김근태 (고려대학교 의과대학) | 한빛사논문 > 한빛사

한빛사논문

조회537

고려대학교 의과대학

Neurology, Sep 25 2023 | https://doi.org/10.1212/WNL.0000000000207814 Clinical Features and Neurotological Findings in Patients With Acute Unilateral Peripheral Vestibulopathy Associated With Antiganglioside Antibody.

Keun-Tae Kim, MD¹, Euyhyun Park², Sun-Uk Lee, MD^3,a, Byungjun Kim, M.D., Ph.D.⁴, Byung-Jo Kim, MD, PhD^1,5 and Ji-Soo Kim, MD, PhD^6,7

¹Department of Neurology, Korea University Medical Center

²Department of Otorhinolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, South Korea

³Korea University Medical Center

⁴Department of Radiology, Korea University Anam Hospital

⁵BK21 FOUR Program in Learning Health Systems, Korea University

⁶Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital

⁷Department of Neurology, Seoul National University College of Medicine

^aCorresponding Author: Sun-Uk Lee

Abstract

Anecdotal studies have reported the presence of anti-ganglioside antibodies in acute unilateral peripheral vestibulopathy (AUPV). This study aimed to determine the prevalence, clinical characteristics, and neurotologic findings of AUPV associated with anti-ganglioside antibodies. Serum anti-gangliosides were measured in consecutive patients with AUPV according to the Bárány Society criteria during the acute and recovery phases, in a referral-based university hospital in South Korea from September 2019 to January 2023. Clinical characteristics and neurotologic findings were compared between those with and without anti-ganglioside antibodies. The results of video-oculography, video head-impulse and bithermal caloric tests, and other neurotologic evaluations including ocular and cervical vestibular-evoked myogenic potentials, subjective visual vertical were compared between the two. MRIs dedicated to the inner ear were also conducted when considered necessary. One hundred and five patients (mean age±standard deviation [SD] = 60±13 years, 57 male) were included for analyses. During the acute phase, 12 patients (12/105, 11%) were tested positive for serum anti-ganglioside antibodies, including anti-GQ1b IgG (n=5) or IgM (n=4), anti-GM1 IgM (n=3), and anti-GD1a IgG (n=1, including one with a positive anti-GQ1b antibody). Patients with anti-ganglioside antibodies showed lesser intensity of spontaneous nystagmus (median [interquartile range (IQR)] = 1.8 [1.2-2.1] vs. 3.4 [1.5-9.5], p=0.003), a lesser degree of canal paresis (30 [17-47] vs. 58 [34-79], p=0.028), and gain asymmetry of the vestibulo-ocular reflex (VOR) for the horizontal semicircular canal (HC) during head impulse tests (HITs) (0.07 [-0.04-0.61] vs. 0.36 [0.18-0.47], p=0.032) than those without antibodies. Negative conversion of antibodies and vestibular recovery were observed in most patients (6/8, 75%). Among 30 AUPV patients with 4-hour delayed 3D-FLAIR dedicated to the inner ear, gadolinium enhancement was observed in 18 (18/30, 60%), either in the vestibule (n=9), semicircular canal (n=6), or vestibular nerve (n=5). The positivity rates based on specific antibodies could not be determined due to limited sample sizes. The association between anti-ganglioside antibodies and AUPV suggests an immune-mediated mechanism in acute vestibular failure and extends the clinical spectrum of anti-ganglioside antibody syndrome.

논문정보

형식Research article
게재일2023년 09월 (BRIC 등록일 2023-10-13)
연구진국내 연구진
분야 의약학 > 신경의학

댓글 작성 로그인

CV 열람하기

연락처 보기