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March 05, 2013; 80 (10) Article

Postinfectious neurologic syndromes

A prospective cohort study

Enrico Marchioni, Sabrina Ravaglia, Cristina Montomoli, Eleonora Tavazzi, Lorenzo Minoli, Fausto Baldanti, Milena Furione, Enrico Alfonsi, Roberto Bergamaschi, Alfredo Romani, Laura Piccolo, Elisabetta Zardini, Stefano Bastianello, Anna Pichiecchio, Pasquale Ferrante, Serena Delbue, Diego Franciotta, Giorgio Bono, Mauro Ceroni
First published January 16, 2013, DOI: https://doi.org/10.1212/WNL.0b013e3182840b95
Enrico Marchioni
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Sabrina Ravaglia
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Cristina Montomoli
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Eleonora Tavazzi
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Lorenzo Minoli
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Fausto Baldanti
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Milena Furione
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Enrico Alfonsi
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Roberto Bergamaschi
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Alfredo Romani
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Laura Piccolo
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Elisabetta Zardini
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Stefano Bastianello
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Anna Pichiecchio
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Pasquale Ferrante
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Serena Delbue
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Diego Franciotta
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Giorgio Bono
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Mauro Ceroni
From the C. Mondino National Institute of Neurology Foundation (E.M., E.T., E.A., R.B., A.R., L.P. E.Z., S.B., A.P., D.F., M.C.), IRCCS, Pavia; Department of Public Health and Neurosciences (S.R., C.M.), Section of Biostatistics and Clinical Epidemiology (C.M.), University of Pavia; Beato Matteo Clinical Institute (S.R.), Vigevano; Infectious Diseases Clinic (L.M.), IRCCS Policlinico San Matteo; Molecular Virology Unit (F.B., M.F.), Virology and Microbiology, IRCCS Policlinico San Matteo, Pavia; Department of Public Health-Microbiology-Virology (P.F.), University of Milan; Fondazione Ettore Sansavini (S.D.), Health Science Foundation, Ravenna; and Neurology Clinic (G.B.), Ospedale di Circolo di Varese, University of Varese, Italy.
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Full PDF
Citation
Postinfectious neurologic syndromes
A prospective cohort study
Enrico Marchioni, Sabrina Ravaglia, Cristina Montomoli, Eleonora Tavazzi, Lorenzo Minoli, Fausto Baldanti, Milena Furione, Enrico Alfonsi, Roberto Bergamaschi, Alfredo Romani, Laura Piccolo, Elisabetta Zardini, Stefano Bastianello, Anna Pichiecchio, Pasquale Ferrante, Serena Delbue, Diego Franciotta, Giorgio Bono, Mauro Ceroni
Neurology Mar 2013, 80 (10) 882-889; DOI: 10.1212/WNL.0b013e3182840b95

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Abstract

Objectives: Postinfectious neurologic syndromes (PINSs) of the CNS include heterogeneous disorders, sometimes relapsing. In this study, we aimed to a) describe the spectrum of PINSs; b) define predictors of outcome in PINSs; and c) assess the clinical/paraclinical features that help differentiate PINSs from multiple sclerosis (MS).

Methods: In this prospective cohort study, adult inpatients with PINSs underwent extensive diagnostic assessment and therapeutic protocols at inclusion and during a minimum 2-year follow-up. We compared them with newly diagnosed, treatment-naive patients with MS, also prospectively recruited.

Results: The study sample comprised 176 patients with PINSs aged 59.9 ± 17.25 years (range: 18–80 years) divided into 2 groups: group 1 (CNS syndromes, 64%)—encephalitis, encephalomyelitis, or myelitis; and group 2 (CNS + peripheral nervous system [PNS] syndromes, 36%)—encephalomyeloradiculoneuritis or myeloradiculoneuritis. We observed the patients for 24 to 170 months (median 69 months). Relapses, almost invariably involving the spinal cord, occurred in 30.5%. PNS involvement was an independent risk factor for relapses (hazard ratio 2.8). The outcome was poor in 43% of patients; risk factors included older age, greater neurologic disability at onset, higher serum-CSF albumin percentage transfer, myelitis, and PNS involvement. Steroid resistance occurred in 30% of the patients, half of whom responded favorably to IV immunoglobulins. Compared with MS, PINSs were characterized by older age, lower tendency to relapse, and distinct CSF findings.

Conclusions: The category of PINSs should be revised: most of the clinical variants have a poor prognosis and are not readily classifiable on the basis of current knowledge. PNS involvement has a critical role in relapses, which seem to affect the spine only.

GLOSSARY

ADEM=
acute disseminated encephalomyelitis;
AQP-4=
aquaporin-4;
BCSFBD=
blood-CSF barrier damage;
E=
encephalitis;
EM=
encephalomyelitis;
EMRN=
encephalomyeloradiculoneuritis;
Ig=
immunoglobulin;
LETM=
longitudinally extensive transverse myelitis;
L-OCB=
CSF oligoclonal banding;
M-PINS=
multiphasic postinfectious neurologic syndrome;
MRN=
myeloradiculoneuritis;
MS=
multiple sclerosis;
NMO=
neuromyelitis optica;
OR=
odds ratio;
PINS=
postinfectious neurologic syndrome;
PNS=
peripheral nervous system;
R-PINS=
recurrent postinfectious neurologic syndrome;
SD=
spectrum disorder;
SNRS=
Scripps Neurological Rating Scale

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 876

  • Supplemental data at www.neurology.org

  • Received April 6, 2012.
  • Accepted September 24, 2012.
  • © 2013 American Academy of Neurology
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Neurology: 96 (15)

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Neurology | Print ISSN:0028-3878
Online ISSN:1526-632X

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