Patient Care Neurology & Psychiatry - November 2007 - (Page 28)

I Case & Comment The most recent association with dietary supplement ciated cognitive changes, 27% see 1 histamine degradation cognitive improvement and 32% consumption. Manifestations of the syndrome are experience cognitive decline.3 as the common protean, with the majority of patients There is still some question whethhaving some or all of these signs and pathway in syndromes er cognitive changes in EMS result symptoms: eosinophilia, peripheral from subjective complaints such as involving eosinophilia pain, fatigue, disrupted sleep, and neuropathy, selective cognitive impairments, rash, scleroderma-like depression or are independently and myalgias. skin changes, myalgias, arthralgias, GI related to the syndrome.4-6 Perisymptoms, and pulmonary disorders. pheral neuropathy also responds The original criteria concerning EMS were issued poorly to treatment, with about 50% remaining from the CDC as a screening guideline during the unchanged after corticosteroid therapy.3 No longrash of new-onset cases in the late 1980s and early term treatments have been described as highly effec1990s. Since then, many have tried to further refine tive in the treatment of chronic EMS. the diagnostic criteria, which no longer explicitly I Resolution mention L-tryptophan ingestion. In 2001, proposed criteria were found to be accurate and reproducible After 1 week of therapy, the patient reported great 2 for use in clinical investigation. The criteria stipulatimprovement of symptoms, especially the myalgias. ed that EMS can be diagnosed if either of 2 patterns At the patient’s 1-month follow-up and after comis satisfied, in the absence of the following exclupleting her prednisone taper, she reported the resosions: the presence of trichinosis, vasculitis, any lution of her lower extremity myalgias and an imother documented infection, allergic reaction, neoprovement in her cognitive functions. In fact, the plastic processes, connective tissue disease, or other patient reported improved sleeping patterns despite type of disease that could adequately explain the her RLS and sleep apnea. A repeat CBC revealed an clinical manifestations. The patterns are eosinophil count of 425 cells/ L (a decrease from • Pattern 1: Presence of a documented illness of 1270 cells/ L). abrupt or relatively discrete onset accompanied by Contributed by ROBERTO CARDARELLI, DO, MPH, evidence of all 3 of the following conditions within 6 Assistant Professor, Department of Family Medicine, University of North Texas Health Science Center (UNTHSC), Fort Worth, Tex; months of onset: (1) eosinophilia, (2) myalgia, and and MILLARD L. TIERCE, MBA, Department of Family Medicine, (3) at least one from among rash, edema, pulmonary UNTHSC, Fort Worth, Tex. involvement, or neuropathy. 1. Smith MJ, Garrett RH. A heretofore undisclosed crux of eosinophilia-myalgia syndrome: compromised histamine degradation. Inflamm • Pattern 2: Presence of an illness, with or without a Res. 2005;54(11):435-450. documented early episode, accompanied by one of 2. Hertzman PA, Clauw DJ, Duffy J, et al. Rigorous new approach to the following combinations occurring within 24 constructing a gold standard for validating new diagnostic criteria, as exemplified by the eosinophilia-myalgia syndrome. Arch Intern Med. hours of illness onset: (1) fasciitis, neuropathy, and 2001;161(19):2301-2306. myalgia or muscle cramps; or (2) any 3 or more of 3. Hertzman PA, Clauw DJ, Kaufman LD, et al. The eosinophilia-myalgia syndrome: status of 205 patients and results of treatment 2 years fasciitis, myopathy, neuropathy, or eosinophilia after onset. Ann Intern Med. 1995;122(11):851-855. (within 6 months of onset).2 4. Pollina DA, Kaufman LD, Masur DM, et al. Pain, fatigue, and sleep in eosinophilia-myalgia syndrome: relationship to neuropsychological In the face of varied patient presentations, a numperformance. J Neuropsychiatry Clin Neurosci. 1998;10(3):338-342. ber of therapies have been documented. Of these, 5. Armstrong C, Lewis T, D’Esposito M, et al. Eosinophilia-myalgia syndrome: selective cognitive impairment, longitudinal effects, and neuglucocorticoids have proved the most widely benefiroimaging findings. J Neurol Neurosurg Psychiatry. 1997;63(5): 633-641. cial. Prednisone therapy appears to be beneficial in 6. Krupp LB, Masur DM, Kaufman LD. Neurocognitive dysfunction symptom resolution, especially in the acute setting, in the eosinophilia-myalgia syndrome. Neurology. 1993;43(5): in the majority of EMS cases. Of patients with asso931-936. research describes 28 PATIENT CARE NEUROLOGY & PSYCHIATRY www.patientcareonline.com http://www.patientcareonline.com

Table of Contents Feed for the Digital Edition of Patient Care Neurology & Psychiatry - November 2007

Patient Care Neurology & Psychiatry - November 2007 Contents Research Digest Medicine in the News The 15-Minute Visit Dementia workup and treatment: Do the drugs really work? Help for Your Patients Who Suffer from Specific Phobias Clinical Clips Case & Comment The Science of Healing Classified Advertising

Patient Care Neurology & Psychiatry - November 2007

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.