Author Of 2 Presentations
P0688 - Area postrema syndrome and longitudinally extensive transverse myelitis in a patient with prostatic adenocarcinoma and Aquaporin-4 antibodies. (ID 1872)
Abstract
Background
Neuromyelitis optica spectrum disorder (NMOSD) is not defined as a “classical” paraneoplastic neurological syndrome (PNS), however there are growing evidences that NMOSD may be associated with cancer.
Objectives
The aim of the present report is to describe the clinical presentation of a patient with NMOSD of probable paraneoplastic origin.
Methods
A 79-years old man presented with acute onset of mild dysphagia associated with intractable hiccups and vomiting one month after radiotherapy for prostatic adenocarcinoma (cT2N0M). Two weeks later, he developed subacute lower-limb weakness and hypoesthesia that rapidly spread involving the trunk and upper limbs. MRI showed an extensive T2 hyperintense, tumefactive spinal cord lesion, extending from C2 to the conus and similar lesion in the area postrema. Cerebrospinal fluid analysis showed increased cell count (mononuclear cells) and protein concentration. He resulted positive for Aquaporin-4-IgG (AQP4) antibodies on serum. He was treated with intravenous steroids with mild improvement.
Results
Our patient fulfills the criteria for a “probable PNS”, according to PNS diagnostic criteria, since NMOSD is a “non-classical” PNS and cancer occurred within two years from the diagnosis. It has been recently highlighted that older male patients (>45 years) presenting with longitudinally extensive transverse myelitis or patient with an “area postrema” syndrome at onset have higher risk for neoplasm associated NMOSD. Appropriate tumor screening should be always performed in patients with the aforementioned clinical features.
Since prostatic cells express AQP4, we hypothesize that AQP4-IgG could be part of the immune response against cancer cells or alternatively that radiotherapy could have led to a break of tolerance against AQP4, given the close temporal relationship with disease onset.
Conclusions
Paraneoplastic NMOSD is a rare disease that is becoming more frequently recognized. Further studies should elucidate the immunological relationship between cancer and AQP4-IgG.
P1086 - Botulinum toxin injections in multiple sclerosis versus post-stroke spasticity (ID 1888)
Abstract
Background
Botulinum toxin (BTX) is an effective and safe treatment for spasticity both in multiple sclerosis (MS) and post-stroke spasticity (PSS).
Objectives
The aim of our single-centre retrospective study was to compare the sites of injection and the dosages of BTX used for the treatment of spasticity in MS and PSS.
Methods
We enrolled 33 patients with MS and 55 patients with PSS that were treated with BTX in our outpatient spasticity clinic. Clinical and demographic data were collected. Total BTX dosage, upper and lower limb dosage, pattern of injected muscles, and their respective dosage were recorded. We performed a statistical analysis to compare BTX treatment dosage in the two conditions and to investigate any predictor of total BTX dosage.
Results
MS patients received a significant lower total BTX dosage compared to PSS (p<0.001): they were treated with lower BTX dosage in the lower limbs (p=0.005), but not in the upper limbs (p=0.30). Patients with MS were rarely injected in the upper limbs. Proximal upper limbs muscles were more frequently injected in MS, while patients with PSS were more frequently treated in distal muscles (fingers). In the lower limbs MS patients were more frequently injected in adductor muscles and rectus femoris while PSS patients were treated in soleus and tibialis posterior. EDSS was the only variable correlated to total BTX dosage (rho=0.399, p=0.021).
Conclusions
In our experience, MS spasticity requires a lower BTX dosage than PSS. This observation could be explained both by a different pattern of muscles affected by spasticity in these two diseases and also by different clinical management (e.g. the need of maintaining a greater residual function in MS, especially in lower limbs).