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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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