This review focused on vaccination in children with movement disorders, including cerebral palsy and the movement disorders triggered by vaccination in children with and without neurological disabilities. The following clinical questions were addressed: 1) Can children with movement disorders be vaccinated? 2) Can vaccination trigger movement disorders in children without neurological disabilities? 3) Can vaccination trigger movement disorders in children with neurological disabilities? and 4) Is there any consensus of care concerning vaccination in children with movement disorders? Following the PRISMA reporting guidelines, 1096 records were identified and 34 relevant papers were included. No evidence that vaccinations are contraindicated for children with movement disorders was noticed. Several reports of neurological adverse events, including movement disorders in children without neurological disabilities after various types of vaccination, were found. The reporting rates were low, the causality was controversial, and patient outcomes were mostly favourable. There was limited (if any) evidence in our search that any vaccination leads to any movement disorder exacerbation. Finally, no generally accepted consensus or standards of care concerning vaccination in patients with movement disorders were found. In summary, we found few precautions for vaccination in this group of patients and concluded that general best practice guidelines for immunization should be followed. In addition, influenza and pneumococcal vaccines are recommended because they can reduce morbidity and mortality in individuals severely affected by movement restrictions.
- MeSH
- chřipka lidská * MeSH
- dítě MeSH
- lidé MeSH
- mozková obrna * komplikace MeSH
- pohybové poruchy * etiologie MeSH
- vakcinace škodlivé účinky MeSH
- vakcíny proti chřipce * MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- MeSH
- autoimunitní nemoci nervového systému * diagnóza terapie MeSH
- cerebelární ataxie diagnóza etiologie MeSH
- demyelinizační autoimunitní nemoci CNS diagnóza farmakoterapie patologie MeSH
- demyelinizační nemoci diagnóza farmakoterapie patologie MeSH
- encefalitida s protilátkami proti NMDA receptorům diagnóza terapie MeSH
- herpetická encefalitida diagnóza etiologie farmakoterapie MeSH
- infekce centrálního nervového systému diagnóza etiologie terapie MeSH
- klíšťová encefalitida diagnóza prevence a kontrola terapie MeSH
- lidé MeSH
- lymská neuroborelióza diagnóza farmakoterapie komplikace MeSH
- meningitida bakteriální diagnóza etiologie farmakoterapie MeSH
- syndrom opsoklonus-myoklonus MeSH
- zánět zrakového nervu diagnóza etiologie terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- acyklovir aplikace a dávkování MeSH
- antibakteriální látky aplikace a dávkování MeSH
- dítě MeSH
- encefalitida virová diagnóza farmakoterapie klasifikace MeSH
- herpetická encefalitida diagnostické zobrazování diagnóza farmakoterapie MeSH
- infekční komplikace v těhotenství etiologie klasifikace MeSH
- klíšťová encefalitida MeSH
- lidé MeSH
- lymská neuroborelióza diagnóza epidemiologie farmakoterapie klasifikace patofyziologie MeSH
- meningoencefalitida MeSH
- meningokoková meningitida farmakoterapie patofyziologie MeSH
- nemoci mozku diagnóza etiologie farmakoterapie klasifikace MeSH
- novorozenec MeSH
- polyradikuloneuropatie diagnóza klasifikace MeSH
- zánět * diagnóza etiologie farmakoterapie klasifikace MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
Neuromyelitis optica (NMO) a její širší spektrum onemocnění (NMO spectrum disorders; NMOSD) je vzácnou klinickou skupinou recidivujících zánětlivých astrocytopatií a demyelinizací. NMO/NMOSD se může objevit v jakémkoli věku a bezprostředně ohrožuje postižené jedince kumulující se trvalou disabilitou. Tato práce je zaměřena na specifika NMO/NMOSD u dětí a věnuje se aktuálním informacím o epidemiologii, diagnostice, klinickém obrazu a terapii. Právě včasná diagnóza a zahájení adekvátní terapie zvyšuje každému nemocnému, a dítěti obzvlášť, šance na lepší prognózu.
Neuromyelitis optica (NMO) and NMO spectrum disorders (NMOSD) are rare clinical conditions of relapsing inflammatory astrocytopathy and demyelination. NMO/NMOSD can occur at any age and endangers a patient with cumulating permanent disability. This paper focuses on specifics of NMO/NMOSD in children and regards current information about epidemiology, diagnostics, clinical course and treatment options. An early diagnosis and appropriate treatment of NMO/NMOSD increase a chance for better outcome in every patient, and especially in a child.
BACKGROUND: Immune-mediated mechanisms substantially contribute to the Rasmussen encephalitis (RE) pathology, but for unknown reasons, immunotherapy is generally ineffective in patients who have already developed intractable epilepsy; overall laboratory data regarding the effect of immunotherapy on patients with RE are limited. We analyzed multiple samples from seven differently treated children with RE and evaluated the effects of immunotherapies on neuroinflammation. Immunotherapy was introduced to all patients at the time of intractable epilepsy and they all had to undergo hemispherothomy. METHODS: Immunohistochemistry, flow cytometry, Luminex multiplex bead and enzyme-linked immunosorbent assay techniques were combined to determine: 1) inflammatory changes and lymphocyte subpopulations in 45 brain tissues; 2) lymphocyte subpopulations and the levels of 12 chemokines/cytokines in 24 cerebrospinal fluid (CSF) samples and 30 blood samples; and 3) the dynamics of these parameters in four RE patients from whom multiple samples were collected. RESULTS: Sustained T cell-targeted therapy with cyclophosphamide, natalizumab, alemtuzumab, and intrathecal methotrexate (ITMTX), but not with azathioprine, substantially reduced inflammation in brain tissues. Despite the therapy, the distributions of CD8+ T cells and the levels of C-X-C motif ligand (CXCL) 10, CXCL13, and B cell activating factor (BAFF) in patients' CSF remained increased compared to controls. A therapeutic approach combining alemtuzumab and ITMTX was the most effective in producing simultaneous reductions in histopathological inflammatory findings and in the numbers of activated CD8+ T cells in the brain tissue, as well as in the overall CD8+ T cell population and chemokine/cytokine production in the CSF. CONCLUSIONS: We provide evidence that various T cell-targeted immunotherapies reduced inflammation in the brains of RE patients. The observation that intractable epilepsy persisted in all of the patients suggests a relative independence of seizure activity on the presence of T cells in the brain later in the disease course. Thus, new therapeutic targets must be identified. CXCL10, CXCL13 and BAFF levels were substantially increased in CSF from all patients and their significance in RE pathology remains to be addressed.
- MeSH
- CD8-pozitivní T-lymfocyty imunologie MeSH
- cytokiny imunologie MeSH
- dítě MeSH
- ELISA MeSH
- encefalitida patologie terapie MeSH
- imunoterapie metody MeSH
- lidé MeSH
- mozek patologie MeSH
- předškolní dítě MeSH
- zánět terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND: The recognition of active inflammation in the central nervous system (CNS) in the absence of infectious agents is challenging. The present study aimed to determine the diagnostic relevance of five selected chemo/cytokines in the recognition of CNS inflammation and in the context of traditional cerebrospinal fluid (CSF) biomarkers (white blood cell [WBC] counts, oligoclonal bands, protein levels, CSF/serum albumin ratios) and clinical diagnoses. METHODS: C-C and C-X-C motif ligands (CCL2, CXCL8, 10 and 13) and interleukin (IL) 6 levels in the CSF and serum from 37 control and 87 symptomatic children with ten different (mostly noninfectious) inflammatory CNS disorders (16 of which had follow-up samples after recovery) were determined using Luminex multiple bead technology and software. Nonparametric tests were used; p < 0.05 was considered statistically significant. Receiver operating characteristic curves were constructed to analyze controls and 1) all symptomatic samples or 2) symptomatic samples without CSF pleocytosis. RESULTS: Compared with the control CSF samples, levels of all investigated chemo/cytokines were increased in symptomatic CSF samples, and only IL-6 remained elevated in recovery samples (p ≤ 0.001). CSF CXCL-13 levels (> 10.9 pg/mL) were the best individual discriminatory criterion to differentiate neuroinflammation (specificity/sensitivity: 97/72% and 97/61% for samples without pleocytosis), followed by CSF WBC counts (specificity/sensitivity: 97/62%). The clinical utility of the remaining CSF chemo/cytokine levels was determined in descending order of sensitivities corresponding to thresholds that ensured 97% specificity for neuroinflammation in samples without pleocytosis (pg/mL; sensitivity %): IL-6 (3.8; 34), CXCL8 (32; 26), CXCL10 (317; 24) and CCL2 (387; 10). Different diagnosis-related patterns of CSF chemo/cytokines were observed. CONCLUSIONS: The increased CSF level of CXCL13 was the marker with the greatest predictive utility for the general recognition of neuroinflammation among all of the individually investigated biomarkers. The potential clinical utility of chemo/cytokines in the differential diagnosis of neuroinflammatory diseases was identified.
- MeSH
- biologické markery krev mozkomíšní mok MeSH
- chemokin CCL2 krev mozkomíšní mok MeSH
- chemokin CXCL10 krev mozkomíšní mok MeSH
- chemokin CXCL13 krev mozkomíšní mok MeSH
- chemokiny krev mozkomíšní mok MeSH
- dítě MeSH
- interleukin-6 krev mozkomíšní mok MeSH
- interleukin-8 krev mozkomíšní mok MeSH
- krevní obraz MeSH
- lidé MeSH
- mladiství MeSH
- nemoci centrálního nervového systému mozkomíšní mok diagnóza imunologie MeSH
- předškolní dítě MeSH
- ROC křivka MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- mladiství MeSH
- mužské pohlaví MeSH
- předškolní dítě MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
Autoimunitní onemocnění centrálního nervového systému jsou potenciálně léčitelná. Jejich výskyt je u dětí vzácný a průběh bývá závažný. Klasifikace prochází vývojem, upravují se diagnostická kritéria a formují se terapeutické přístupy. Cílem je, aby diagnóza autoimunitního postižení byla stanovena co nejdříve a mohla být zahájena adekvátní terapie. Text ve stručnosti přináší aktualizovaný pohled na nejčastější klinické jednotky a přehled terminologie v této oblasti.
Autoimmune disorders affecting central nervous system are potentially treatable. They are rare in childhood and a clinical courseis often serious. The classification and diagnostic criteria are developing as well as therapeutic approaches. The aim is to determinea diagnosis of autoimmune condition and to initiate an accurate therapy as soon as possible. This review is focused on updatesof the most common clinical diagnoses and the terminology in this area.
- MeSH
- akutní diseminovaná encefalomyelitida diagnóza epidemiologie klasifikace terapie MeSH
- autoimunitní nemoci nervového systému MeSH
- demyelinizační autoimunitní nemoci CNS diagnóza epidemiologie klasifikace MeSH
- diferenciální diagnóza MeSH
- dítě MeSH
- encefalitida s protilátkami proti NMDA receptorům diagnóza epidemiologie MeSH
- incidence MeSH
- lidé MeSH
- neuromyelitis optica diagnostické zobrazování klasifikace MeSH
- roztroušená skleróza diagnostické zobrazování epidemiologie klasifikace MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
