Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.

<h4>Objectives</h4>Sjögren syndrome is an autoimmune disease involving mainly salivary and lacrimal glands. Beyond widely described PNS involvement, high variable prevalence of CNS manifestations ranging from 2.5 and 60% of all pSS patients has been reported, without specific syndrome de...

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Autores principales:	Manuela Morreale, Pasquale Marchione, Patrizia Giacomini, Simona Pontecorvo, Massimo Marianetti, Claudio Vento, Emanuele Tinelli, Ada Francia
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2014
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/76cd7d3589144ab4ace8bcd2dd91d9f6
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spelling	oai:doaj.org-article:76cd7d3589144ab4ace8bcd2dd91d9f62021-11-18T08:37:20ZNeurological involvement in primary Sjögren syndrome: a focus on central nervous system.1932-620310.1371/journal.pone.0084605https://doaj.org/article/76cd7d3589144ab4ace8bcd2dd91d9f62014-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/24465419/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Objectives</h4>Sjögren syndrome is an autoimmune disease involving mainly salivary and lacrimal glands. Beyond widely described PNS involvement, high variable prevalence of CNS manifestations ranging from 2.5 and 60% of all pSS patients has been reported, without specific syndrome definition. The aim of this cohort study was to evaluate the prevalence of CNS signs and symptoms in pSS patients and to identify possible biomarkers of CNS damage.<h4>Methods</h4>120 patients with pSS diagnosis according to the 2002 American-European Consensus Group criteria were enrolled after exclusion of secondary causes. All patients underwent to a wide neurological, neuropsychological, psychiatric, neuroradiological and ultrasonographic evaluation.<h4>Results</h4>Central and peripheral nervous system involvement was observed in 81 patients with a prevalence of 67.5%. The prevalence of CNS involvement was significantly higher than PNS disease (p 0.001). 68 patients (84%) shown non-focal CNS symptoms and 64 (79%) focal CNS deficits with headache as the most common feature (46.9%), followed by cognitive (44.4%) and mood disorders (38.3%). Particularly, we observed a high prevalence of migraine without aura, subcortical frontal executive functions and verbal memory impairment and apathy/alexythimia. MR spectroscopy revealed a reduction of NAA levels or NAA/Cr ratio decrease in subcortical frontal and basal ganglia white matter, while ultrasonography showed an impairment of microvasculature response. At multivariate analysis, headache, cognitive disorders and psychiatric symptoms was significantly associated to serological markers (anti-SSA), MRS and ultrasonographic features.<h4>Conclusions</h4>The higher prevalence of MWO-mimic headache, cognitive dys-executive syndrome and mood disorders observed in this series confirmed previous evidences of a higher diffused CNS compromission rather than focal involvement such as SM-like clinical course or NMO-like syndrome. The association with immunological biomarkers, metabolic cerebral dysfunction and microvascular damage suggests a possible endothelial dysfunction of the cerebral microcirculation or a potential inflammation-mediated shift of the neurovascular coupling.Manuela MorrealePasquale MarchionePatrizia GiacominiSimona PontecorvoMassimo MarianettiClaudio VentoEmanuele TinelliAda FranciaPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 9, Iss 1, p e84605 (2014)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Manuela Morreale Pasquale Marchione Patrizia Giacomini Simona Pontecorvo Massimo Marianetti Claudio Vento Emanuele Tinelli Ada Francia Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.
description	<h4>Objectives</h4>Sjögren syndrome is an autoimmune disease involving mainly salivary and lacrimal glands. Beyond widely described PNS involvement, high variable prevalence of CNS manifestations ranging from 2.5 and 60% of all pSS patients has been reported, without specific syndrome definition. The aim of this cohort study was to evaluate the prevalence of CNS signs and symptoms in pSS patients and to identify possible biomarkers of CNS damage.<h4>Methods</h4>120 patients with pSS diagnosis according to the 2002 American-European Consensus Group criteria were enrolled after exclusion of secondary causes. All patients underwent to a wide neurological, neuropsychological, psychiatric, neuroradiological and ultrasonographic evaluation.<h4>Results</h4>Central and peripheral nervous system involvement was observed in 81 patients with a prevalence of 67.5%. The prevalence of CNS involvement was significantly higher than PNS disease (p 0.001). 68 patients (84%) shown non-focal CNS symptoms and 64 (79%) focal CNS deficits with headache as the most common feature (46.9%), followed by cognitive (44.4%) and mood disorders (38.3%). Particularly, we observed a high prevalence of migraine without aura, subcortical frontal executive functions and verbal memory impairment and apathy/alexythimia. MR spectroscopy revealed a reduction of NAA levels or NAA/Cr ratio decrease in subcortical frontal and basal ganglia white matter, while ultrasonography showed an impairment of microvasculature response. At multivariate analysis, headache, cognitive disorders and psychiatric symptoms was significantly associated to serological markers (anti-SSA), MRS and ultrasonographic features.<h4>Conclusions</h4>The higher prevalence of MWO-mimic headache, cognitive dys-executive syndrome and mood disorders observed in this series confirmed previous evidences of a higher diffused CNS compromission rather than focal involvement such as SM-like clinical course or NMO-like syndrome. The association with immunological biomarkers, metabolic cerebral dysfunction and microvascular damage suggests a possible endothelial dysfunction of the cerebral microcirculation or a potential inflammation-mediated shift of the neurovascular coupling.
format	article
author	Manuela Morreale Pasquale Marchione Patrizia Giacomini Simona Pontecorvo Massimo Marianetti Claudio Vento Emanuele Tinelli Ada Francia
author_facet	Manuela Morreale Pasquale Marchione Patrizia Giacomini Simona Pontecorvo Massimo Marianetti Claudio Vento Emanuele Tinelli Ada Francia
author_sort	Manuela Morreale
title	Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.
title_short	Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.
title_full	Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.
title_fullStr	Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.
title_full_unstemmed	Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.
title_sort	neurological involvement in primary sjögren syndrome: a focus on central nervous system.
publisher	Public Library of Science (PLoS)
publishDate	2014
url	https://doaj.org/article/76cd7d3589144ab4ace8bcd2dd91d9f6
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Neurological involvement in primary Sjögren syndrome: a focus on central nervous system.

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