M.Bojar Přednáška Neu 2.LFUK1 EB virus and NS impairment. EB virus role in acute and chronic CNS and peripheral NS impairment. Infectious mononucleosis (IM) - usually a self- limited disease. Serious sequelae may happen: pulmonary, ophthalmologic, NS &blood systems. Triad of fever, pharyngitis and cervical lymphadenopathy; lymphocytosis with predominance of atypical lymphocytes. IM- acute monophasic disorders of NS in children&teenagers: meningo- encephalitis, myelitis, neuritis, plexitis, radiculitis.

M.Bojar Přednáška Neu 2.LFUK2 EB virus and NS impairment. EBV in Guillain-Barré syndrom (10% of all GBs) Hypothesis of EBV role in MS, CFS. EB virus NS impairment - * Diagnostics: presence of IgM antibody to EBV viral capsid antigen (VCA), during acute primary EBV infection.PCR.ELM. - CSF Therapy. Steroids. Plasmapheresis. Immunomodulation. (Acyclovir blocks replication).

M.Bojar Přednáška Neu 2.LFUK3 EB virus and NS impairment. EB virus role in CNS impairment 3 Broad variety of CNS disorders, relatively(?) low incidence: acute or chronic encephalitis, encephalopathy aseptic meningitis acute cerebellar ataxia disseminate encephalomyelitis, myelitis, transverse myelitis, cerebral lymphoma

M.Bojar Přednáška Neu 2.LFUK4 EB virus and NS impairment. EB virus role in CNS impairment 4 Clinical symptoms : initial sy of EB viremia. With or without manifestation of IM, without sy of infection or without blood/lab change ( but CSF). ataxia, coma, confused states dysequilibirum, vertigo, fatigue headache, meningeal irit. paresis, seizures, spasticity, sphincter disorders

M.Bojar Přednáška Neu 2.LFUK5 EB virus and NS impairment. EB virus role in peripheral NS impairment 5 Protean manifestation of peripheral NS disorders, relatively(?) higher incidence. cranial nerves impairment - N.II, N.VI, N.VII,N.VIII Guillain-Barré syndrome (GB sy = AIDP sy) isolated mononeuritis, polyneuritis, plexitis plexopathy - brachial, lumbosacral - (sy cauda equinae), painful plexopathy

M.Bojar Přednáška Neu 2.LFUK6 EB virus and NS impairment. EB virus role in peripheral NS impairment 6 Clinical symptoms of pNS impairment: with or without IM manifestation, without symptoms of infection or blood chemistry/lab changes. n.abducens or facial n. palsy, peripheral monoparesis or quadruparesis, sensitive disorders, sphincter disorders

M.Bojar Přednáška Neu 2.LFUK7 EB virus and NS impairment. EBV role in Guillain-Barré syndrome 7 Acute inflammatory demyelinating polyradiculoneuropathy (AIDP = GBSy) History of preceding flu-like/gastrointestinal infection inducing by autoimmunopathic mechanisms edema, segmental demyel. & inflammatory changes Etiology: serol.&PCR&ELM evidence - CMV 15%, EBV 10%, Helicobacter jejuni 25%? Incidence - 5/ ?

M.Bojar Přednáška Neu 2.LFUK8 EB virus and NS impairment. EBV role in Guillain-Barré syndrome 8 Clinical sy: Sensory sy- symmetrical, acral par-,hyp-esthesia. Motor weakness - rapidly progressing - distal symmetrical impairment - para/quadruparesis. Cranial nerves involvement - facial palsy. (diparesis), bulbar paralysis. Autonomic dysfunction. Acute pandysautonomia.

M.Bojar Přednáška Neu 2.LFUK9 EB virus and NS impairment. EBV role in Guillain-Barré syndrome 9 Diagnosis: clin. sy, CSF (elevated proteins, norm.El), EMG - low CMV(less 70%), prologned TL, conduciton block. MEP, SSEP, VEP - abnormalities. MRI ? - demyelinating white matter lesions (B,M) Therapy : steroids, plasmapheresis, gammaglobulins, physiotherapy & RHB

M.Bojar Přednáška Neu 2.LFUK10 EB virus and NS impairment. Hypothesis of EBV role in MS, CFS 10 MS - a sequel to delayed exposure to a common infectious agent in immunopathic, sensitive individuals? An association between infectious mononucleosis (IM) and MS has been repeatedly proposed. No proved evidence that EBV is the verified causative agent of MS. However it is repeatedly classified as a probable co-factor in the MS pathogenesis. (Prospective epidem.study- Haahr et al. Aarhus, Denmark1995. CFS - poorly understood condition with various nonspecif. symptoms and possible linkeage with infectious agents.

M.Bojar Přednáška Neu 2.LFUK11 EB virus and NS impairment. HV1,2&EBV detection in patients with NS disorders 11 Multicentric study - (neuropathy,neuroinf.,Lb,stroke,MS) Serological markers of active HV inf. n=218 EBV- 15,6% HV1,2 - 11,2% HV3 6,4% CMV 2% Serological findings in CSF (IgG antibodies) n=154 EBV- 33% HV1,2 - 11% HV3 1,9% more HV 7% Detection of HV in CSF by el. microscopy n 508 “neuroinfection” - 9,5% Lyme borrel. 2% MS 1% Roubalová,Schramlová, Suchánková,Pitha,Bojar,Effler-Laborat..diagnostika herpet.infekcí u pac. s onemocněním.NS. Klin.Biochem.Metab.,5(26),1997, 1, 19-23