Immune triggers preceding neuralgic amyotrophy.

Lenka Schilg-Hafer, Christoph Niederhauser, Peter Gowland, Stefano Fontana, Gladys Martinetti-Lucchini, Einar Wilder-Smith, Giulia Zezza, Andrea Monika Humm, Pinelopi Tsouni, Bernhard Friedrich Décard, Agustina Maria Lascano, Anne-Kathrin Peyer, Alex Vicino, Davide Sparasci, Thomas Hundsberger, Bettina Schreiner, Paolo Ripellino, Anelia Dietmann, Olivier Scheidegger, Enea Pianezzi, Thierry Kuntzer, Hans H Jung, Orlando Petrini, Claudio Gobbi

Journal: European journal of neurology 2024;31(12):e16462

PMID: 39364568

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Abstract

BACKGROUND AND PURPOSE

Infections and vaccinations have been identified as potential immunological triggers of neuralgic amyotrophy (NA), but the exact type and frequency of the preceding agents is unknown.

METHODS

This was a multicentre, prospective, observational, matched case-control study. NA was diagnosed by neuromuscular experts according to validated clinical criteria and electrodiagnostic studies. Clinical data and biological samples of NA patients were collected within 90 days from disease onset between June 2018 and December 2023. All NA patients were asked about prior infection and vaccination in the month before disease onset. Serological tests for hepatitis E virus, human immunodeficiency virus, severe acute respiratory syndrome coronavirus 2, Epstein-Barr virus, cytomegalovirus, parvovirus B19, varicella-zoster virus, Borrelia burgdorferi, Mycoplasma pneumoniae and Bartonella henselae were performed in a central laboratory. Each case was matched with a healthy control for age, sex, place of residence and time of blood collection.

RESULTS

Fifty-seven patients and corresponding controls were included. The mean age was 45 years for both groups. NA onset was preceded by a symptomatic infectious trigger confirmed by microbiological tests in 15/57 (26.3%) patients. Coronavirus disease 2019 vaccination was considered a potential trigger in 7/57 (12.3%) subjects. An acute viral infection was associated with a bilateral involvement of the brachial plexus (p = 0.003, Cramèr's V = 0.43).

CONCLUSIONS

Confirmed immune triggers (infection or vaccination) preceded disease onset in 22/57 (38.6%) NA cases. We suggest to test NA patients in the acute phase for intracellular antigens, especially in the case of concomitant bilateral involvement and hepatitis.

Address: Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.; Department of Neurology, Cantonal Hospital, St Gallen, Switzerland.; Department of Neurology, University and Hospital Zurich, Zurich, Switzerland.; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.; Department of Neurology, University Hospital and University of Basel, Basel, Switzerland.; Neurology Division, Department of Clinical Neuroscience, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.; Nerve-Muscle Unit, Neurology Service, Department of Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.; Cantonal Hospital, Lucerne, Switzerland.; Department of Neurology, Hôpital du Valais, Sion, Switzerland.; Neurology Unit, Department of Medicine, HFR Fribourg Cantonal Hospital, Fribourg, Switzerland.; Laboratory of Microbiology EOC, Bellinzona, Switzerland.; Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.; Cantonal Hospital, Lucerne, Switzerland.; University of Applied Sciences and Arts of Southern Switzerland, Bellinzona, Switzerland.; Blood Transfusion Service SRC Southern Switzerland, Lugano, Switzerland.; Interregional Blood Transfusion SRC, Bern, Switzerland.; Interregional Blood Transfusion SRC, Bern, Switzerland.; Interregional Blood Transfusion SRC, Bern, Switzerland.; Institute for Infectious Diseases, University of Bern, Bern, Switzerland.; Department of Neurology, Neurocenter of Southern Switzerland EOC, Lugano, Switzerland.; Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland.

DOI: 10.1111/ene.16462

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MeSH Terms: Humans, Brachial Plexus Neuritis, Female, Male, Middle Aged, Adult, Case-Control Studies, Prospective Studies, COVID-19, COVID-19 Vaccines, Aged