Bladder dysfunction as the initial presentation of multiple system atrophy: a prospective cohort study

Background While bladder dysfunction is observed in the majority of patients with human T cell lymphotropic virus type 1 (HTLV-1)-associated myelopathy (HAM), it is also observed in patients who do not fulfill all diagnostic criteria for HAM. These patients are classified as having possible or probable HAM/TSP. However, it remains unclear whether the severity and progression of bladder dysfunction occurs similarly between these two groups. Objective Compare the severity and evolution of bladder dysfunction in HTLV-1-infected patients with possible and definite HAM/TSP. Methods The present prospective cohort study followed 90 HTLV-1 patients with possible HAM/TSP and 84 with definite HAM/TSP between April 2011 and February 2019. Bladder dysfunction was evaluated by bladder diary, overactive bladder symptoms scores (OABSS) and urodynamic studies. Bladder dysfunction progression was defined as the need for clean self-intermittent catheterization (CIC). Results At baseline, nocturia, urgency and OABSS scores were worse in definite compared to possible HAM/TSP patients. The main urodynamic finding was detrusor overactivity, present in 77.8% of the patients with definite HAM/TSP versus 58.7% of those with possible HAM/TSP (P = 0.05). Upon study conclusion, the cumulative frequency of patients requiring CIC increased in both groups, from 2 to 6 in possible HAM/TSP and from 28 to 44 in definite HAM/TSP patients. The estimated time to need for CIC was 6.7 years (95%CI 6.5–7.0) in the possible HAM/TSP group compared to 5.5 years (95%CI 4.8–6.1) in the definite HAM/TSP group. Conclusions Although both groups showed similarities in bladder dysfunction and tended to progress to requiring CIC over time, patients with possible HAM/TSP presented less severe manifestations at baseline and progressed more slowly than those with definite HAM/TSP.

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Disease progression and prognostic factors in multiple system atrophy: A prospective cohort study

Neurobiology of Disease ◽

10.1016/j.nbd.2020.104813 ◽

2020 ◽

Vol 139 ◽

pp. 104813 ◽

Cited By ~ 2

Author(s):

Alexandra Foubert-Samier ◽

Anne Pavy-Le Traon ◽

Florian Guillet ◽

Mélanie Le-Goff ◽

Catherine Helmer ◽

...

Keyword(s):

Cohort Study ◽

Prognostic Factors ◽

Multiple System Atrophy ◽

Disease Progression ◽

Prospective Cohort Study ◽

Prospective Cohort

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Neurological Consequences of Diabetic Ketoacidosis at Initial Presentation of Type 1 Diabetes in a Prospective Cohort Study of Children

Diabetes Care ◽

10.2337/dc13-1904 ◽

2014 ◽

Vol 37 (6) ◽

pp. 1554-1562 ◽

Cited By ~ 89

Author(s):

Fergus J. Cameron ◽

Shannon E. Scratch ◽

Caroline Nadebaum ◽

Elisabeth A. Northam ◽

Ildiko Koves ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cohort Study ◽

Diabetic Ketoacidosis ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Initial Presentation

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A Prospective Cohort Study to Identify Clinical, Biological, and Imaging Features That Predict the Etiology of Acute Encephalitis

Clinical Infectious Diseases ◽

10.1093/cid/ciaa598 ◽

2020 ◽

Author(s):

Marion Le Maréchal ◽

Alexandra Mailles ◽

Arnaud Seigneurin ◽

Pierre Tattevin ◽

Jean-Paul Stahl ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Specific Pattern ◽

Initial Presentation ◽

Mixed Data ◽

Diagnostic Tools ◽

Imaging Features ◽

Varicella Zoster ◽

Infectious Encephalitis

Abstract Background New diagnostic tools have been developed to improve the diagnosis of infectious encephalitis. Using a prospective cohort of encephalitis patients, our objective was to identify possible clusters of patients with similar patterns among encephalitis of unknown cause (EUC) and to describe to what extent a patient’s initial presentation may be predictive of encephalitis etiology, particularly herpes simplex virus (HSV) and varicella-zoster virus (VZV). Methods The National Cohort of Infectious Encephalitis in France is an ongoing prospective cohort study implemented in France in 2016. Patients who present with documented or suspected acute infectious encephalitis were included. Focusing on the variables that describe the initial presentation, we performed a factor analysis of mixed data (FAMD) to investigate a pattern of association between the initial presentation of a patient and the etiologic pathogen. Results As of 1 August 2018, data from 349 patients were analyzed. The most frequent pathogens were HSV (25%), VZV (11%), tick-borne encephalitis virus (6%), Listeria (5%), influenza virus (3%), and EUC (34%). Using the FAMD, it was not possible to identify a specific pattern related to the group of EUC. Age, temporal or hemorrhagic lesions, and cerebral spinal fluid lymphocytosis were significantly associated with HSV/VZV encephalitis. Conclusions No initial clinical/imaging/biology pattern was identified at admission among EUC, despite the improvement in diagnostic tools. In this context, the recommendation for a universal, early, probabilistic, initial treatment against HSV and VZV is still relevant, regardless of the initial clinical presentation of the encephalitis.

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