Neurology
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Data Supplement
Right arrow Correspondence:
Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when Correspondence are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Google Scholar
Right arrow Articles by Isobe, N.
Right arrow Articles by Kawano, Y.
PubMed
Right arrow PubMed Citation
Right arrow Articles by Isobe, N.
Right arrow Articles by Kawano, Y.
Related Collections
Right arrow All Immunology
Right arrow All Clinical Neurology
Right arrow Peripheral neuropathy
Right arrow All Spinal Cord
Right arrow All epidemiology
NEUROLOGY 2009;73:790-797
© 2009 American Academy of Neurology

Neural damage associated with atopic diathesis

A nationwide survey in Japan

N. Isobe, MD, J. Kira, MD, PhD, N. Kawamura, MD, PhD, T. Ishizu, MD, PhD, K. Arimura, MD, PhD and Y. Kawano, MD, PhD

From the Department of Neurology (N.I., J.K., N.K., T.I., Y.K.), Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka; and the Department of Neurology and Geriatrics (K.A.), Kagoshima University, Graduate School of Medical and Dental Sciences, Kagoshima, Japan.

Address correspondence and reprint requests to Dr. Jun-ichi Kira, Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan kira{at}neuro.med.kyushu-u.ac.jp

Background: We previously reported the occurrence of myelitis in patients with atopic disorders (atopic myelitis [AM]). To uncover the spectrum of neural damage associated with atopy, we conducted a cross-sectional nationwide survey of AM and atopy-related peripheral neuritis (APN), including Churg–Strauss syndrome (CSS), in individuals with atopic diathesis.

Method: Cases with AM diagnosed between 1996 and 2006 and cases with APN between 2000 and 2006 were collected from all over Japan. Detailed data on 109 patients with AM and 133 patients with APN were collated.

Results: Patients with APN showed a preponderance of women, higher age at onset, and greater eosinophil counts than patients with AM. Patients with AM most commonly showed cervical cord involvement, whereas patients with APN preferentially exhibited mononeuritis multiplex predominantly affecting the lower limbs. Among patients with AM, motor weakness and muscle atrophy were significantly more frequent in those with bronchial asthma than in those with other atopic disorders. Patients with APN who met the criteria for CSS showed a higher age at onset, higher frequencies of systemic organ involvement, and greater disability than those who did not. Abnormalities suggesting peripheral nervous system involvement were seen in 25.7% of patients with AM, whereas 18.8% of patients with APN had abnormalities indicating CNS involvement. Multiple logistic regression analyses revealed that atopic dermatitis increased the risk of myelitis, whereas high age at onset and bronchial asthma decreased that risk.

Conclusions: Atopy-related neural inflammation multifocally affects CNS and peripheral nervous system tissues. Both preceding atopic disorders and age seem to influence the distribution of neural damage.

Abbreviations: AM = atopic myelitis; ANCA = antineutrophil cytoplasmic antibody; APN = atopy-related peripheral neuritis; BAEP = brainstem auditory-evoked potential; CI = confidence interval; CSS = Churg–Strauss syndrome; EDSS = Expanded Disability Status Scale of Kurtzke; EP = evoked potential; IgE = immunoglobulin E; IgG = immunoglobulin G; MEP = motor-evoked potential; mRS = modified Rankin Scale; NCS = nerve conduction study; NS = not significant; OCB = oligoclonal immunoglobulin G bands; OR = odds ratio; pcorr = corrected p value; PNS = peripheral nervous system; puncorr = uncorrelated p value; SEP = somatosensory-evoked potential; SNAP = sensory nerve action potential; Th2 = T helper 2; VEP = visual-evoked potential.

Supplemental data at www.neurology.org

Supported in part by grants from the Research Committees of Neuroimmunological Diseases and of New Treatment Strategies for Intractable Neuropathies Based on Their Pathomechanism, Ministry of Health, Labour and Welfare, Japan.

Disclosure: Author disclosures are provided at the end of the article.

Received January 11, 2009. Accepted in final form June 15, 2009.






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2009 by AAN Enterprises, Inc.