547 e-Letters

  • Sensory Ataxia and Anti-contactin-1 IgG4-Associated Paranodopathy
    Nobuhiro Yuki

    With interest, we read an excellent paper written by a German group, in which four patients with chronic inflammatory demyelinating polyneuropathy (CIDP) carried IgG autoantibodies against contactin-1 (CNTN1) expressed at the paranodes in the peripheral nerves.[1] Human IgG antibodies consist of four subclasses (IgG1-4) with different structural and functional characteristics. IgG4 are generally believed to be non- infla...

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  • Nodopathy or paranodopathy: that is the question
    Nobuhiro Yuki

    In peripheral nerves, the domain organization of myelinated axons depends on specific axoglial contacts between the axonal membrane and Schwann cells at nodes, paranodes and juxtaparanodes. The term nodo- paranodopathy was originally proposed to characterize neuropathies with anti-ganglioside antibodies by a common pathological continuum starting with dysfunction/disruption at the nodes of Ranvier, a transitory nerve fai...

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  • CNS involvement in V30M transthyretin amyloidosis: clinical, neuropathological and biochemical data from another center.
    Isabel S. Conceicao

    We read with great interest the recent study by Maia et al., which reports retrospectively central nervous system (CNS) involvement in patients with familial amyloid polyneuropathy associated with Val30Met mutation (ATTR Val30Met FAP)1. This complication was observed in 31% of ATTR Val30Met FAP patients with long survival due to liver transplantation (LT). CNS disorders occurred on average 14.6 years after the onset of TT...

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  • Cerebellar ataxia: lessons from research
    Graziella Quattrocchi

    I read with interest the review by Tada et al. [1], which, based on the current knowledge on the cerebellar systems, propose an interesting framework to interpret cerebellar ataxias in clinical settings. The Authors classify cerebellar ataxias into two main categories: those with a loss of Purkinje cells, translating into a malformation of internal models; and those with a disturbance of afferent systems, causing a mis- s...

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  • Azathioprine and cyclosporine for myasthenia gravis in pregnancy
    Alexander F. Lipka

    We read the recently published UK guideline for treating myasthenia gravis (MG) patients in pregnancy with great interest [1]. As stated by the workgroup in their article, few studies are available concerning drug safety in pregnancy in these patients. In our experience, most drugs indeed carry a very small risk in the treatment of MG during pregnancy. However, based on additional literature we would advise some caution...

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  • Re:How accurate is the record linkage?
    Julian Gold

    We thank Dr. Voci for his comments[1] on our article.[2] As described in the paper, our data comprise Hospital Episode Statistics (HES) obtained from the English national Health and Social Care Information Centre (HSCIC) and mortality record abstracts obtained from the Office for National Statistics. All data from both sources were anonymised to the same standard by encryption of personal identifiers before being supplied...

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  • How accurate is the record linkage?
    Claudio Voci

    This is an interesting study. However, I am somewhat concerned whether the record linkage could be appropriately performed. In most healthcare information systems, HIV patients characteristics are protected. Did the authors have enough information on the patients to perform probabilistic matching? It would be of interest if the authors could show that the matching is adequate by showing that there is not a general reduce...

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  • Response to "Incident dementia and cognitive decline in patients with stroke/TIA" by Professor Tomoyuki Kawada
    Perminder Sachdev

    Professor Kawada expresses three concerns regarding the outcomes of our study into how cognitive deficits progress in the years following a stroke [1]. Firstly, he cites Rajan et al. [2] as finding that cognitive decline was greater after stroke than before stroke, and suggests that our study should have considered pre-stroke cognitive decline. How doing so would have affected our outcomes or their interpretation is uncle...

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  • Incident dementia and cognitive decline in patients with stroke/TIA
    Tomoyuki Kawada

    Sachdev et al. conducted a 3-year follow-up study to know the progress of cognitive deficits after stroke or transient ischemic attack (TIA) (1). The authors gathered 183 stroke/TIA patients and 97 healthy controls, and concluded that cognitive decline in post-stroke patients was not greater than in controls, except for verbal memory, although rates of incident dementia were 5.9% per year in patients and 0.4% in controls,...

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  • Rapid cognitive decline in attention, executive function and memory: the gold standard for delirium?
    Paul J Regal

    I endorse the authors' use of multiple information sources to identify prevalent delirium in medical and surgical inpatients 1-2: family and other informants, junior and senior physicians, medical case notes and nurses. Although the authors did not use the model I developed, I suggest that their paper is about distinguishing rapid cognitive decline (RCD, one form being delirium) from slow cognitive decline (SCD) in dementia...

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