MATEUS MISTIERI SIMABUKURO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
5 resultados
Resultados de Busca
Agora exibindo 1 - 5 de 5
- Central Nervous System Demyelination Associated With Immune Checkpoint Inhibitors: Review of the Literature(2020) OLIVEIRA, Marcos C. B.; BRITO, Marcelo H. de; SIMABUKURO, Mateus M.Immune checkpoint inhibitors (ICI) are a novel class of antineoplastic treatment that enhances immunity against tumors. They are associated with immune adverse events, and several neurological syndromes have been described, including multiple sclerosis and atypical demyelination. We performed a systematic literature review of case reports with neurological immune adverse events that presented with central nervous system demyelination, up to December 2019. We found 23 cases: seven with myelitis, four isolated optic neuritis, one neuromyelitis optica spectrum disorder, five multiple sclerosis, and six with atypical demyelination. Ipilimumab was the most frequently used ICI (11/23). The median time to develop symptoms from the onset of ICI was 6.5 weeks [range 1.0-43.0], and from last ICI dose was 14 days [range 0-161]. Anatomopathological examination was performed in four cases, with the finding of a T-cell mediated immune response. Outcomes were generally favorable after immunosuppression: 18 patients had improvement or a full recovery, three patients did not respond to treatment, three patients died, and in one, treatment was not reported. We describe the patients' clinical presentation, treatment administered, and outcomes. We further speculate on possible pathophysiological mechanisms and discuss potential treatments that may be worth investigating.
- Hashimoto encephalopathy in the 21st century(2020) MATTOZZI, Simone; SABATER, Lidia; ESCUDERO, Domingo; ARINO, Helena; ARMANGUE, Thais; SIMABUKURO, Mateus; IIZUKA, Takahiro; HARA, Makoto; SAIZ, Albert; SOTGIU, Stefano; DALMAU, Josep; GRAUS, FrancescObjectiveTo report the presenting syndromes and to determine whether pretreatment criteria of Hashimoto encephalopathy (HE) predict response to steroids.MethodsWe assessed symptoms and steroid responsiveness in 24 patients with pretreatment criteria of HE, including (1) subacute onset of cognitive impairment, psychiatric symptoms, or seizures; (2) euthyroid status or mild hypothyroidism; (3) serum thyroid peroxidase antibodies (TPOAb) >200 IU/mL; (4) absent neuronal antibodies in serum/CSF; and (5) no other etiologies. Additional studies included determination of TPOAb (>200 IU/mL) in 74 patients with criteria of possible autoimmune encephalitis (AE) without neuronal antibodies and 205 patients with different neuroimmunologic diseases, psychosis, or new-onset refractory status epilepticus (NORSE). Serum antibodies to the amino (Nu Eta 2)-terminal of alpha -enolase (NH2-alpha -enolaseAb) were examined in the indicated 24 patients and 13 controls.ResultsThe 24 patients (14 women) with suspected HE had a median age of 48 years (range 8-79 years). Four syndromes were identified: psychiatric (7, 29%), encephalopathy (7, 29%), NORSE-like (6, 25%), and limbic encephalitis (4, 17%). Only 6 of 19 (31.6%) patients completely responded to steroids. The frequency of TPOAb in the 74 patients with possible AE (6 of 74, 8.1%) was similar to that of the 205 controls (17 of 205, 8.2%; p = 0.84). NH2-alpha -enolaseAb were identified in 1 of 24 suspected HE cases and 1 of 13 controls.ConclusionCurrent pretreatment criteria of HE do not predict steroid responsiveness. The detection of TPOAb across all control groups reveals their poor disease-specificity. NH2-alpha -enolaseAb did not help in the diagnosis of HE. These findings imply a redefinition of HE that requires a systematic exclusion of antibody-mediated encephalitis.
- Clinical features, prognostic factors, and antibody effects in anti-mGluR1 encephalitis(2020) SPATOLA, Marianna; PEDROL, Mar Petit; MAUDES, Estibaliz; SIMABUKURO, Mateus; MUNIZ-CASTRILLO, Sergio; PINTO, Anne-Laurie; WANDINGER, Klaus-Peter; SPIEGLER, Juliane; SCHRAMM, Peter; DUTRA, Livia Almeida; IORIO, Raffaele; KORNBLUM, Cornelia; BIEN, Christian G.; HOEFTBERGER, Romana; LEYPOLDT, Frank; TITULAER, Maarten J.; SMITT, Peter Sillevis; HONNORAT, Jerome; ROSENFELD, Myrna R.; GRAUS, Francesc; DALMAU, JosepObjective To clinically characterize patients with anti-metabotropic glutamate receptor (mGluR) 1 encephalitis, to identify prognostic factors, and to study the immunoglobulin G (IgG) subclasses and effects of antibodies on neuronal mGluR1 clusters. Methods Clinical information on new and previously reported patients was reviewed. Antibodies to mGluR1 and IgG subclasses were determined with brain immunohistochemistry and cell-based assays, and their effects on mGluR1 clusters were studied on rat hippocampal neurons. Results Eleven new patients were identified (10 adults, 1 child);4 were female. In these and 19 previously reported cases (n = 30, median age 55 years), the main clinical manifestation was a subacute cerebellar syndrome that in 25 (86%) patients was associated with behavioral/cognitive changes or other neurologic symptoms. A tumor was found in 3 of 26 (11%). Brain MRI was abnormal in 7 of 19 (37%) at onset and showed cerebellar atrophy in 10 of 12 (83%) at follow-up. Twenty-five of 30 (83%) patients received immunotherapy. Follow-up was available for 25: 13 (52%) had clinical stabilization; 10 (40%) showed significant improvement; and 2 died. At the peak of the disease, patients with bad outcome at 2 years (modified Rankin Scale score > 2, n = 7) were more likely to have higher degree of initial disability, as reflected by a worse Scale for Assessment and Rating of Ataxia score, and more frequent need of assistance to walk. Antibodies to mGluR1 were mainly IgG1 and caused a significant decrease of mGluR1 clusters in cultured neurons. Conclusions Anti-mGluR1 encephalitis manifests as a severe cerebellar syndrome, often resulting in longterm disability and cerebellar atrophy. The antibodies are pathogenic and cause significant decrease of mGluR1 clusters in cultured neurons.
bookPart Encefalites autoimunes: quando suspeitar e diagnósticos diferenciais(2020) SIMABUKURO, Mateus MistieribookPart Encefalites autoimunes: quando suspeitar e diagnósticos diferenciais(2020) SIMABUKURO, Mateus Mistieri