interventions. Other variables predictive of a good seizure outcome were not identified. Permanent complications of epilepsy surgery were observed in 31 %. The most important were word finding difficulties (22 %), depression (18 %) and memory deficits (12 %). In conclusion, epilepsy surgery is an excellent treatment option for selected patients, with a good seizure outcome in around 80 % of patients and complications in about 30 %.