title: A nationwide survey of combined central and peripheral demyelination in Japan.
abstract: OBJECTIVE
  To clarify the clinical features of combined central and peripheral demyelination (CCPD) via a nationwide survey.
  
  
  METHODS
  The following characteristics were used to define CCPD: T2 high-signal intensity lesions in the brain, optic nerves or spinal cord on MRI, or abnormalities on visual-evoked potentials; conduction delay, conduction block, temporal dispersion or F-wave abnormalities suggesting demyelinating neuropathy based on nerve conduction studies; exclusion of secondary demyelination. We conducted a nationwide survey in 2012, sending questionnaires to 1332 adult and paediatric neurology institutions in Japan.
  
  
  RESULTS
  We collated 40 CCPD cases, including 29 women. Age at onset was 31.7±14.1 years (mean±SD). Sensory disturbance (94.9%), motor weakness (92.5%) and gait disturbance (79.5%) were common. Although cerebrospinal fluid protein levels were increased in 82.5%, oligoclonal IgG bands and elevated IgG indices were detected in 7.4% and 18.5% of cases, respectively. Fifteen of 21 patients (71.4%) had abnormal visual-evoked potentials. Antineurofascin 155 antibodies were positive in 5/11 (45.5%). Corticosteroids, intravenous immunoglobulins and plasmapheresis resulted in an 83.3%, 66.7% and 87.5% improvement, respectively, whereas interferon-β was effective in only 10% of cases. CCPD cases with simultaneous onset of central nervous system (CNS) and peripheral nervous system (PNS) involvement exhibited greater disability, but less recurrence and more frequent extensive cerebral and spinal cord MRI lesions compared to those with temporarily separated onset, whereas optic nerve involvement was more common in the latter.
  
  
  CONCLUSIONS
  CCPD shows different characteristics from classical demyelinating diseases, and distinctive features exist between cases with simultaneous and temporarily separated onset of CNS and PNS involvement.
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Hidenori
authors: H
authors: Ogata
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Dai
authors: D
authors: Matsuse
authors: Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Ryo
authors: R
authors: Yamasaki
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Department of Neurology, Kawamura Hospital, Gifu, Japan.
authors: Nobutoshi
authors: N
authors: Kawamura
authors: Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Takuya
authors: T
authors: Matsushita
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Tomomi
authors: T
authors: Yonekawa
authors: Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
authors: Makoto
authors: M
authors: Hirotani
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Hiroyuki
authors: H
authors: Murai
authors: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors: Jun-ichi
authors: J
authors: Kira
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D015815:Cell Adhesion Molecules / Q000134:cerebrospinal fluid; D002493:Central Nervous System Diseases / Q000453:epidemiology; D003711:Demyelinating Diseases / Q000150:complications / Q000453:epidemiology*; D004185:Disability Evaluation; D005074:Evoked Potentials, Visual; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology; D006306:Health Surveys; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D009414:Nerve Growth Factors / Q000134:cerebrospinal fluid; D009431:Neural Conduction; D009901:Optic Nerve Diseases / Q000453:epidemiology / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology; D011379:Prognosis; D012678:Sensation Disorders / Q000209:etiology; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D015815:Cell Adhesion Molecules; D016756:Immunoglobulins, Intravenous; C054305:NFASC protein, human; D009414:Nerve Growth Factors
keywords: EPIDEMIOLOGY; MULTIPLE SCLEROSIS; NEUROIMMUNOLOGY; NEUROMUSCULAR; NEUROPATHY