Cytokines Single Nucleotide Polymorphisms (SNPs) Association With Myasthenia Gravis (MG) In Algerian Patients: A Case-Control Study On A Small Group.

ABSTRACT: Myasthenia gravis (MG) is an autoimmune disease of multifactorial etiology in which genetic factors and cytokines seem to play an important role. The aim of this study was to investigate potential associations of cytokines single nucleotide polymorphisms (SNPs) and MG in Algerian patients. We performed a case-control study that included 27 patients and 74 healthy subjects. Cytokines SNPs genotyping was performed by the polymerase chain reaction sequence-specific primers (PCR-SSP) method. Our results showed that the TNF-α -308G/A (P < 0.005) and TGF-ß1 +869T/T (P < 0.05) genotypes were more frequent among patients with MG compared with healthy individuals, whereas TNF-α -308G/G (P < 0.0001), TGF-ß1 +869T/C (P < 0.05), and IFN-γ +874A/A (P < 0.05) were less frequent. Our results also showed that IL-10 and IL-6 SNPs did not show any significant difference in distribution between MG patients and healthy individuals. Our observations support the hypothesis that implicates genetic variants of certain cytokines in MG. However, ours results should be replicated with a larger sample size. In addition, the precise underlying processes remain to be clarified. HIGHLIGHTS: TNF-α -308G/A and TGF-ß1 +869T/C genotypes predispose to MG.IFN-γ +874A/A genotype protects against MG.IL-6 -174C/G SNP is not associated with MG.

Diagnosis and classification of optic neuritis.

There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.

Rehabilitation of language processing disorders in bilingual patients with Alzheimer's disease.

We studied language information processing abilities in subjects with Alzheimer's disease (AD) who were bilingual (French and dialectical Arabic). The results show a disruption of certain semantic aspects of their mother tongue (L1); a process based on the lexical implications of terms and continuity. On the other hand, grammatical levels appeared to be relatively unaffected in oral speech in L1 but were disturbed in the second language (L2). We consequently adapted a cognitive-language stimulation protocol for bilingual patients (PSCLAB) to respond to these deficits. The effectiveness of the PSCLAB in terms of rehabilitation was assessed in 30 such patients through discourse analysis carried out before and after initiating the protocol. The results show that cognitive/language training using the PSCLAB appears to improve language behaviour of bilingual patients with AD, although this should be confirmed through larger controlled studies.

[Rehabilitation of language processing disorders in bilingual patients with Alzheimer disease]. / Réhabilitation des perturbations des informations langagières chez des patients bilingues atteints de maladie d'Alzheimer.

We studied the levels of language production processing of bilingual subjects with Alzheimer's disease (AD). The results focus on the deficit of levels of language production processing of bilingual patients with AD at the semantic level of the first language in two aspects, which are the procedure based on the lexical implications of the terms and the continuity. While the grammatical level seems rather affected in the second language (L2) and relatively spared in the first language (L1). Consequently, the cognitive-language stimulation protocol for bilingual patients with AD is developed to offer cognitive training adapted to this deficit. The present study aims at assessing the effectiveness of PSCLAB in the rehabilitation of disturbed levels of language production processing in bilingual patients with AD from early to medium stage, by analyzing the discourse of 30 bilingual patients before and after the administration of the protocol. The results of this study suggest a cognitive language training. The PSCLAB seems effective in the rehabilitation of disturbed levels of language production processing in these patients, although controlled studies with larger samples may be necessary in order to conclude to a therapeutic efficacy of this protocol.

Neuromyelitis optica spectrum disorders with antibodies to myelin oligodendrocyte glycoprotein or aquaporin-4: Clinical and paraclinical characteristics in Algerian patients.

BACKGROUND: Neuromyelitis optica (NMO) is a severe autoimmune inflammatory disorder of the central nervous system. NMO and its abortive forms are referred to as NMO spectrum disorders (NMOSD). NMOSD are mostly associated with antibodies to aquaporin-4 (AQP4-IgG). However, recent studies have demonstrated antibodies to myelin oligodendrocyte glycoprotein (MOG-IgG) in a subset of patients. Data on NMOSD in North Africa are sparse. OBJECTIVE: To describe the frequency of MOG-IgG and AQP4-IgG among patients with optic neuritis (ON) and/or myelitis in Algeria as well as the clinical and paraclinical features associated with these antibodies. METHODS: Retrospective testing of 42 patients with optic neuritis and/or myelitis treated at the teaching hospital of TiziOuzou for MOG-IgG and AQP4-IgG, and retrospective evaluation of the patients' medical records. RESULTS: Six of 42 (14.3%) patients were positive for AQP4-IgG and 3/42 (7.1%) were positive for MOG-IgG. No patient was positive for both AQP4-IgG and MOG-IgG. All antibody-positive patients were women. MOG-IgG was associated with severe episodes of ON in all MOG-IgG-positive patients. Steroid treatment was followed by complete remission in two patients. AQP4-IgG was associated with ON and/or longitudinally extensive transverse myelitis (LETM), often with severe onset. While all six of the AQP4-IgG-positive patients met the 2015 IPND criteria for NMOSD, only one of the three MOG-IgG-positive patients did so. Interestingly, clinically silent extensive spinal cord or brain lesions were present in two of the three MOG-IgG-positive patients, and altered visual evoked potentials without clinical evidence of ON were found in three of the six AQP4-IgG-positive patients. CONCLUSION: MOG-IgG and AQP4-IgG are found in a substantial subset of Algerian patients with ON and/or myelitis, are present predominantly in women, and may be associated with differences in clinical presentation and, possibly, outcome. Only a subset of MOG-IgG positive patients meets the current diagnostic criteria for NMOSD.

Neuromyelitis optica spectrum disorders in Algeria: A preliminary study in the region of Tizi Ouzou.

BACKGROUND: Neuromyelitis optica (NMO) is a disabling inflammatory condition that targets astrocytes in the optic nerves and spinal cord. Recent advances led to the individualization of a set of conditions now referred as NMO spectrum disorder (NMOSD). OBJECTIVE: To describe the prevalence and characteristics of NMO SD in north Algeria. PATIENTS AND METHODS: The present study is a retrospective and descriptive work which took place in Nedir Mohamed teaching hospital, Tizi-Ouzou, Algeria. 938 Medical files of patients with CNS inflammatory demyelinating diseases were reviewed then patients with optic neuritis and/or myelitis were preselected. Patients who met the 2015 neuromyelitis optica spectrum disorders criteria were selected and analyzed RESULTS: 08 Patients (3.4%) met the 2015 criteria for neuromyelitis optica spectrum disorders, 3/8 (37.5%) were positive to AQ4-IgG and 5/8 (62.5%) were negative. Mean age of onset was 29 years, female to male ratio was 3:1, cerebral MRI was normal in 75% of cases and longitudinally extensive transverse myelitis was present in 75% of cases. 37/232 Patients (15.9%) were considered at high risk of neuromyelitis optica spectrum disorders CONCLUSION: The present study suggests that the spectrum of NMO disorders is a rare entity among patients with optic nerve and spinal cord demyelinating lesions in north Algeria. However, the lack of accurate AQ4-IgG test certainly underestimates its real prevalence.

[Parenchymal neuro-Behcet's disease. Clinical and paraclinical characteristics, a report of 40 cases]. / Neuro-Behçet dans sa forme parenchymateuse. Caractéristiques cliniques et paracliniques (40 cas).

OBJECTIVE: Describe the clinical and paraclinical characteristics of parenchymal neuro-Behcet's disease. METHODS: This is a prospective, descriptive study, concerning 40 patients with parenchymal neuro-Behcet's disease. The patients were followed during 3 years, benefited a thorough physical examination and paraclinical made of inflammatory laboratory tests, infectious serology, serum/CSF autoimmunity assessment, brain/spine MRI and evoked potentials. We also evaluated the frequency of HLA-B51. RESULTS: We identified 22 men and 18 women. The average age was 32 years. The beginning was poly-symptomatic in 65% cases. Twenty-eight patients (70%) reported a decrease in visual acuity, 40% (16 cases) associated with uveitis, 33 cases (82.5%) complained of headache and 11 cases (27.5%) with dizziness. Inaugural signs consisted of motor disorders (50%) and balance disorders (40%). The inflammatory serum markers were positive in 75% and oligoclonal bands present in CSF were found in 7 patients. Infracentimetric demyelinating lesions in MRI study were located in the brainstem (52.5%), the subcortical white matter (40%), the periventricular region (42.5%), cerebellum (32.5%), basal ganglia (30%), internal capsule (25%) and corpus callosum (12.5%). The HLA-B51 was found in 53% of cases. CONCLUSION: Behçet's disease mainly affects young male. The neurological complications are highly polymorphic, involving severe vital or functional prognosis.