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

Research output: Contribution to journalArticlepeer-review

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: 1880 years) divided into 2 groups: group 1 (CNS syndromes, 64%) - encephalitis, encephalomyelitis, or myelitis; and group 2 (CNS + peripheral nervous system [PNS] syndromes, 36%) - encephalomyelor- adiculoneuritis 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.

Original languageEnglish
Pages (from-to)882-889
Number of pages8
JournalNeurology
Volume80
Issue number10
DOIs
Publication statusPublished - Mar 5 2013

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

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