scholarly journals P.091 Consensus Guidelines for Utilization and Monitoring of Intravenous Immunoglobulin for Central Nervous System Disorders in British Columbia

2021 ◽  
Vol 48 (s3) ◽  
pp. S45-S45
Author(s):  
CE Uy ◽  
HM Cross ◽  
J Percy ◽  
D Schrader ◽  
R Carruthers ◽  
...  
Keyword(s):  
Central Nervous System ◽  
British Columbia ◽  
Nervous System ◽  
Intravenous Immunoglobulin ◽  
Consensus Guidelines ◽  
Level Of Evidence ◽  
Inflammatory Conditions ◽  
Outcomes Measures ◽  
Exceptional Circumstance ◽  
Robust Evidence

Background: Intravenous immunoglobulin (IVIG) may benefit many inflammatory central nervous system (CNS) disorders based on multiple immunomodulatory effects. IVIG is being used in inflammatory CNS conditions however robust evidence and guidelines are lacking in many disorders. Over the last 5 years, the percentage of IVIG used for CNS indications within neurology almost doubled in British Columbia (BC), Canada. Clear local guidelines may guide rational use. Methods: Consensus guidelines for IVIG use for CNS indications were developed by a panel of subspecialty neurologists and the Provincial Blood Coordinating Office, informed by focused literature review. Guidelines were structured similarly to existing BC peripheral nervous system guidelines and Australian Consensus Guidelines. Utilization and efficacy will be monitored provincewide on an ongoing basis. Results: Categories of conditions for Possible Indication (N=11) and Exceptional Circumstance Use (N=4) were created based on level of evidence for efficacy. Dosing and monitoring recommendations were made and outcomes measures defined. Rationale for Not Indicated conditions (N=3) was included. Guidelines will be distributed to BC neurologists for feedback and re-evaluated after 1 year. Conclusions: IVIG use in CNS inflammatory conditions has an emerging role. Guidelines for use and monitoring of outcomes will help improve resource utilization and provide further evidence regarding effectiveness.

Balancing immunosuppression and infection: recurrent enterovirus encephalitis in SLE

2019 ◽  
Vol 19 (6) ◽  
pp. 508-510 ◽  
Author(s):  
Sanjay Cheema ◽  
Eva Bunting ◽  
Catriona Good ◽  
Vijay Hajela ◽  
Basil H Ridha ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Intravenous Immunoglobulin ◽  
Lupus Erythematosus ◽  
Evidence Based ◽  
Systemic Lupus ◽  
Cns Lupus ◽  
Autoimmune Conditions

A young woman with systemic lupus erythematosus (SLE) developed recurrent enterovirus meningoencephalitis while taking prednisolone, azathioprine and rituximab. After reducing the immunosuppression, she developed a central nervous system (CNS) flare of SLE, with enterovirus still present in the cerebrospinal fluid (CSF). There are no evidence-based specific treatments for enterovirus encephalitis, but she responded well to intravenous immunoglobulin alongside pulsed methylprednisolone and rituximab. This case highlights the difficulties in managing people with co-existing infective and autoimmune conditions, especially if each affects the CNS. A viral infection and SLE flare can resemble one another clinically, although here the radiological differentiation of CNS lupus versus enterovirus encephalitis helped to guide the diagnosis.

scholarly journals Chemokines Referee Inflammation within the Central Nervous System during Infection and Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Douglas M. Durrant ◽  
Jessica L. Williams ◽  
Brian P. Daniels ◽  
Robyn S. Klein
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Essential Role ◽  
Inflammatory Cell ◽  
Cell Types ◽  
Effector Molecules ◽  
The Past ◽  
Inflammatory Conditions ◽  
Endothelial Barriers ◽  
The Central Nervous System

The discovery that chemokines and their receptors are expressed by a variety of cell types within the normal adult central nervous system (CNS) has led to an expansion of their repertoire as molecular interfaces between the immune and nervous systems. Thus, CNS chemokines are now divided into those molecules that regulate inflammatory cell migration into the CNS and those that initiate CNS repair from inflammation-mediated tissue damage. Work in our laboratory throughout the past decade has sought to elucidate how chemokines coordinate leukocyte entry and interactions at CNS endothelial barriers, under both homeostatic and inflammatory conditions, and how they promote repair within the CNS parenchyma. These studies have identified several chemokines, including CXCL12 and CXCL10, as critical regulators of leukocyte migration from perivascular locations. CXCL12 additionally plays an essential role in promoting remyelination of injured white matter. In both scenarios we have shown that chemokines serve as molecular links between inflammatory mediators and other effector molecules involved in neuroprotective processes.

scholarly journals Hierarchy of evidence referring to the central nervous system in a high-impact radiation oncology journal: a 10-year assessment. Descriptive critical appraisal study

2015 ◽  
Vol 133 (4) ◽  
pp. 307-313 ◽  
Author(s):  
Fabio Ynoe Moraes ◽  
Lorine Arias Bonifacio ◽  
Gustavo Nader Marta ◽  
Samir Abdallah Hanna ◽  
Álvaro Nagib Atallah ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Radiation Oncology ◽  
Critical Appraisal ◽  
Randomized Clinical Trials ◽  
Geographical Location ◽  
Case Series ◽  
Level Of Evidence ◽  
Systematic Assessment ◽  
The Central Nervous System

CONTEXT AND OBJECTIVE: To the best of our knowledge, there has been no systematic assessment of the classification of scientific production within the scope of radiation oncology relating to central nervous system tumors. The aim of this study was to systematically assess the status of evidence relating to the central nervous system and to evaluate the geographic origins and major content of these published data.DESIGN AND SETTING: Descriptive critical appraisal study conducted at a private hospital in São Paulo, Brazil.METHODS: We evaluated all of the central nervous system studies published in the journal Radiotherapy & Oncology between 2003 and 2012. The studies identified were classified according to their methodological design and level of evidence. Information regarding the geographical location of the study, the institutions and authors involved in the publication, main condition or disease investigated and time of publication was also obtained.RESULTS: We identified 3,004 studies published over the 10-year period. Of these, 125 (4.2%) were considered eligible, and 66% of them were case series. Systematic reviews and randomized clinical trials accounted for approximately 10% of all the published papers. We observed an increase in high-quality evidence and a decrease in low-quality published papers over this period (P = 0.036). The inter-rater reliability demonstrated significant agreement between observers in terms of the level of evidence.CONCLUSIONS: Increases in high-level evidence and in the total number of central nervous system papers were clearly demonstrated, although the overall number of such studies remained relatively small.

Successful Intravenous Immunoglobulin Treatment of Atypical Lichen Myxedematosus Associated with Hypothyroidism and Central Nervous System Involvement: Case Report and Discussion of the Literature

2013 ◽  
Vol 17 (1) ◽  
pp. 69-73 ◽  
Author(s):  
Magnus Macnab ◽  
Patrick Kenny
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Intravenous Immunoglobulin ◽  
Thyroid Dysfunction ◽  
Central Nervous System Involvement ◽  
Response To Treatment ◽  
Ivig Treatment ◽  
Systemic Complications ◽  
Disease Case ◽  
Lichen Myxedematosus

Background: Lichen myxedematosus (LM) is a rare idiopathic disorder characterized by papules, plaques, and/or nodules in the skin secondary to mucin deposition and variable dermal fibrosis in the absence of thyroid disease. Case reports are the predominant literature on LM due to its rarity, and the data are limited regarding the disease. No standard treatment regimen exists, and the response to treatment varies. Objective: This report adds to the limited literature on atypical LM associated with thyroid dysfunction and contributes to the growing body of evidence supporting intravenous immunoglobulin (IVIg) as effective therapy for extensive cases. Methods and Results: We report an unusual case of atypical LM associated with hypothyroidism, central nervous system (CNS) disturbances, and atrial fibrillation in a 64-year-old male. The patient experienced remarkable improvement within 3 months of beginning IVIg treatment; however, he required repeat therapy due to the recurrence of CNS symptoms 3 months after treatment. Conclusion: We agree with previous authors that thyroid dysfunction alone should not preclude a diagnosis of LM. Additionally, we contribute to the increasing evidence of IVIg being an effective treatment, particularly in the setting of systemic complications or acute worsening of LM.

scholarly journals Regulation of Injury-Induced Neurogenesis by Nitric Oxide

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Bruno P. Carreira ◽  
Caetana M. Carvalho ◽  
Inês M. Araújo
Keyword(s):  
Nitric Oxide ◽  
Central Nervous System ◽  
Nervous System ◽  
Adult Brain ◽  
Inflammatory Conditions ◽  
Pathological Conditions ◽  
Proliferation And Differentiation ◽  
The Central Nervous System ◽  
Cellular Types ◽  
Powerful Strategy

The finding that neural stem cells (NSCs) are able to divide, migrate, and differentiate into several cellular types in the adult brain raised a new hope for restorative neurology. Nitric oxide (NO), a pleiotropic signaling molecule in the central nervous system (CNS), has been described to be able to modulate neurogenesis, acting as a pro- or antineurogenic agent. Some authors suggest that NO is a physiological inhibitor of neurogenesis, while others described NO to favor neurogenesis, particularly under inflammatory conditions. Thus, targeting the NO system may be a powerful strategy to control the formation of new neurons. However, the exact mechanisms by which NO regulates neural proliferation and differentiation are not yet completely clarified. In this paper we will discuss the potential interest of the modulation of the NO system for the treatment of neurodegenerative diseases or other pathological conditions that may affect the CNS.

CXCL16 is elevated in the cerebrospinal fluid versus serum and in inflammatory conditions with suspected and proved central nervous system involvement

2006 ◽  
Vol 397 (1-2) ◽  
pp. 145-148 ◽  
Author(s):  
Linda M.P. le Blanc ◽  
Antoine W.T. van Lieshout ◽  
Gosse J. Adema ◽  
Piet L.C.M. van Riel ◽  
Marcel M. Verbeek ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Cerebrospinal Fluid ◽  
Nervous System ◽  
Central Nervous System Involvement ◽  
System Involvement ◽  
Inflammatory Conditions

scholarly journals Role of CCR2 in Inflammatory Conditions of the Central Nervous System

2014 ◽  
Vol 34 (9) ◽  
pp. 1425-1429 ◽  
Author(s):  
Hannah X Chu ◽  
Thiruma V Arumugam ◽  
Mathias Gelderblom ◽  
Tim Magnus ◽  
Grant R Drummond ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Central Nervous System ◽  
Nervous System ◽  
Ischemic Stroke ◽  
Inflammatory Diseases ◽  
Protective Effects ◽  
Cns Inflammation ◽  
Inflammatory Conditions ◽  
The Central Nervous System ◽  
Effective Development

CC chemokine receptor 2 (CCR2) plays important roles in extravasation and transmigration of monocytes under inflammatory conditions. CCR2 and its ligands have been extensively studied in a range of inflammatory diseases in the central nervous system (CNS), including multiple sclerosis, Alzheimer's disease and ischemic stroke. This brief review summarizes our current understanding of the physiologic and pathologic roles of CCR2, focusing on its involvement in CNS inflammatory diseases. There appears to be a rationale for exploring therapies involving CCR2 inhibition in multiple sclerosis and ischemic stroke, but there is also evidence for immunomodulatory and protective effects of CCR2 activity during CNS inflammation. The critical balance between protective and detrimental roles of CCR2-dependent recruitment of leukocytes must therefore be carefully examined to guide safe and effective development of any therapies involving CCR2 modulation.

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