Convergence spasm with horizontal nystagmus in anti-GAD65 antibody syndrome

Objective: Islet autoimmunity is associated with diabetes incidence. We investigated whether there was an interaction between dietary fish intake or plasma phospholipid polyunsaturated omega-3 fatty acid (n-3 PUFA) concentration with GAD65 antibody positivity on the risk of developing adult onset diabetes. Research Design and Methods: We used prospective data on 11,247 incident cases of adult onset diabetes and 14,288 non-cases from the EPIC-InterAct case-cohort study, conducted in eight European countries. Baseline plasma samples were analyzed for GAD65 antibodies and phospholipid n-3 PUFAs. Adjusted hazard ratios (HRs) for incident diabetes in relation to GAD65 antibody status and tertiles of plasma phospholipid n-3 PUFA or fish intake were estimated using Prentice-weighted Cox regression. Additive (proportion attributable to interaction; AP) and multiplicative interaction between GAD65 antibody positivity (≥65 U/ml) and low fish/n-3 PUFA were assessed. Results: The hazard of diabetes in antibody positive individuals with low intake of total and fatty fish, respectively, was significantly elevated (HR 2.52, 95% CI 1.76-3.63; 2.48, 1.79-3.45) compared to people who were GAD65 antibody negative and had high fish intake, with evidence of additive (AP 0.44, 95% CI 0.16-0.72; 0.48, 0.24-0.72) and multiplicative (p=0.0465; 0.0103) interaction. Individuals with high GAD65 antibody levels (≥167.5 U/ml) and low total plasma phospholipid n-3 PUFA had more than 4-fold higher hazard of diabetes (HR 4.26, 2.70-6.72), AP 0.46 (0.12-0.80), compared to antibody negative individuals with high n-3 PUFA. Conclusions: High fish intake or relative plasma phospholipid n-3 PUFA concentrations may partially counteract the increased diabetes risk conferred by GAD65 antibody positivity.

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Cannabis sativa intoxication in a dog – a case report

Clínica Veterinária ◽

10.46958/rcv.2017.xxii.n.126.p.46-50 ◽

2017 ◽

Vol XXII (126) ◽

pp. 46-50

Author(s):

Juliana Barroso Félix ◽

Lúcia de Fátima L. dos Santos ◽

Paula Priscila Correia Costa ◽

Bruna Pinto Coutinho ◽

Daniela Brízida Borga

Keyword(s):

Case Report ◽

Plant Species ◽

Cannabis Sativa ◽

Supportive Treatment ◽

Accidental Ingestion ◽

Pupillary Reflex ◽

The Usa ◽

Horizontal Nystagmus

Marijuana consists of a mixture of dried leaves and flowers of the plant Cannabis sativa. Animals are usually poisoned by accidental ingestion. The effects of the plant are associated with cannabinoids, which are not found in other plant species. An increase in poisoning cases in dogs was observed in some states of the USA. In Brazil, reports are scarce. The objective of this study is to report a case of a dog intoxicated by marijuana. The animal was admitted to the hospital with incoordination, depression, mydriasis, decreased pupillary reflex, horizontal nystagmus, opisthotonos, bradycardia, and obnubilation. The patient was hospitalized and subjected to supportive treatment, since there is no antidote for this kind of poisoning. Patient recovery took approximately 36 hours.

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022 Patient-initiated event monitoring for acute vertigo

Journal of Neurology Neurosurgery & Psychiatry ◽

10.1136/jnnp-2019-anzan.21 ◽

2019 ◽

Vol 90 (e7) ◽

pp. A8.2-A8

Author(s):

Allison S Young ◽

Corinna Lechner ◽

Andrew P Bradshaw ◽

Hamish G MacDougall ◽

Deborah A Black ◽

...

Keyword(s):

Spontaneous Nystagmus ◽

Slow Phase ◽

Vestibular Disorders ◽

Positional Nystagmus ◽

Low Velocity ◽

Event Monitoring ◽

Superior Semicircular Canal Dehiscence ◽

Positional Vertigo ◽

Horizontal Nystagmus ◽

Vertical Nystagmus

IntroductionThe diagnosis of vestibular disorders may be facilitated by analysing patient-initiated capture of ictal nystagmus.MethodsAdults with a history of recurrent vertigo were taught to self-record spontaneous and positional-nystagmus at home while symptomatic, using video-goggles. Patients with final diagnoses of disorders presenting with recurrent vertigo were analysed: 121 patients with Ménière’s Disease (MD), Vestibular Migraine (VM), Benign Positional Vertigo (BPV), Episodic Ataxia Type II (EAII), Vestibular Paroxysmia (VP) or Superior Semicircular Canal Dehiscence (SSCD) were included.ResultsOf 43 MD patients, 40 showed high-velocity spontaneous horizontal-nystagmus (median slow-phase velocity (SPV) 39.7 degrees/second (°/s); Twenty-one showed horizontal-nystagmus reversing direction within 12-hours (24 on separate days). In 44 of 67 patients with VM, low velocity spontaneous horizontal (n=28, 4.9°/s), up-beating (n=6, 15.5°/s) or down-beating-nystagmus (n=10, 5.1°/s) was observed; Sixteen showed positional-nystagmus only, and seven had no nystagmus. Spontaneous horizontal-nystagmus with SPV >12.05°/s had a sensitivity and specificity of 95.3% and 82.1% for MD. Nystagmus direction-change within 12-hours was highly specific (95.7%) for MD. Spontaneous vertical-nystagmus was highly specific (93.0%) for VM. In the seven BPV patients, spontaneous-nystagmus was absent or <3°/s, and characteristic paroxysmal positional nystagmus was observed in all cases. Patients with central and MD-related positional vertigo demonstrated persistent nystagmus. Two patients with EAII showed spontaneous vertical nystagmus, one patient with VP showed short bursts of horizontal-torsional nystagmus lasting 5–10s, and one patient with SSCD demonstrated paroxysmal torsional down-beating nystagmus when supine.ConclusionsPatient-initiated vestibular event-monitoring is feasible and could facilitate rapid and accurate diagnosis of episodic vestibular disorders.

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Improvement of stiff-person syndrome symptoms in pregnancy

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000684 ◽

2020 ◽

Vol 7 (3) ◽

pp. e684 ◽

Cited By ~ 1

Author(s):

Megan E. Esch ◽

Scott D. Newsome

Keyword(s):

Glutamic Acid ◽

Clinical Improvement ◽

Glutamic Acid Decarboxylase ◽

Clinical Symptoms ◽

Acid Decarboxylase ◽

Stiff Person Syndrome ◽

Treatment Changes ◽

Gad65 Antibody ◽

Insight Into ◽

In Pregnancy

ObjectiveTo describe 2 cases from a single academic institution of improvement in stiff-person syndrome (SPS) symptoms during pregnancy and to review the clinical outcomes of SPS in 6 additional pregnancies described in the literature.MethodsEvaluation of clinical symptoms and treatment changes of disease state during pregnancy.ResultsSeven patients with 9 pregnancies are described in women with a diagnosis of SPS. Six of 7 (86%) women were positive for glutamic acid decarboxylase (GAD65) antibody. In 5 of 9 (56%) pregnancies, symptomatic medications (antispasmodics) were significantly reduced with stabilization or improvement in symptoms through pregnancy. Nine live, healthy pregnancies resulted. All 7 (100%) women experienced worsening of symptoms after the birth of their children, and symptomatic therapies were resumed and/or increased.ConclusionsThe immune pathogenesis of SPS continues to be explored. Immunomodulatory shifts during pregnancy may influence changes of clinical SPS symptoms and provide insight into the unique pathogenesis of SPS. Some women with SPS may be able to reduce symptomatic medications related to clinical improvement during pregnancy. Women with SPS may safely carry pregnancies to term, delivering healthy and unaffected babies.

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Nystagmus characteristics of healthy controls

Journal of Vestibular Research ◽

10.3233/ves-200022 ◽

2020 ◽

Vol 30 (6) ◽

pp. 345-352

Author(s):

Allison S. Young ◽

Sally M. Rosengren ◽

Mario D’Souza ◽

Andrew P. Bradshaw ◽

Miriam S. Welgampola

Keyword(s):

Upright Position ◽

Community Dwelling ◽

Spontaneous Nystagmus ◽

Slow Phase ◽

Healthy Controls ◽

Positional Nystagmus ◽

Low Velocity ◽

Video Oculography ◽

Significant Difference ◽

Horizontal Nystagmus

BACKGROUND: Healthy controls exhibit spontaneous and positional nystagmus which needs to be distinguished from pathological nystagmus. OBJECTIVE: Define nystagmus characteristics of healthy controls using portable video-oculography. METHODS: One-hundred and one asymptomatic community-dwelling adults were prospectively recruited. Participants answered questions regarding their audio-vestibular and headache history and were sub-categorized into migraine/non-migraine groups. Portable video-oculography was conducted in the upright, supine, left- and right-lateral positions, using miniature take-home video glasses. RESULTS: Upright position spontaneous nystagmus was found in 30.7% of subjects (slow-phase velocity (SPV)), mean 1.1±2.2 degrees per second (°/s) (range 0.0 – 9.3). Upright position spontaneous nystagmus was horizontal, up-beating or down-beating in 16.7, 7.9 and 5.9% of subjects. Nystagmus in at least one lying position was found in 70.3% of subjects with 56.4% showing nystagmus while supine, and 63.4% in at least one lateral position. While supine, 20.8% of subjects showed up-beating nystagmus, 8.9% showed down-beating, and 26.7% had horizontal nystagmus. In the lateral positions combined, 37.1% displayed horizontal nystagmus on at least one side, while 6.4% showed up-beating, 6.4% showed down-beating. Mean nystagmus SPVs in the supine, right and left lateral positions were 2.2±2.8, 2.7±3.4, and 2.1±3.2°/s. No significant difference was found between migraine and non-migraine groups for nystagmus SPVs, prevalence, vertical vs horizontal fast-phase, or low- vs high-velocity nystagmus (<5 vs > 5°/s). CONCLUSIONS: Healthy controls without a history of spontaneous vertigo show low velocity spontaneous and positional nystagmus, highlighting the importance of interictal nystagmus measures when assessing the acutely symptomatic patient.

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