Early diagnosis and monitoring of neurodegenerative langerhans cell histiocytosis

Elena Sieni, Carmen Barba, Marzia Mortilla, Sara Savelli, Laura Grisotto, Gianpiero Di Giacomo, Katiuscia Romano, Claudio Fonda, Annibale Biggeri, Renzo Guerrini, Maurizio Aricò

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Abstract

Background Neurodegenerative Langerhans Cell Histiocytosis (ND-LCH) is a rare, unpredictable consequence that may devastate the quality of life of patients cured from LCH. We prospectively applied a multidisciplinary diagnostic work-up to early identify and follow-up patients with ND-LCH, with the ultimate goal of better determining the appropriate time for starting therapy. Methods We studied 27 children and young adults with either ND-LCH verified by structural magnetic resonance imaging (MRI) (group 1) or specific risk factors for (diabetes insipidus, craniofacial bone lesions), but no evidence of, neurodegenerative MRI changes (group 2). All patients underwent clinical, neurophysiological and MRI studies. Results Seventeen patients had MRI alterations typical for ND-LCH. Nine showed neurological impairment but only three were symptomatic; 11 had abnormal somatosensory evoked potentials (SEPs), and five had abnormal brainstem auditory evoked potentials (BAEPs). MR spectroscopy (MRS) showed reduced cerebellar NAA/Cr ratio in nine patients. SEPs showed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for predicting ND-LCH of 70.6% (95%CI, 44.0%-89.7%), 100% (69.2%-100%), 100% (73.5%-100%), and 66.7%(38.4%-88.2%), respectively. Repeated investigations in group 1 revealed increasingly abnormal EP parameters, or neurological examination, or both, in nine of fifteen patients while MRI remained unchanged in all but one patient. Conclusion A targeted MRI study should be performed in all patients with risk factors for ND-LCH for early identification of demyelination. The combined use of SEPs and careful neurological evaluation may represent a valuable, low-cost, well-tolerated and easily available methodology to monitor patients from pre-symptomatic to symptomatic stages. We suggest a multidisciplinary protocol including clinical, MRS, and neurophysiological investigations to identify a population target for future therapeutic trials.

Original languageEnglish
Article numbere0131635
JournalPLoS One
Volume10
Issue number7
DOIs
Publication statusPublished - Jul 15 2015

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ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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Sieni, E., Barba, C., Mortilla, M., Savelli, S., Grisotto, L., Di Giacomo, G., Romano, K., Fonda, C., Biggeri, A., Guerrini, R., & Aricò, M. (2015). Early diagnosis and monitoring of neurodegenerative langerhans cell histiocytosis. PLoS One, 10(7), [e0131635]. https://doi.org/10.1371/journal.pone.0131635