Abstract Background During pregnancy, dynamic changes occur not only in coagulation, but also in immune responses. We report a case of a patient who developed an inflammatory disease in the central nervous system during late pregnancy and was challenging to diagnose. Case presentation A 27‐year‐old woman experienced dysarthria during pregnancy at approximately 33 gestational weeks. From the 38th week of pregnancy, she developed general fatigue, clumsiness of the left hand and numbness of the right side of the body. After delivery of her child at 41 weeks’ gestation, she was moved to the neurology ward for further investigation. She showed limb ataxia of the left extremities and sensory disturbance on the right side of the body, including the face. Magnetic resonance imaging detected multiple gadolinium‐enhanced lesions at the brainstem and cerebrum. High‐dose intravenous methylprednisolone pulse therapy was effective, but her symptoms still remained, including palatal myoclonus. Diagnosing this patient was challenging, but clinically isolated syndrome or multiple sclerosis and neuro‐Behҫet's disease were the main candidates. Conclusions We present a case of a pregnant woman who developed brain inflammatory lesions with unknown etiology. Longitudinal follow up is mandatory for diagnosis with careful tapering of oral prednisolone.
Antibodies to the aquaporin-4 (AQP4) water channel in neuromyelitis optica spectrum disorder (NMOSD) are reported to trigger the complement cascade, which is implicated in astrocyte damage and subsequent neuronal injury. The PREVENT study demonstrated that the terminal complement inhibitor eculizumab reduces adjudicated relapse risk in patients with anti-AQP4 immunoglobulin G-positive (AQP4+) NMOSD. The objective of this analysis was to evaluate the efficacy of eculizumab in reducing relapse risk and its safety in AQP4+ NMOSD across clinically relevant subgroups in PREVENT.In the randomized, double-blind, time-to-event, phase 3 PREVENT trial, 143 adults received eculizumab (maintenance dose, 1200 mg/2 weeks) or placebo (2:1), with stable-dose concomitant immunosuppressive therapy (IST) permitted (except rituximab and mitoxantrone). Post hoc analyses of relapses and adverse events were performed for prespecified and post hoc subgroups based on concomitant IST and prior rituximab use, demographic and disease characteristics, and autoimmune comorbidity.The significant reduction in relapse risk observed for eculizumab versus placebo in the overall PREVENT population was consistently maintained across subgroups based on concomitant IST and previous rituximab use, age, sex, region, race, time since clinical onset of NMOSD, historical annualized relapse rate, baseline Expanded Disability Status Scale score, and history of another autoimmune disorder. The serious infection rate was lower with eculizumab than placebo regardless of rituximab use in the previous year, concomitant IST use, or history of another autoimmune disorder.Across a wide range of clinically relevant AQP4+ NMOSD patient subgroups in PREVENT, eculizumab therapy was consistently effective versus placebo in reducing relapse risk, with no apparent increase in serious infection rate.NCT01892345 (ClinicalTrials.gov).
Abstract Objective A large number of disease‐modifying drugs are available for multiple sclerosis ( MS ); however, there is no established biomarker to predict long‐term disease severity and future relapses in MS . We aimed to clarify the alterations in peripheral blood T cell subsets that are associated with MS relapse and disease severity, according to cytokine production profiles in the remission phase. Methods Blood samples collected from 29 relapsing–remitting MS patients in the remission phase and 21 healthy controls (HC) were analyzed for various cytokine‐producing T cell subsets by flow cytometry. Results MS patients in the remission phase had significantly higher percentages of interleukin ( IL )‐17+ CD 4+ T cells, IL ‐4+ CD 4+ T cells, IL ‐9+ CD 4+ T cells, interferon‐γ+ CD 8+ T cells and IL ‐4+ CD 8+ T cells than HC ( P = 0.047, P = 0.007, P = 0.026, P = 0.015 and P = 0.007, respectively). In MS , the percentages of IL ‐9+ CD 4+ T cells, IL ‐9+ CD 8+ T cells and IFN‐γ+ IL ‐17+ CD 8+ T cells showed a significant positive correlation with annualized relapse rates (ARR) ( P = 0.011, r = 0.47, P = 0.007, r = 0.49 and P = 0.044, r = 0.38, respectively). Conclusions In the remission phase of MS , both anti‐inflammatory cytokine‐producing T cells and pro‐inflammatory cytokine‐producing T cells are increased; however, only the percentages of pro‐inflammatory cytokine‐producing T cells, such as IL ‐9‐producing CD 4+ T cells, IL ‐9‐producing CD 8+ T cells and IFN‐γ‐ and IL ‐17‐producing CD 8+ T cells, correlate with ARR. These pro‐inflammatory cytokine‐producing T cells in the remission phase might be candidate biomarkers for future relapses in MS patients.
There were two purposes of this study. The first purpose was to introduce the “X-ray TV M-mode waveform” which is reconstructed from sequential X-ray TV images and the “reconstructed ultrasound M-mode waveform” which is delivered from ultrasound B-mode images. The second purpose was to evaluate the usefulness of these two types of waveforms in the investigation of tongue movement during swallowing. The instrument system employed in this study consisted of ultrasound and X-ray TV synchronized by a time marker. After the X-ray images and ultrasound B-mode images were recorded on an optical disk, X-ray TV M-mode waveform and ultrasound M-mode waveform were reconstructed using an MC 68030/OS-9 computer. No significant differences in quality of images were observed between the X-ray TV M-mode waveform and the reconstructed ultrasound M-mode waveform. Therefore, both waveforms of the X-ray TV M-mode and the reconstructed ultrasound M-mode are equally useful in measuring tongue movement. (J. Oral Sci. 41, 1-4, 1999)
