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Shahid M, Dinov D, Brenton JN. Clinical Response to Late-Stage Cyclophosphamide in a Child With Refractory N-Methyl-d-Aspartate Receptor Encephalitis. Pediatr Neurol 2024; 160:8-10. [PMID: 39173308 DOI: 10.1016/j.pediatrneurol.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 07/18/2024] [Accepted: 07/23/2024] [Indexed: 08/24/2024]
Affiliation(s)
| | - Darina Dinov
- Virginia Commonwealth University, Richmond, Virginia
| | - J Nicholas Brenton
- Division of Child Neurology, Department of Neurology, University of Virginia, Charlottesville, Virginia
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2
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Villéga F, Fernandes A, Jézéquel J, Uyttersprot F, Benac N, Zenagui S, Bastardo L, Gréa H, Bouchet D, Villetelle L, Nicole O, Rogemond V, Honnorat J, Dupuis JP, Groc L. Ketamine alleviates NMDA receptor hypofunction through synaptic trapping. Neuron 2024; 112:3311-3328.e9. [PMID: 39047728 DOI: 10.1016/j.neuron.2024.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 04/16/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
Activity-dependent modulations of N-methyl-D-aspartate glutamate receptor (NMDAR) trapping at synapses regulate excitatory neurotransmission and shape cognitive functions. Although NMDAR synaptic destabilization has been associated with severe neurological and psychiatric conditions, tuning NMDAR synaptic trapping to assess its clinical relevance for the treatment of brain conditions remains a challenge. Here, we report that ketamine (KET) and other clinically relevant NMDAR open channel blockers (OCBs) promote interactions between NMDAR and PDZ-domain-containing scaffolding proteins and enhance NMDAR trapping at synapses. We further show that KET-elicited trapping enhancement compensates for depletion in synaptic receptors triggered by autoantibodies from patients with anti-NMDAR encephalitis. Preventing synaptic depletion mitigates impairments in NMDAR-mediated CaMKII signaling and alleviates anxiety- and sensorimotor-gating-related behavioral deficits provoked by autoantibodies. Altogether, these findings reveal an unexpected dimension of OCB action and stress the potential of targeting receptor anchoring in NMDAR-related synaptopathies.
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Affiliation(s)
- Frédéric Villéga
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France; Department of Pediatric Neurology, CIC-1401, University Children's Hospital of Bordeaux, Bordeaux, France
| | - Alexandra Fernandes
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Julie Jézéquel
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Floriane Uyttersprot
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Nathan Benac
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Sarra Zenagui
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Laurine Bastardo
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Hélène Gréa
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Delphine Bouchet
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Léa Villetelle
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Olivier Nicole
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France
| | - Véronique Rogemond
- Synaptopathies and Autoantibodies Team, Institut NeuroMyoGene-MeLis, INSERM U1314, CNRS UMR 5284, Université Claude Bernard Lyon1, 69373 Lyon, France; French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677 Bron, France
| | - Jérôme Honnorat
- Synaptopathies and Autoantibodies Team, Institut NeuroMyoGene-MeLis, INSERM U1314, CNRS UMR 5284, Université Claude Bernard Lyon1, 69373 Lyon, France; French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69677 Bron, France
| | - Julien P Dupuis
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France.
| | - Laurent Groc
- University of Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, IINS UMR 5297, 33000 Bordeaux, France.
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3
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Xue H, Hu J, Chen Y, Huang W, Liu H, Xu H, Shi M. Anti-NMDAR encephalitis with delayed ovarian teratoma in a young woman: a case report with 5 years of follow-up. BMC Neurol 2024; 24:377. [PMID: 39375580 PMCID: PMC11460029 DOI: 10.1186/s12883-024-03891-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 09/30/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder with a variety of clinical manifestations. It has been established that anti-NMDAR encephalitis may be related to ovarian teratoma in female patients. However, a considerable number of patients have no obvious evidence of ovarian teratoma during the onset of the disease. CASE A 25-year-old previously-healthy female experienced a series of acute symptoms within two days, including confusion, disorientation, short-term memory loss, auditory hallucinations, abnormal behavior, refractory status epilepticus, etc. Her brain MRI and abdominal imaging showed no definite abnormality while her electroencephalogram exhibited the presence of low to moderate amplitude sharp, spike, and multi-spike waves. Serum and cerebrospinal fluid tests yielded positive results for anti-NMDAR antibodies. However, an ultrasound scan failed to identify an ovarian teratoma. Consequently, the diagnosis of anti-NMDAR encephalitis without teratoma was made after 4 days onset. After the plasma exchange and immunoglobulin therapy, her neurological symptoms improved and obtained a clinical cure. In the next eight months of follow-up, the patient accidentally touched a lump in the lower abdomen without any symptoms, and abdominal ultrasound and CT scan revealed a left ovarian tumor. Then she underwent left ovarian teratoma resection surgery and histopathology showed a mature cystic teratoma with neural components. The patient continued to receive five years of follow-up, and her condition remained stable without any recurrence, except that there had been a low titer of anti-NMDAR antibody in her serum. CONCLUSION Our case demonstrated the importance of long-term follow-up for female patients with anti-NMDAR encephalitis, since anti-NMDAR encephalitis-associated ovarian teratomas may develop in a delayed manner, even without any symptoms.
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Affiliation(s)
- Hailong Xue
- Department of Neurology, 987th Hospital of PLA Joint Service Support Force, No. 45 Dongfeng Street, Baoji, Shaanxi Province, 721015, China
| | - Junhao Hu
- Department of Neurology, 987th Hospital of PLA Joint Service Support Force, No. 45 Dongfeng Street, Baoji, Shaanxi Province, 721015, China
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 15 Changle West Street, Xi'an, Shaanxi Province, 710032, China
| | - Yingge Chen
- Department of Neurology, 987th Hospital of PLA Joint Service Support Force, No. 45 Dongfeng Street, Baoji, Shaanxi Province, 721015, China
| | - Wenbin Huang
- Department of Neurology, 987th Hospital of PLA Joint Service Support Force, No. 45 Dongfeng Street, Baoji, Shaanxi Province, 721015, China
| | - Haoling Liu
- Department of Neurology, 987th Hospital of PLA Joint Service Support Force, No. 45 Dongfeng Street, Baoji, Shaanxi Province, 721015, China
| | - Hongli Xu
- Department of Neurology, 987th Hospital of PLA Joint Service Support Force, No. 45 Dongfeng Street, Baoji, Shaanxi Province, 721015, China
| | - Ming Shi
- Department of Neurology, Xijing Hospital, Air Force Medical University, No. 15 Changle West Street, Xi'an, Shaanxi Province, 710032, China.
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Hartung TJ, Bartels F, Kuchling J, Krohn S, Leidel J, Mantwill M, Wurdack K, Yogeshwar S, Scheel M, Finke C. MRI findings in autoimmune encephalitis. Rev Neurol (Paris) 2024:S0035-3787(24)00590-3. [PMID: 39358087 DOI: 10.1016/j.neurol.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 08/09/2024] [Accepted: 08/28/2024] [Indexed: 10/04/2024]
Abstract
Autoimmune encephalitis encompasses a spectrum of conditions characterized by distinct clinical features and magnetic resonance imaging (MRI) findings. Here, we review the literature on acute MRI changes in the most common autoimmune encephalitis variants. In N-methyl-D-aspartate (NMDA) receptor encephalitis, most patients have a normal MRI in the acute stage. When lesions are present in the acute stage, they are typically subtle and non-specific white matter lesions that do not correspond with the clinical syndrome. In some NMDA receptor encephalitis cases, these T2-hyperintense lesions may be indicative of an NMDA receptor encephalitis overlap syndrome with simultaneous co-existence of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Encephalitis with leucine-rich glioma-inactivated 1 (LGI1)-, contactin-associated protein-like 2 (CASPR2)- or glutamic acid decarboxylase (GAD)- antibodies typically presents as limbic encephalitis (LE) with unilateral or bilateral T2/fluid attenuated inversion recovery (FLAIR) hyperintensities in the medial temporal lobe that can progress to hippocampal atrophy. Gamma aminobutyric acid-B (GABA-B) receptor encephalitis also often shows such medial temporal hyperintensities but may additionally involve cerebellar lesions and atrophy. Gamma aminobutyric acid-A (GABA-A) receptor encephalitis features multifocal, confluent lesions in cortical and subcortical areas, sometimes leading to generalized atrophy. MRI is unremarkable in most patients with immunoglobulin-like cell adhesion molecule 5 (IgLON5)-disease, while individual case reports identified T2/FLAIR hyperintense lesions, diffusion restriction and atrophy in the brainstem, hippocampus and cerebellum. These findings highlight the need for MRI studies in patients with suspected autoimmune encephalitis to capture disease-specific changes and to exclude alternative diagnoses. Ideally, MRI investigations should be performed using dedicated autoimmune encephalitis imaging protocols. Longitudinal MRI studies play an important role to evaluate potential relapses and to manage long-term complications. Advanced MRI techniques and current research into imaging biomarkers will help to enhance the diagnostic accuracy of MRI investigations and individual patient outcome prediction. This will eventually enable better treatment decisions with improved clinical outcomes.
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Affiliation(s)
- T J Hartung
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - F Bartels
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany; Humboldt-Universität zu Berlin, Berlin School of Mind and Brain, Berlin, Germany
| | - J Kuchling
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - S Krohn
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany; Humboldt-Universität zu Berlin, Berlin School of Mind and Brain, Berlin, Germany
| | - J Leidel
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - M Mantwill
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - K Wurdack
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - S Yogeshwar
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany; Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany
| | - M Scheel
- Charité - Universitätsmedizin Berlin, Department of Neuroradiology, Berlin, Germany
| | - C Finke
- Charité - Universitätsmedizin Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany; Humboldt-Universität zu Berlin, Berlin School of Mind and Brain, Berlin, Germany; Charité - Universitätsmedizin Berlin, Einstein Center for Neurosciences Berlin, Berlin, Germany.
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5
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Gombolay G, Brenton JN, Yang JH, Stredny CM, Kammeyer R, Fisher KS, Sandweiss AJ, Erickson TA, Kannan V, Otten C, Steriade C, Vu N, Santoro JD, Robles-Lopez K, Goodrich R, Otallah S, Arellano J, Christiana A, Morris M, Gorman MP, Kornbluh AB, Kahn I, Sepeta L, Jiang Y, Muscal E, Murray KO, Moodley M, Hardy D. Isolated Psychiatric Symptoms in Children With Anti-N-Methyl-d Aspartate Receptor Encephalitis. Pediatr Neurol 2024; 159:12-15. [PMID: 39094249 PMCID: PMC11381152 DOI: 10.1016/j.pediatrneurol.2024.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/25/2024] [Accepted: 07/11/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Isolated psychiatric symptoms can be the initial symptom of pediatric anti-N-methyl-d-aspartate (NMDA) receptor autoimmune encephalitis (pNMDARE). Here we report on the prevalence of isolated psychiatric symptoms in pNMDARE. We also assess whether initial neurodiagnostic tests (brain magnetic resonance imaging [MRI], electroencephalography [EEG], and/or cerebrospinal fluid [CSF] white blood cell count) are abnormal in children with isolated psychiatric symptoms and pNMDARE. METHODS This multicenter retrospective cohort study from CONNECT (Conquering Neuroinflammation and Epilepsies Consortium) from 14 institutions included children under age 18 years who were diagnosed with pNMDARE. Descriptive statistics using means, medians, and comparisons for continuous versus discrete data was performed. RESULTS Of 249 children included, 12 (5%) had only psychiatric symptoms without other typical clinical features of autoimmune encephalitis at presentation. All but one (11 of 12 = 92%) had at least one abnormal finding on initial ancillary testing: eight of 12 (67%) had an abnormal EEG, six of 12 (50%) had an abnormal MRI, and five of 12 (42%) demonstrated CSF pleocytosis. The single patient with a normal MRI, EEG, and CSF profile had low positive CSF NMDA antibody (titer of 1:1), and symptoms improved without immunotherapy. CONCLUSIONS Isolated first-episode psychiatric symptoms in pNMDARE are uncommon, and the majority of children will exhibit additional neurodiagnostic abnormalities. Delaying immunotherapy in a child with isolated psychiatric symptoms and normal neurodiagnostic testing may be warranted while awaiting confirmatory antibody testing.
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Affiliation(s)
- Grace Gombolay
- Department of Pediatrics, Emory University SOM and Children's Healthcare of Atlanta, Atlanta, Georgia.
| | - J Nicholas Brenton
- Division of Pediatric Neurology, Department of Neurology, University of Virginia Health System, Charlottesville, Virginia
| | - Jennifer H Yang
- Department of Pediatrics, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California
| | - Coral M Stredny
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ryan Kammeyer
- Department of Pediatrics, University of Colorado SOM and Children's Hospital Colorado, Denver, Colorado
| | - Kristen S Fisher
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Alexander J Sandweiss
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Timothy A Erickson
- Section of Pediatric Tropical Medicine, Department of Pediatrics, Center for Human Immunobiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; Laboratories for Emerging and Tropical Diseases, School of Public Health, Texas A&M University, College Station, Texas
| | - Varun Kannan
- Department of Pediatrics, Emory University SOM and Children's Healthcare of Atlanta, Atlanta, Georgia; Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Catherine Otten
- Department of Pediatrics, Seattle Children's/University of Washington, Seattle, Washington
| | - Claude Steriade
- Department of Neurology, New York University SOM, New York, New York
| | - NgocHanh Vu
- Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan D Santoro
- Department of Neurology and Pediatrics, Children's Hospital Los Angeles; Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karla Robles-Lopez
- Department of Pediatrics, University of Texas at Austin and Dell Medical School, Austin, Texas
| | - Robert Goodrich
- Department of Neurology, Atrium Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Scott Otallah
- Department of Neurology, Atrium Wake Forest Baptist Health, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Janetta Arellano
- Pediatric Neurology, Children's Hospital of Orange County, Orange, California
| | - Andrew Christiana
- Department of Neurology, New York University SOM, New York, New York
| | - Morgan Morris
- Department of Pediatrics, Emory University SOM and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Mark P Gorman
- Department of Neurology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Alexandra B Kornbluh
- Department of Pediatrics, Children's National Hospital, George Washington University Medical School, Washington, District of Columbia
| | - Ilana Kahn
- Department of Pediatrics, Children's National Hospital, George Washington University Medical School, Washington, District of Columbia
| | - Leigh Sepeta
- Department of Pediatrics, Children's National Hospital, George Washington University Medical School, Washington, District of Columbia
| | - Yike Jiang
- Section of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Eyal Muscal
- Division of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; Section of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kristy O Murray
- Section of Pediatric Tropical Medicine, Department of Pediatrics, Center for Human Immunobiology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Manikum Moodley
- Department of Pediatrics, University of Texas at Austin and Dell Medical School, Austin, Texas
| | - Duriel Hardy
- Department of Pediatrics, University of Texas at Austin and Dell Medical School, Austin, Texas
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Luykx JJ, Visscher R, Winter-van Rossum I, Waters P, de Witte LD, Fleischhacker WW, Lin BD, de Boer N, van der Horst M, Yeeles K, Davidson M, Pollak TA, Hasan A, Lennox BR. Clinical symptoms and psychosocial functioning in patients with schizophrenia spectrum disorders testing seropositive for anti-NMDAR antibodies: a case-control comparison with patients testing negative. Lancet Psychiatry 2024; 11:828-838. [PMID: 39300641 DOI: 10.1016/s2215-0366(24)00249-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 07/23/2024] [Accepted: 07/23/2024] [Indexed: 09/22/2024]
Abstract
BACKGROUND Antibodies against the N-methyl-D-aspartate receptor (NMDAR) have been described in the serum of people with schizophrenia spectrum disorders (schizophrenia). However, the prevalence and clinical relevance of these antibodies in schizophrenia is unclear. This knowledge gap includes the possibility of such antibodies being associated with a distinct clinical profile, which in turn might warrant a distinct treatment approach. We aimed to assess the seroprevalence of anti-NMDAR antibodies in schizophrenia, and compare symptoms and psychosocial functioning between patients with schizophrenia who were seropositive and seronegative for these antibodies. METHODS In this case-control comparison, by combining new and existing studies, we included patients diagnosed with schizophrenia from four independent cohorts for whom anti-NMDAR serostatus had been assessed (or could be assessed by us) with live cell-based assays. Included cohorts were from the EULAST study (a trial conducted across 15 European countries and Israel), the OPTiMiSE study (an interventional study in Europe), and the PPiP1 and PPiP2 studies (conducted in the UK). Patients from these cohorts were analysed if they had complete Positive and Negative Syndrome Scale (PANSS) data. No participant had been diagnosed with autoimmune encephalitis or received treatment for this condition. After calculating the prevalence of serum anti-NMDAR antibodies, we examined possible differences in PANSS scores (negative, positive, and general symptom subscales, and total score) between anti-NMDAR-seropositive and anti-NMDAR-seronegative patients. Psychosocial functioning as measured by Personal Social Performance (PSP) score was also compared. All analyses were exploratory and no adjustment was done for multiple testing. People with lived experience were not involved in the conduct of this study. FINDINGS We collected individual patient data from 1114 patients with schizophrenia across the four cohorts. The study population had a mean age of 28·6 years (SD 7·6) and comprised 382 (34·3%) women and 732 (65·7%) men, including patients of White (929 [83·4%]), Asian (54 [4·8%]), Black (68 [6·1%]), and other (62 [5·6%]) ethnicities. Overall, 41 (3·7%) participants (range 3·1-4·0% across cohorts) tested positive for serum anti-NMDAR antibodies. Lower symptom severity on the negative symptoms PANSS subscale was observed for anti-NMDAR-seropositive patients (mean score 15·8 [SD 6·4]) than for anti-NMDAR-seronegative patients (18·2 [6·8]; Cohen's d=0·36; p=0·026), as well as on the general symptoms PANSS subscale (32·9 [8·9] vs 36·1 [10·1]; d=0·33; p=0·029) and total PANSS score (65·5 [18·5] vs 72·6 [19·3]; d=0·37; p=0·013). Mean PSP score was better in anti-NMDAR-positive patients (62·0 [17·0]) than in anti-NMDAR-negative patients (53·5 [16·3]; d=0·52; p=0·014). INTERPRETATION Serum NMDAR antibodies are present in 3-4% of patients with schizophrenia and are associated with relatively low severity of negative symptoms and relatively good psychosocial functioning. Thus, although the findings await replication in cohorts from other geographical regions, serum anti-NMDAR antibodies might be associated with a different form of psychotic illness. These findings could inform future prognostic and interventional studies examining whether anti-NMDAR antibodies are associated with a specific course of illness or with treatment response. FUNDING None.
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Affiliation(s)
- Jurjen J Luykx
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, Netherlands; GGZ inGeest Mental Health Care, Amsterdam, Netherlands; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands.
| | - Robbert Visscher
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Inge Winter-van Rossum
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - W Wolfgang Fleischhacker
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy, Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria; Weill Cornell Medicine, New York, NY, USA
| | - Bochao Danae Lin
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Nini de Boer
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Marte van der Horst
- Department of Psychiatry, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht University, Utrecht, Netherlands
| | - Ksenija Yeeles
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Michael Davidson
- Department of Basic and Clinical Sciences, University of Nicosia Medical School, Nicosia, Cyprus
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Augsburg, Faculty of Medicine, Augsburg, Germany; German Center for Mental Health (DZPG), Partner Site Munich-Augsburg, Augsburg, Germany
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Cai L, Li G, Abdulaziz AT, Gong X, Liu X, Kong X, Guo K, Li A, Li J, Zhou D, Hong Z. Efficacy and safety of different oral prednisone tapering courses in adult anti-NMDAR encephalitis: A multicenter prospective cohort study. Epilepsia 2024. [PMID: 39324872 DOI: 10.1111/epi.18107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/16/2024] [Accepted: 08/16/2024] [Indexed: 09/27/2024]
Abstract
OBJECTIVE In adult anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis, corticosteroids are commonly used as first-line treatment. However, the optimal oral prednisone tapering (OPT) following intravenous methylprednisolone pulse therapy remains unclear. We aim to compare the efficacy and safety of different OPT courses in anti-NMDAR encephalitis. METHODS The CHASE study, a multicenter prospective observational cohort study, enrolled patients with autoimmune encephalitis from October 2011 to March 2023. Patients were grouped based on oral prednisone tapering course: ≤3 months (Group ≤3 month), 3-6 months (Group 3-6 months, including 3 months), and >6 months (Group > 6 months). Kaplan-Meier plots were used to analyze time to relapse and time to total recovery within 2 years. RESULTS Among 666 screened patients, 171 (median [IQR] age 27 [21.0-36.5] years, 55.0% female) met selection criteria. Responders at 3 months were prevalent in Group ≤3 months (OR 7.251 [95% CI 2.252 to 23.344] and Group 3-6 months (OR, 3.857 [95% CI 1.107 to 13.440] than in Group >6 months. Clinical Assessment Scale for Autoimmune Encephalitis (CASE) scores at 12 months were higher in Group >6 months than in Group ≤3 months and Group 3-6 months (β, -2.329 [95% CI -3.784 to -.875]; β, -2.871 [95% CI -4.490, -1.253]). CASE seizures subscore was higher in Group >6 months than in Group 3-6 months (β, -.452 [95% CI -.788 to -.116]). No significant difference in seizure freedom rates among the groups. Adverse events were higher in Group 3-6 months and Group >6 months than in Group ≤3 months (OR 6.045 [95% CI 2.352 to 15.538]; OR 6.782 [95% CI 1.911 to 24.073]). SIGNIFICANCE Longer oral prednisone courses for adult patients with anti-NMDAR encephalitis did not show superior effects compared to shorter courses in improving modified Rankin Scale (mRS) scores and CASE scores, reducing the risk of relapse within 2 years, or achieving seizure freedom. Instead, extended prednisone courses may lead to more side effects- particularly weight gain. This outcome recommends evaluating the possibility of shortening the duration of oral prednisone after a thorough patient assessment.
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Affiliation(s)
- Linjun Cai
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Gaowei Li
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ammar T Abdulaziz
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xue Gong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xu Liu
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xueying Kong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Kundian Guo
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Aiqing Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jinmei Li
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-Inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurology, West China Tianfu Hospital of Sichuan University, Chengdu, Sichuan, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China
| | - Zhen Hong
- Department of Neurology, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-Inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China
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8
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Nitsch S, Höftberger R. What we've learnt about autoimmune neurological diseases from neuropathology. Rev Neurol (Paris) 2024:S0035-3787(24)00593-9. [PMID: 39317583 DOI: 10.1016/j.neurol.2024.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2024] [Revised: 08/15/2024] [Accepted: 08/28/2024] [Indexed: 09/26/2024]
Abstract
Antibody-associated autoimmune neurological diseases are a group of disorders with various immune effector mechanisms that result in significant differences in disease course and prognosis. Paraneoplastic or idiopathic autoimmune encephalitis associated with antibodies against intracellular antigens are mostly characterized by a T-cell-dominated inflammation with neuronal loss, astrogliosis, and microglial nodules. In anti-Yo paraneoplastic cerebellar degeneration CD8+/granzymeB+ T cells were demonstrated in close apposition to neurons along with a nuclear upregulation of the activator of transcription 1, suggesting an important role of interferon-gamma in disease pathogenesis. Early and late disease stages may show different lesion types. For example, tissue samples from patients with temporal lobe epilepsy associated with antiglutamic acid decarboxylase 65 antibodies in early disease stages show numerous infiltrating T cells targeting hippocampal neurons and high numbers of B cells and plasma cells, while in chronic stages inflammation gets less and is followed by hippocampal sclerosis. Similarly, antiglial fibrillary acidic protein meningoencephalomyelitis may show loss of astrocytes only in the very early lesions, whereas in subacute and chronic stages astrocytes can get replenished most likely due to their high regeneration potential. In contrast, neuropathology of autoimmune neurological diseases mediated by surface antibodies is mostly characterized by a dysfunction of neurons in the absence of immune-mediated neuronal damage. The interaction of surface antibodies with their target antigen and the resulting downstream mechanisms are variable and can range from an internalization of the receptor in well-preserved neurons in anti-N-methyl-D-aspartate receptor encephalitis to an irreversible internalization and blocking of the receptor that may be associated with an accumulation of phosphorylated tau in specific brain regions in anti-IgLON5 disease. Interestingly, anti-IgLON5 patients with short disease duration were shown to present prominent deposition of IgG4 in the neuropil and on neuronal membranes in the absence of neuronal tau deposits, suggesting that the immune mechanisms precede neurodegeneration. Knowledge about pathomechanisms and patterns of tissue damage in different disease stages of antibody-associated autoimmune diseases will help to identify novel biomarkers and can give important clues for possible therapeutic interventions.
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Affiliation(s)
- S Nitsch
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - R Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
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9
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Zhu X, Huang Y, Qiu J, Zhong Z, Peng Y, Liang X, Chen J, Zhou J, Liang X, Wang H, Xie W, Ding Y. Chaihu Guizhi Decoction prevents cognitive, memory impairments and sensorimotor gating deficit induced by N-methyl-d-aspartate receptor antibody in mice. JOURNAL OF ETHNOPHARMACOLOGY 2024; 337:118806. [PMID: 39278296 DOI: 10.1016/j.jep.2024.118806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 09/04/2024] [Accepted: 09/06/2024] [Indexed: 09/18/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Anti-NMDAR encephalitis is one of the most common types of autoimmune encephalitis, primarily presenting with prodromal symptoms, such as fever and headache, followed by a range of neurological and psychiatric symptoms. Chaihu Guizhi Decoction (CGD), a traditional Chinese medicine formulated by Zhang Zhongjing in the Eastern Han Dynasty, has been effectively used in clinical practice to treat the symptoms of Taiyang and Shaoyang disorders, including fever, headache, and psychiatric disorders. AIM OF THE STUDY To demonstrate the protective effects of CGD in an animal model of anti-NMDAR encephalitis and explore the potential mechanisms involved. MATERIALS AND METHODS UHPLC-HRMS was used to identify CGD's chemical components and serum metabolomic profiles. Network pharmacology and molecular docking were performed to predict potential targets of CGD for the treatment of anti-NMDAR encephalitis. The effect of CGD on anti-NMDAR encephalitis was evaluated using a mouse model induced by patients' antibodies. Behavioral tests were performed to assess cognitive impairment and schizophrenia-like behaviors. The effect of CGD on the cell-surface NMDAR GluN1 subunit in cultured neurons treated with patient antibodies was detected by immunofluorescence. Golgi staining was used to observe morphological changes in hippocampal dendrites. The expression of NMDAR-interacting proteins and various neuroreceptors in the hippocampus were examined to validate the targets predicted using network pharmacology and molecular docking. RESULTS CGD alleviated cognitive, memory, and sensorimotor gating deficits in mice treated with anti-NMDAR encephalitis patients' antibodies. Further experiments demonstrated the effect of CGD in preventing NMDAR reduction both in vitro and in vivo. Meanwhile, CGD regulated NMDAR-interacting proteins and dopamine receptors but did not affect hippocampal dendritic morphology and synaptic density. Additionally, CGD modifies metabolic pathways associated with anti-NMDAR encephalitis and other neurological and psychiatric disorders. CONCLUSIONS CGD exhibited protective effects against anti-NMDAR encephalitis by mitigating the antibody-induced reduction in NMDAR and NMDAR-interacting proteins.
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Affiliation(s)
- Xiaoyu Zhu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Yingyi Huang
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Jing Qiu
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Zheng Zhong
- Department of Chemistry and the Swire Institute of Marine Science, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - Yu Peng
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, China
| | - Xiaoshan Liang
- Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jinyu Chen
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Jieli Zhou
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Xiaotao Liang
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China
| | - Honghao Wang
- Department of Neurology, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, Guangdong, 510180, China.
| | - Wei Xie
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China; Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
| | - Yuewen Ding
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, Guangdong, 510515, China; Department of Traditional Chinese Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, 510515, China.
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10
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Guasp M, Dalmau J. Predicting the future of autoimmune encephalitides. Rev Neurol (Paris) 2024:S0035-3787(24)00583-6. [PMID: 39277478 DOI: 10.1016/j.neurol.2024.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/25/2024] [Accepted: 08/02/2024] [Indexed: 09/17/2024]
Abstract
The concept that many neurologic and psychiatric disorders of unknown cause are immune-mediated has evolved fast during the past 20 years. The main contribution to the expansion of this field has been the discovery of antibodies that attack neuronal or glial cell-surface proteins or receptors, directly modifying their structure and function. These antibodies facilitate the diagnosis and prompt treatment of patients who often improve with immunotherapy. The identification of this group of diseases, collectively named "autoimmune encephalitides", was preceded by many years of investigations on other autoimmune CNS disorders in which the antibodies are against intracellular proteins, occur more frequently with cancer, and associate with cytotoxic T-cell responses that are less responsive to immunotherapy. Here, we first trace the recent history of the autoimmune encephalitides and address how to assess the clinical value and implement in our practice the rapid pace of autoantibody discovery. In addition, we review recent developments in the post-acute stage of the two main autoimmune encephalitides (NMDAR and LGI1) focusing on symptoms that are frequently overlooked or missed, and therefore undertreated. Because a better understanding of the pathophysiology of these diseases relies on animal models, we examine currently available studies, recognizing the existing needs for better and all-inclusive neuro-immunobiological models. Finally, we assess the status of biomarkers of disease outcome, clinical scales, current treatment strategies, and emerging therapies including CAR T-cell technology. Altogether, this overview is intended to identify gaps of knowledge and provide suggestions for improvement and insights for future research.
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Affiliation(s)
- M Guasp
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-CaixaResearch Institute, Barcelona, Spain; Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Raras (CIBERER), Madrid, Spain
| | - J Dalmau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)-CaixaResearch Institute, Barcelona, Spain; Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red, Enfermedades Raras (CIBERER), Madrid, Spain; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Cobanovic S, Blaabjerg M, Illes Z, Nissen MS, Nielsen CH, Kondziella D, Buhelt S, Mahler MR, Sellebjerg F, Romme Christensen J. Cerebrospinal fluid soluble CD27 is a sensitive biomarker of inflammation in autoimmune encephalitis. J Neurol Sci 2024; 466:123226. [PMID: 39278170 DOI: 10.1016/j.jns.2024.123226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 09/06/2024] [Accepted: 09/08/2024] [Indexed: 09/17/2024]
Abstract
BACKGROUND Autoimmune encephalitis (AE) comprises a group of rare, severe neuroinflammatory conditions. Current biomarkers of neuroinflammation are often normal in AE which therefore can be difficult to rule out in patients with seizures, cognitive and/or neuropsychiatric symptoms. Cerebrospinal fluid (CSF) soluble CD27 (sCD27) and soluble B-cell maturation antigen (sBCMA) have high sensitivity for neuroinflammation in other neuroinflammatory conditions. In this exploratory study we investigate the potential of sCD27 and sBCMA in CSF as biomarkers of neuroinflammation in AE. METHODS Concentrations of sCD27 and sBCMA were measured in CSF from 40 AE patients (20 patients were untreated (12 with anti-N-Methyl-d-Aspartate receptor antibodies (NMDA) and 8 with anti-Leucine-rich Glioma-Inactivated 1 antibodies (LGI1)), and 37 symptomatic controls (SCs). RESULTS CSF concentrations of sCD27 were increased in untreated NMDA AE patients (median 1571 pg/ml; p < 0.001) and untreated LGI1 AE patients (median 551 pg/ml; p < 0.05) compared to SCs (median 250 pg/ml). CSF sBCMA was increased in untreated NMDA AE patients (median 832 pg/ml) compared to SCs (median 429 pg/ml). CSF sCD27 and sBCMA correlated with the CSF cell count. Receiver operating characteristic curve analysis of untreated AE patients versus SCs showed an area under the curve of 0.97 for sCD27 and 0.76 for sBCMA. CONCLUSION CSF sCD27 is a suitable biomarker of neuroinflammation in AE with an ability to discriminate patients with NMDA AE and LGI1 AE from symptomatic controls. CSF sCD27 may be suited for ruling out AE and other neuroinflammatory conditions in the early phase of the diagnostic work-up.
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Affiliation(s)
- Stefan Cobanovic
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Morten Blaabjerg
- Department of Neurology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5220, Odense, Denmark
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5220, Odense, Denmark
| | - Mette Scheller Nissen
- Department of Neurology, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5220, Odense, Denmark
| | - Claus Henrik Nielsen
- Institute for Inflammation Research, Department of Rheumatology and Spine Disease, Copenhagen University Hospital, Ole Maaløes Vej 26, 2200 Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Rigshospitalet, Copenhagen University Hospital - Rigshospitalet, Inge Lehmanns Vej 8, 2100 Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Sophie Buhelt
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Mie Reith Mahler
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Finn Sellebjerg
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Jeppe Romme Christensen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark.
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12
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Yan Y, Yao C, Zhang B, Yang Z, Xie J, Tang M, Long Q, Tu E, Dong X. Olanzapine vs. magnesium valproate vs. lamotrigine in anti-N-methyl-D-aspartic acid receptor encephalitis: a retrospective study. BMC Neurol 2024; 24:331. [PMID: 39251922 PMCID: PMC11382376 DOI: 10.1186/s12883-024-03811-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 08/20/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND This study aimed to compare the impact of olanzapine, magnesium valproate, and lamotrigine as adjunctive treatments for anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. And it is expected to add supporting points related to the rebalance of neurotransmitters in the brain through adjuvant therapy in the clinical management of anti-NMDAR encephalitis. METHODS This retrospective study included patients diagnosed with anti-NMDAR encephalitis who received standardized immunotherapy at Hunan Brain Hospital between January 2018 and December 2020. RESULTS Compared to the olanzapine group, both the magnesium valproate and lamotrigine groups showed lower scores on the positive and negative symptom scale (PANSS) total score after 3 weeks of treatment (all P < 0.05). The Montreal Cognitive Assessment Scale (MoCA) scores in the magnesium valproate and lamotrigine groups were significantly higher than in the olanzapine group after 3 weeks and 3 months of treatment (all P < 0.05). After 3 months of treatment, the proportions of patients with a modified Rankin scale score (mRS) of 0-1 in the magnesium valproate and lamotrigine groups were significantly higher than in the olanzapine group (all P < 0.05). The electroencephalogram (EEG) abnormality ranks at 3 months were significantly lower in the magnesium valproate and lamotrigine groups compared with the olanzapine group (all P < 0.05). Furthermore, the Glx/Cr ratio significantly decreased after 3 months of treatment (all P < 0.05) in the magnesium valproate and lamotrigine groups, while the Glx/Cr ratio in the olanzapine group showed no significant change (P > 0.05). CONCLUSION Compared with olanzapine, the addition of magnesium valproate or lamotrigine to immunotherapy might be associated with a lower PANSS score, higher MoCA score, and lower mRS score. The improvement of neurological functions and cognitive function may be related to the decreased Glx/Cr ratio.
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Affiliation(s)
- Yinhua Yan
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- Department of Neurology, Brain Hospital of Hunan Province (The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China
| | - Chenxiao Yao
- The Hospital of Trade-Business of Hunan Province, Changsha, 410006, Hunan, China
| | - Bo Zhang
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- Hunan society of traditional Chinese medicine and integrated traditional Chinese and Western Medicine, Changsha, 410005, Hunan, China
| | - Zhenyu Yang
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- Department of Neurology, Brain Hospital of Hunan Province (The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China
| | - Jiahui Xie
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- Department of Neurology, Brain Hospital of Hunan Province (The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China
| | - Miao Tang
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- Department of Neurology, Brain Hospital of Hunan Province (The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China
| | - Qiong Long
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China
- Department of Neurology, Brain Hospital of Hunan Province (The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China
| | - Ewen Tu
- College of Clinical Medicine, Hunan University of Chinese Medicine, Changsha, 410007, Hunan, China.
- Department of Neurology, Brain Hospital of Hunan Province (The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China.
| | - Xuanqi Dong
- Brain Hospital of Hunan Province, Brain Hospital of Hunan Province(The Second Hospital of Hunan Province), Changsha, 410007, Hunan, China.
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13
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Boeken OJ, Heine J, Duda-Sikula M, Patricio V, Picard G, Buttard C, Benaiteau M, Mendes Á, Howard F, Easton A, Kurpas D, Honnorat J, Dalmau J, Finke C. Assessment of long-term psychosocial outcomes in N-methyl-D-aspartate receptor encephalitis - the SAPIENCE study protocol. BMC Neurol 2024; 24:322. [PMID: 39242986 PMCID: PMC11378596 DOI: 10.1186/s12883-024-03842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND N-methyl-D-aspartate-receptor (NMDAR) encephalitis is a rare neurological autoimmune disease with severe neuropsychiatric symptoms during the acute phase. Despite good functional neurological recovery, most patients continue to experience cognitive, psychiatric, psychological, and social impairments years after the acute phase. However, the precise nature and evolving patterns over time of these long-term consequences remain unclear, and their implications for the well-being and quality of life of predominantly young patients have yet to be thoroughly examined. METHODS SAPIENCE is a European multi-center (n = 3) prospective observational cohort study studying the long-term cognitive, psychiatric, psychological, and social outcome in patients with NMDAR encephalitis. The study consists of three interconnected levels. Level 1 comprises a qualitative interview and focus groups with patients and their caregivers. Level 2 consists of a condensed form of the interview, standardized questionnaires, and a detailed neuropsychological examination of patients. Level 3 involves an online survey that will be open to patients world-wide and explores patient-reported outcomes (PROMs), and patient-reported experiences (PREMs) in association with clinical and cognitive outcomes. Levels 1 to 3 will progressively contribute developing of structured interviews, survey questions, and treatment guidelines by informing one another. DISCUSSION SAPIENCE is an in-depth study of the long-term effects of NMDAR encephalitis and bridges the gap between standardized assessments and individual patient experiences, intending to improve patient care and to increase awareness of the psychosocial long-term consequences of the disease. Through collaboration of experts in clinical neurology and social and health psychology across Europe, SAPIENCE aims to create online assessment tools and formulate guidelines for patient-centered post-acute care that will help enhance the quality of life for patients and caregivers.
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Affiliation(s)
- Ole Jonas Boeken
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10177, Berlin, Berlin, Germany
| | - Josephine Heine
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10177, Berlin, Berlin, Germany
| | - Marta Duda-Sikula
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, WrocławDepartment of Family Medicine, Wroclaw Medical University, Bartla 5 St., wyb. Ludwika, Pasteura1, Wroclaw, 51-618, 50-367, Poland
| | - Víctor Patricio
- Fundacio de Clinic per a la Recerca Clinic Barcelona - Biomédica (FCRB) - Institut de Investigacions, Biomediques August Pi I Sunyer, c/Rosselló 149-153, Barcelona, Spain
| | - Géraldine Picard
- French reference center on paraneoplastic neurological diseases and autoimmune encephalitis, UMR MELIS Inserm, Université Claude Bernard Lyon1, Hôpital neurologique 59 Bd Pinel, Bron cedex, 69677, 1314 / CNRS 5284, France
| | - Chloé Buttard
- French reference center on paraneoplastic neurological diseases and autoimmune encephalitis, UMR MELIS Inserm, Université Claude Bernard Lyon1, Hôpital neurologique 59 Bd Pinel, Bron cedex, 69677, 1314 / CNRS 5284, France
| | - Marie Benaiteau
- French reference center on paraneoplastic neurological diseases and autoimmune encephalitis, UMR MELIS Inserm, Université Claude Bernard Lyon1, Hôpital neurologique 59 Bd Pinel, Bron cedex, 69677, 1314 / CNRS 5284, France
| | - Álvaro Mendes
- Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Portugal, Rua Alfredo Allen, 8, 4200-180, Porto, Portugal
| | - Fuchsia Howard
- Faculty of Applied Sciences, The University of British Columbia, T201 - 211, Westbrook Mall, Vancouver, Canada
| | - Ava Easton
- Encephalitis International, YO17 7DT, Malton, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Donata Kurpas
- Department of Family and Pediatric Nursing, Faculty of Health Sciences, WrocławDepartment of Family Medicine, Wroclaw Medical University, Bartla 5 St., wyb. Ludwika, Pasteura1, Wroclaw, 51-618, 50-367, Poland
| | - Jérôme Honnorat
- French reference center on paraneoplastic neurological diseases and autoimmune encephalitis, UMR MELIS Inserm, Université Claude Bernard Lyon1, Hôpital neurologique 59 Bd Pinel, Bron cedex, 69677, 1314 / CNRS 5284, France
| | - Josep Dalmau
- Fundacio de Clinic per a la Recerca Clinic Barcelona - Biomédica (FCRB) - Institut de Investigacions, Biomediques August Pi I Sunyer, c/Rosselló 149-153, Barcelona, Spain
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10177, Berlin, Berlin, Germany.
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14
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Wang H, Xie C, Deng B, Ding J, Li N, Kou Z, Jin M, He J, Wang Q, Wen H, Zhang J, Zhou Q, Chen S, Chen X, Yuan TF, Zhu S. Structural basis for antibody-mediated NMDA receptor clustering and endocytosis in autoimmune encephalitis. Nat Struct Mol Biol 2024:10.1038/s41594-024-01387-3. [PMID: 39227720 DOI: 10.1038/s41594-024-01387-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 08/07/2024] [Indexed: 09/05/2024]
Abstract
Antibodies against N-methyl-D-aspartate receptors (NMDARs) are most frequently detected in persons with autoimmune encephalitis (AE) and used as diagnostic biomarkers. Elucidating the structural basis of monoclonal antibody (mAb) binding to NMDARs would facilitate the development of targeted therapy for AE. Here, we reconstructed nanodiscs containing green fluorescent protein-fused NMDARs to label and sort individual immune B cells from persons with AE and further cloned and identified mAbs against NMDARs. This allowed cryo-electron microscopy analysis of NMDAR-Fab complexes, revealing that autoantibodies bind to the R1 lobe of the N-terminal domain of the GluN1 subunit. Small-angle X-ray scattering studies demonstrated NMDAR-mAb stoichiometry of 2:1 or 1:2, structurally suitable for mAb-induced clustering and endocytosis of NMDARs. Importantly, these mAbs reduced the surface NMDARs and NMDAR-mediated currents, without tonically affecting NMDAR channel gating. These structural and functional findings imply that the design of neutralizing antibody binding to the R1 lobe of NMDARs represents a potential therapy for AE treatment.
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Affiliation(s)
- Han Wang
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Chun Xie
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Bo Deng
- Department of Neurology, Huashan Hospital and Institute of Neurology, National Center for Neurological Disorders, Fudan University, Shanghai, China
| | - Jingjun Ding
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine and School of Psychology, Shanghai, China
| | - Na Li
- National Facility for Protein Science in Shanghai, Shanghai Advanced Research Institute, Chinese Academy of Sciences, Shanghai, China
| | - Zengwei Kou
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Mengmeng Jin
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | - Jie He
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
- University of Chinese Academy of Sciences, Beijing, China
| | | | - Han Wen
- DP Technology, Beijing, China
| | - Jinbao Zhang
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China
| | - Qinming Zhou
- Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Sheng Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital and Institute of Neurology, National Center for Neurological Disorders, Fudan University, Shanghai, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine and School of Psychology, Shanghai, China.
| | - Shujia Zhu
- Institute of Neuroscience, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
- University of Chinese Academy of Sciences, Beijing, China.
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15
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Michalski K, Abdulla T, Kleeman S, Schmidl L, Gómez R, Simorowski N, Vallese F, Prüss H, Heckmann M, Geis C, Furukawa H. Structural and functional mechanisms of anti-NMDAR autoimmune encephalitis. Nat Struct Mol Biol 2024:10.1038/s41594-024-01386-4. [PMID: 39227719 DOI: 10.1038/s41594-024-01386-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 08/07/2024] [Indexed: 09/05/2024]
Abstract
Autoantibodies against neuronal membrane proteins can manifest in autoimmune encephalitis, inducing seizures, cognitive dysfunction and psychosis. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most dominant autoimmune encephalitis; however, insights into how autoantibodies recognize and alter receptor functions remain limited. Here we determined structures of human and rat NMDARs bound to three distinct patient-derived antibodies using single-particle electron cryo-microscopy. These antibodies bind different regions within the amino-terminal domain of the GluN1 subunit. Through electrophysiology, we show that all three autoantibodies acutely and directly reduced NMDAR channel functions in primary neurons. Antibodies show different stoichiometry of binding and antibody-receptor complex formation, which in one antibody, 003-102, also results in reduced synaptic localization of NMDARs. These studies demonstrate mechanisms of diverse epitope recognition and direct channel regulation of anti-NMDAR autoantibodies underlying autoimmune encephalitis.
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Affiliation(s)
- Kevin Michalski
- W.M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Taha Abdulla
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Sam Kleeman
- W.M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
- School of Biological Sciences, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Lars Schmidl
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Ricardo Gómez
- W.M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Noriko Simorowski
- W.M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA
| | - Francesca Vallese
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Manfred Heckmann
- Department of Neurophysiology, Institute of Physiology, University of Würzburg, Würzburg, Germany
| | - Christian Geis
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hiro Furukawa
- W.M. Keck Structural Biology Laboratory, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.
- School of Biological Sciences, Cold Spring Harbor Laboratory, Cold Spring Harbor, NY, USA.
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16
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Ribeiro L, Psimaras D, Vollhardt R, Honnorat J, Méneret A, Demeret S, Celier A, Valyraki NE, Cousyn L, Le Guennec L, Arnulf I, Gales AZ. REM and NREM Sleep Parasomnia in Anti-NMDA Receptor Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200203. [PMID: 38917379 PMCID: PMC11216806 DOI: 10.1212/nxi.0000000000200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 12/01/2023] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Encephalitis with anti-N-methyl-d-aspartate receptor antibodies (anti-NMDARe) is a rare disorder characterized by cognitive impairment, psychosis, seizures, and abnormal movements. Abnormal behaviors during REM sleep have not been described in anti-NMDARe. METHODS Patients were monitored by video-polysomnography on a first night followed by multiple sleep latency tests and 18 hours of bed rest. RESULTS Two patients with anti-NMDARe developed during the acute and postacute phase parasomnias including REM sleep behavior disorder and continuous finalistic quiet gesturing during a mixed N2/R sleep. The parasomnia disorder was improved by gabapentin and clonazepam. DISCUSSION Video-polysomnography avoids misdiagnosing these parasomnia behaviors for seizure or movement disorders and allows adequate treatment.
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Affiliation(s)
- Luis Ribeiro
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Dimitri Psimaras
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Raphael Vollhardt
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Jerome Honnorat
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Aurélie Méneret
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Sophie Demeret
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Adam Celier
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Nefeli E Valyraki
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Louis Cousyn
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Loic Le Guennec
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Isabelle Arnulf
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
| | - Ana Z Gales
- From the Sleep Clinic (L.R., R.V., I.A., A.Z.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France; Neurology Department (L.R.), Unidade Local de Saude, Matosinhos, Portugual; Department of Neurology 2 (D.P.), Neuro-oncology Department, Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris; National Reference Centre on Paraneoplastic Neurological Syndromes (J.H.), Hospices Civils de Lyon, MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1; and Neurology Department (A.M., S.D., A.C., N.E.V., L.C., L.L.G.), Pitié-Salpêtrière Hospital, APHP-Sorbonne University, Paris, France
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17
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Gao D, Lv X, Shen Z, Wang H, Zhao W, Wang H, Jin X, Tan L, Yin L, Wang J, Yue W, Wang H. Early Diagnosis of CNS Virus Infections from Neurological Autoimmune Diseases: A Cross-Sectional Study from China in ER Setting. Brain Sci 2024; 14:888. [PMID: 39335384 PMCID: PMC11430841 DOI: 10.3390/brainsci14090888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Revised: 08/27/2024] [Accepted: 08/28/2024] [Indexed: 09/30/2024] Open
Abstract
It is challenging to differentiate between central nervous system (CNS) virus infections and neurological autoimmune diseases in the emergency department. Considering their different pathogenesis, we assume they differ in neuropsychiatric symptoms and laboratory results. A total of 80 patients were included in this study, 50 with CNS virus infections and 30 with CNS autoimmune diseases, confirmed by a polymerase chain reaction (PCR) of cerebrospinal fluid (CSF). A binary logistic regression model and receiver operating characteristic (ROC) curve were employed to examine the discrimination between the two types of diseases based on neuropsychiatric symptoms and laboratory results. Compared to patients with neurological autoimmune diseases, patients with CNS virus infections had a higher incidence of abnormal behavior (p = 0.026) and abnormal sensation/thought (p = 0.029); higher total (p = 0.005), direct (p = 0.004), and indirect bilirubin (p = 0.004); and increased CSF cell (p = 0.01) and CSF white cell counts (p = 0.01). Patients with disturbance of consciousness and abnormal sensation/thought were 7.79-fold and 5.07-fold more likely to be diagnosed with CNS virus infections (OR = 7.79, p = 0.008; OR = 5.07, p = 0.032). Each unit increase in blood indirect bilirubin concentration and CSF white cell counts increased the risk of developing CNS virus infections by 1.25-fold and 1.01-fold (OR = 1.25, p = 0.016; OR = 1.01, p = 0.011). ROC analysis showed that the area under the curve was 88.0% (p < 0.001). Our study found that patients with CNS viral infections tend to have higher blood indirect bilirubin concentration, CSF leukocyte count, frequency of disorders of consciousness, and abnormal sensation and thought, which may help differentiate them from those with neurological autoimmune diseases.
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Affiliation(s)
- Daiquan Gao
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Xue Lv
- The First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Zuoyao Shen
- The First Affiliated Hospital of Xinxiang Medical College, Xinxiang 453100, China
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Huicong Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Wenfeng Zhao
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Huang Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Xiukun Jin
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Liuchen Tan
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
| | - Lu Yin
- Medical Research & Biometrics Centre, Fuwai Hospital, National Centre for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 102300, China
| | - Junhui Wang
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON M5G 1X5, Canada
- Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan 727000, China
| | - Weihua Yue
- NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100191, China
| | - Hongxing Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital of Capital Medical University, National Center for Neurological Disorders, National Clinical Research Center for Geriatric Diseases, Beijing Psychosomatic Disease Consultation Center, Capital Medical University, Beijing 100053, China
- Beijing Institute of Brain Disorders, Beijing 100069, China
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18
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Cheng CK, Yi M, Wang L, Huang Y. Role of gasdermin D in inflammatory diseases: from mechanism to therapeutics. Front Immunol 2024; 15:1456244. [PMID: 39253076 PMCID: PMC11381298 DOI: 10.3389/fimmu.2024.1456244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Accepted: 08/08/2024] [Indexed: 09/11/2024] Open
Abstract
Inflammatory diseases compromise a clinically common and diverse group of conditions, causing detrimental effects on body functions. Gasdermins (GSDM) are pore-forming proteins, playing pivotal roles in modulating inflammation. Belonging to the GSDM family, gasdermin D (GSDMD) actively mediates the pathogenesis of inflammatory diseases by mechanistically regulating different forms of cell death, particularly pyroptosis, and cytokine release, in an inflammasome-dependent manner. Aberrant activation of GSDMD in different types of cells, such as immune cells, cardiovascular cells, pancreatic cells and hepatocytes, critically contributes to the persistent inflammation in different tissues and organs. The contributory role of GSDMD has been implicated in diabetes mellitus, liver diseases, cardiovascular diseases, neurodegenerative diseases, and inflammatory bowel disease (IBD). Clinically, alterations in GSDMD levels are potentially indicative to the occurrence and severity of diseases. GSDMD inhibition might represent an attractive therapeutic direction to counteract the progression of inflammatory diseases, whereas a number of GSDMD inhibitors have been shown to restrain GSDMD-mediated pyroptosis through different mechanisms. This review discusses the current understanding and future perspectives on the role of GSDMD in the development of inflammatory diseases, as well as the clinical insights of GSDMD alterations, and therapeutic potential of GSDMD inhibitors against inflammatory diseases. Further investigation on the comprehensive role of GSDM shall deepen our understanding towards inflammation, opening up more diagnostic and therapeutic opportunities against inflammatory diseases.
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Affiliation(s)
- Chak Kwong Cheng
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Min Yi
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Department of Endocrinology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Li Wang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Yu Huang
- Department of Biomedical Sciences, City University of Hong Kong, Hong Kong, Hong Kong SAR, China
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19
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Yang X, Sun A, Kong L, Yang X, Zhao X, Wang S. Inhibition of NLRP3 inflammasome alleviates cognitive deficits in a mouse model of anti-NMDAR encephalitis induced by active immunization. Int Immunopharmacol 2024; 137:112374. [PMID: 38851162 DOI: 10.1016/j.intimp.2024.112374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/21/2024] [Accepted: 05/28/2024] [Indexed: 06/10/2024]
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a neurological disorder, characterized by cognitive deficits as one of its vital features. The nucleotide-binding oligomerization domain-like receptor (NLRP3) inflammasome is a key contributor to neuroinflammation and cognitive deficits in neurological diseases. However, the underlying mechanism of anti-NMDAR encephalitis remains unclear, and the biological function of the NLRP3 inflammasome in this condition has not been elucidated. In this study, a mouse model of anti-NMDAR encephalitis was induced by active immunization with the GluN1356-385 peptide (NEA model). The NLRP3 inflammasome in the hippocampus and temporal cortex was investigated using real-time quantitative PCR (RT-qPCR), western blotting, and immunofluorescence staining. The impact of MCC950 on cognitive function and NLRP3 inflammation was assessed. Confocal immunofluorescence staining and Sholl analysis were employed to examine the function and morphology of microglia. In the current study, we discovered overactivation of the NLRP3 inflammasome and an enhanced inflammatory response in the NEA model, particularly in the hippocampus and temporal cortex. Furthermore, significant cognitive dysfunction was observed in the NEA model. While, MCC950, a selective inhibitor of the NLRP3 inflammasome, sharply attenuated the inflammatory response in mice, leading to mitigated cognitive deficits of mice and more regular arrangements of neurons and reduced number of hyperchromatic cells were also observed in the hippocampus area. In addition, we found that the excess elevation of NLRP3 inflammasome was mainly expressed in microglia accompanied with the overactivation of microglia, while MCC950 treatment significantly inhibited the increased number and activated morphological changes of microglia in the NEA model. Altogether, our study reveals the vital role of overactivated NLRP3 signaling pathway in aggravating the inflammatory response and cognitive deficits and the potential protective effect of MCC950 in anti-NMDAR encephalitis. Thus, MCC950 represents a promising strategy for anti-inflammation in anti-NMDAR encephalitis and our study lays a theoretical foundation for it to become a clinically targeted drug.
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Affiliation(s)
- Xiaxin Yang
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Anqi Sun
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Liangbo Kong
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Xue Yang
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Xiuhe Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China.
| | - Shengjun Wang
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China.
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20
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Li EC, Lai QL, Zhang TY, Du BQ, Zhao J, Cai MT, Zhang YX, Fang GL. Type 2 herpes simplex virus-induced anti-N-methyl-D-aspartate receptor encephalitis responsive to immunoglobulin monotherapy. J Neurovirol 2024:10.1007/s13365-024-01228-5. [PMID: 39158759 DOI: 10.1007/s13365-024-01228-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 07/24/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
Herpes simplex virus-2 encephalitis (HSV2E) in immunocompetent adults is exceptionally rare, and the subsequent onset of autoimmune encephalitis after HSV2E is even less common. This report presents the inaugural Chinese case of anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) induced by HSV2E, confirmed via metagenomic next-generation sequencing (mNGS). The patient demonstrated a favorable response to intravenous immunoglobulin (IVIG) monotherapy. This case emphasizes the importance of considering autoimmune encephalitis in patients exhibiting new or recurrent neurological symptoms after HSV2E recovery. Comprehensive mNGS and neuronal antibody testing are essential for timely diagnosis. Moreover, IVIG monotherapy can serve as an effective treatment for NMDARE induced by HSV2, providing a viable alternative, particularly when steroid therapy is contraindicated.
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Affiliation(s)
- Er-Chuang Li
- Department of Neurology, Taikang Ningbo Hospital, Ningbo, 315042, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, 310013, China
| | - Tian-Yi Zhang
- Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310003, China
| | - Bing-Qing Du
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jing Zhao
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, 208 East Huancheng Road, Hangzhou, 310003, China
| | - Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, 208 East Huancheng Road, Hangzhou, 310003, China.
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21
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Tamura Y, Fukuda M, Ishiyama A, Nishida H, Kashii H, Mashimo H, Inoue K, Sakuma H, Kumada S. Abnormal theta-band rhythm: EEG abnormality as potential biomarkers for disease severity in pediatric anti-NMDAR encephalitis. Epilepsy Behav Rep 2024; 27:100704. [PMID: 39206447 PMCID: PMC11350254 DOI: 10.1016/j.ebr.2024.100704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/04/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children often requires early immunosuppressive therapy before antibody detection. While various electroencephalogram (EEG) patterns, including extreme delta brushes (EDBs), have been reported in adults, pediatric EEG characteristics remain understudied. This study aims to assist clinicians in identifying severe cases early, potentially improving treatment outcomes through prompt intervention. This retrospective case series examined EEG features influenced by disease severity in children with anti-NMDAR encephalitis. We evaluated six children (1-13 years old; four females, two males) treated at Tokyo Metropolitan Neurological Hospital from January 2007 to January 2023. The severity of autoimmune encephalitis in our patients was assessed using the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). The literature proposes a severity classification for the CASE score, wherein scores of 0-8 points are categorized as mild, 9-18 points as moderate, and 19-27 points as severe. In our patients, CASE scores ranged from 4 to 25 (median:19). We reviewed acute-phase EEG recordings, including 13 long-term videos and 58 conventional recordings. None of the patients maintained a normal posterior-dominant rhythm, and only one exhibited EDBs. Notably, three patients with higher CASE scores (≥15) displayed abnormal theta-band rhythm during non-REM sleep and prolonged EEG recovery times. Our findings suggest that abnormal theta-band rhythms may serve as a potential acute-phase EEG biomarker for severe anti-NMDAR encephalitis in children.
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Affiliation(s)
- Yumie Tamura
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Mitsumasa Fukuda
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
| | - Akihiko Ishiyama
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
| | - Hiroya Nishida
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Hirofumi Kashii
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
| | - Hideaki Mashimo
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
- Department of Pediatrics, Teikyo University Hospital, Japan
| | - Kenji Inoue
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
- Department of Pediatrics, Chiba Rehabilitation Center, Japan
| | - Hiroshi Sakuma
- Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, Japan
| | - Satoko Kumada
- Department of Neuropediatrics, Tokyo Metropolitan Neurological Hospital, Japan
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22
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Irani SR. Autoimmune Encephalitis. Continuum (Minneap Minn) 2024; 30:995-1020. [PMID: 39088286 DOI: 10.1212/con.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVE This article focuses on the clinical features and diagnostic evaluations that accurately identify patients with ever-expanding forms of antibody-defined encephalitis. Forms of autoimmune encephalitis are more prevalent than infectious encephalitis and represent treatable neurologic syndromes for which early immunotherapies lead to the best outcomes. LATEST DEVELOPMENTS A clinically driven approach to identifying many autoimmune encephalitis syndromes is feasible, given the typically distinctive features associated with each antibody. Patient demographics alongside the presence and nature of seizures, cognitive impairment, psychiatric disturbances, movement disorders, and peripheral features provide a valuable set of clinical tools to guide the detection and interpretation of highly specific antibodies. In turn, these clinical features in combination with serologic findings and selective paraclinical testing, direct the rationale for the administration of immunotherapies. Observational studies provide the mainstay of evidence guiding first- and second-line immunotherapy administration in autoimmune encephalitis and, whereas these typically result in some clinical improvements, almost all patients have residual neuropsychiatric deficits, and many experience clinical relapses. An improved pathophysiologic understanding and ongoing clinical trials can help to address these unmet medical needs. ESSENTIAL POINTS Antibodies against central nervous system proteins characterize various autoimmune encephalitis syndromes. The most common targets include leucine-rich glioma inactivated protein 1 (LGI1), N-methyl-d-aspartate (NMDA) receptors, contactin-associated proteinlike 2 (CASPR2), and glutamic acid decarboxylase 65 (GAD65). Each antibody-associated autoimmune encephalitis typically presents with a recognizable blend of clinical and investigation features, which help differentiate each from alternative diagnoses. The rapid expansion of recognized antibodies and some clinical overlaps support panel-based antibody testing. The clinical-serologic picture guides the immunotherapy regime and offers valuable prognostic information. Patient care should be delivered in conjunction with autoimmune encephalitis experts.
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23
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Jia Y, Li M, Hu S, Leng H, Yang X, Xue Q, Zhang M, Wang H, Huang Z, Wang H, Ye J, Liu A, Wang Y. Psychiatric features in NMDAR and LGI1 antibody-associated autoimmune encephalitis. Eur Arch Psychiatry Clin Neurosci 2024; 274:1051-1061. [PMID: 37029805 DOI: 10.1007/s00406-023-01606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Patients with autoimmune encephalitis (AE) often developed psychiatric features during the disease course. Many studies focused on the psychiatric characteristic in anti-NMDAR encephalitis (NMDAR-E), but anti-LGI1 encephalitis (LGI1-E) had received less attention regarding the analysis of psychiatric features, and no study compared psychiatric characteristic between these two groups. The clinical data of AE patients (62 NMDAR-E and 20 LGI1-E) who developed psychiatric symptoms were analyzed in this study. In NMDAR-E, the most common higher-level feature was "behavior changes" (60/62, 96.8%) and the lower-level feature "incoherent speech" was observed in 33 patients (33/62, 53.2%), followed by "agitation" (29/62, 46.8%) and "incongruent laughter/crying" (20/62, 32.3%). Similar to NMDAR-E, "behavior changes" was most common in LGI1-E (17/20, 85.0%), but the features of suicidality, eating, and obsessive-compulsive were not reported. The top three lower-level features were visual hallucinations (9/20, 45.0%), incoherent speech (8/20, 40.0%), and mood instability (7/20, 35.0%). The comparative study found that "incongruent laughter/crying", in lower-level features, was more frequently observed in NMDAR-E (32.3% vs. 0%, p = 0.002). Moreover, the Bush Francis Catatonia Rating Scale (BFCRS) assessing the catatonic symptoms in NMDAR-E were higher than LGI1-E, but the 18 item-Brief Psychiatric Rating Scale (BPRS-18) showed no difference in the two groups. In summary, both NMDAR-E and LGI1-E often developed psychiatric symptoms. In contrast with LGI1-E, the psychiatric feature "incongruent laughter/crying" was more frequently associated with NMDAR-E, and catatonic symptoms were more severe in NMDAR-E.
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Affiliation(s)
- Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Mingyu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Haixia Leng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Xiaotong Yang
- Department of Neurology, Youanmen Hospital, Fengtai, Beijing, China
| | - Qing Xue
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Mengyao Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Huifang Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
- Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China.
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China.
- Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
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24
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Jamet Z, Mergaux C, Meras M, Bouchet D, Villega F, Kreye J, Prüss H, Groc L. NMDA receptor autoantibodies primarily impair the extrasynaptic compartment. Brain 2024; 147:2745-2760. [PMID: 38758090 PMCID: PMC11292910 DOI: 10.1093/brain/awae163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 04/19/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
Autoantibodies directed against the N-methyl-D-aspartate receptor (NMDAR-Ab) are pathogenic immunoglobulins detected in patients suffering from NMDAR encephalitis. NMDAR-Ab alter the receptor membrane trafficking, synaptic transmission and neuronal network properties, leading to neurological and psychiatric symptoms in patients. Patients often have very little neuronal damage but rapid and massive (treatment-responsive) brain dysfunctions related to an unknown early mechanism of NMDAR-Ab. Our understanding of this early molecular cascade remains surprisingly fragmented. Here, we used a combination of single molecule-based imaging of membrane proteins to unveil the spatiotemporal action of NMDAR-Ab on live hippocampal neurons. We first demonstrate that different clones of NMDAR-Ab primarily affect extrasynaptic (and not synaptic) NMDARs. In the first minutes, NMDAR-Ab increase extrasynaptic NMDAR membrane dynamics, declustering its surface interactome. NMDAR-Ab also rapidly reshuffle all membrane proteins located in the extrasynaptic compartment. Consistent with this alteration of multiple proteins, effects of NMDAR-Ab were not mediated through the sole interaction between the NMDAR and EphB2 receptor. In the long term, NMDAR-Ab reduce the NMDAR synaptic pool by slowing down receptor membrane dynamics in a cross-linking-independent manner. Remarkably, exposing only extrasynaptic NMDARs to NMDAR-Ab was sufficient to produce their full-blown effect on synaptic receptors. Collectively, we demonstrate that NMDAR-Ab initially impair extrasynaptic proteins, then the synaptic ones. These data thus shed new and unsuspected light on the mode of action of NMDAR-Ab and, probably, our understanding of (extra)synaptopathies.
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Affiliation(s)
- Zoe Jamet
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Camille Mergaux
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Morgane Meras
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Delphine Bouchet
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
| | - Frédéric Villega
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
- Department of Pediatric Neurology, CIC-0005, University Children's Hospital of Bordeaux, F-33000 Bordeaux, France
| | - Jakob Kreye
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117 Berlin, Germany
| | - Laurent Groc
- Interdisciplinary Institute for Neuroscience, IINS, UMR 5297, University of Bordeaux, CNRS, F-33000 Bordeaux, France
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25
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Umutoni Mihigo G, Uljic L, Kaushal J, Amoah S, Jha K, Jolayemi A. Patterns of Neuropsychiatric Manifestations of Ovarian Teratomas: A Systematic Review of Case Reports. Cureus 2024; 16:e67190. [PMID: 39295702 PMCID: PMC11410426 DOI: 10.7759/cureus.67190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/21/2024] Open
Abstract
Ovarian teratomas are germ cell tumors composed of multiple cell types. Ovarian teratomas may express antigens found in the nervous system or neuroendocrine proteins. These neural antigens and neuroendocrine proteins may lead to an autoimmune response with associated encephalitis. There are a growing number of case reports of autoimmune encephalitis in patients with ovarian teratomas. However, the patterns of neuropsychiatric manifestations of ovarian teratomas associated with encephalitis have not been established. The aim of this article is to conduct a systematic review to determine the patterns of neuropsychiatric manifestations of ovarian teratoma-associated encephalitis, focusing on their frequency and clinical course. Thirty-three case reports were collected and analyzed for a systematic review. The studies were full-text, peer-reviewed journal publications from April 2014 to April 2024. Fifty-eight patients were included in our study. The age group of 22-35 years old was the most reported, with 25 (43.1%) patients. The most commonly reported symptoms were memory impairment in 29 (50%) patients, hallucinations in 25 (43.1%) patients, and aggressive behavior in 23 (39.7%) patients. Neuropsychiatric symptoms had a prodromal phase of flu-like symptoms in 31 (53.4%) patients. The neuropsychiatric symptoms preceded the diagnosis of ovarian teratoma in 57 (98.3%) patients. In 53 (91.4%) patients, patients did not respond to psychiatric medications. Autoimmune antibodies to neural antigens were found in 45 (77.6%) patients, with 25 (43.1%) patients having neural tissue present in the teratoma. Treatment of the underlying teratoma and encephalitis led to full recovery in 37 (63.8%) patients. However, long-term outcomes such as relapse and mortality were discussed in only 11 (19.0%) patients. Findings suggest that neuropsychiatric symptoms correlate with teratoma-associated encephalitis and often precede tumor detection. The treatment of the teratoma led to full recovery of the neuropsychiatric manifestations; however, the long-term outcomes of the patients need to be further studied. Future research is needed on the prognosis of patients with neuropsychiatric manifestations of ovarian teratoma.
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Affiliation(s)
| | - Luigjina Uljic
- Medicine, American University of Antigua, St. John's, ATG
| | - Jasrina Kaushal
- Internal Medicine, Medical University of the Americas, Charlestown, KNA
| | - Shannia Amoah
- Medicine, American University of Antigua, St. John's, ATG
| | - Kudrat Jha
- Medicine, American University of Antigua, St. John's, ATG
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26
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Hartung TJ, von Schwanenflug N, Krohn S, Broeders TAA, Prüss H, Schoonheim MM, Finke C. Eigenvector Centrality Mapping Reveals Volatility of Functional Brain Dynamics in Anti-NMDA Receptor Encephalitis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00209-X. [PMID: 39074556 DOI: 10.1016/j.bpsc.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/18/2024] [Accepted: 07/21/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Anti-NMDA receptor encephalitis (NMDARE) causes long-lasting cognitive deficits associated with altered functional connectivity. Eigenvector centrality (EC) mapping represents a powerful new method for data-driven voxelwise and time-resolved estimation of network importance-beyond changes in classical static functional connectivity. METHODS To assess changes in functional brain network organization, we applied EC mapping in 73 patients with NMDARE and 73 matched healthy control participants. Areas with significant group differences were further investigated using 1) spatial clustering analyses, 2) time series correlation to assess synchronicity between the hippocampus and cortical brain regions, and 3) correlation with cognitive and clinical parameters. RESULTS Dynamic, time-resolved EC showed significantly higher variability in 13 cortical areas (familywise error p < .05) in patients with NMDARE compared with healthy control participants. Areas with dynamic EC group differences were spatially organized in centrality clusters resembling resting-state networks. Importantly, variability of dynamic EC in the frontotemporal cluster was associated with impaired verbal episodic memory in patients (r = -0.25, p = .037). EC synchronicity between the hippocampus and the medial prefrontal cortex was reduced in patients compared with healthy control participants (familywise error p < .05, tmax = 3.76) and associated with verbal episodic memory in patients (r = 0.28, p = .019). Static EC analyses showed group differences in only one brain region (left intracalcarine cortex). CONCLUSIONS Widespread changes in network dynamics and reduced hippocampal-medial prefrontal synchronicity were associated with verbal episodic memory deficits and may thus represent a functional neural correlate of cognitive dysfunction in NMDARE. Importantly, dynamic EC detected substantially more network alterations than traditional static approaches, highlighting the potential of this method to explain long-term deficits in NMDARE.
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Affiliation(s)
- Tim J Hartung
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Nina von Schwanenflug
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology and Experimental Neurology, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephan Krohn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology and Experimental Neurology, Berlin, Germany
| | - Tommy A A Broeders
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Harald Prüss
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology and Experimental Neurology, Berlin, Germany; German Center for Neurodegenerative Diseases, Berlin, Germany
| | - Menno M Schoonheim
- Department of Anatomy and Neurosciences, MS Center Amsterdam, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carsten Finke
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology and Experimental Neurology, Berlin, Germany; Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany.
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27
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Hirjak D, Rogers JP, Wolf RC, Kubera KM, Fritze S, Wilson JE, Sambataro F, Fricchione G, Meyer-Lindenberg A, Ungvari GS, Northoff G. Catatonia. Nat Rev Dis Primers 2024; 10:49. [PMID: 39025858 DOI: 10.1038/s41572-024-00534-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024]
Abstract
Catatonia is a neuropsychiatric disorder characterized by motor, affective and cognitive-behavioural signs, which lasts from hours to days. Intensive research over the past two decades has led to catatonia being recognized as an independent diagnosis in the International Classification of Diseases, 11th Revision (ICD-11) since 2022. Catatonia is found in 5-18% of inpatients on psychiatric units and 3.3% of inpatients on medical units. However, in an unknown number of patients, catatonia remains unrecognized and these patients are at risk of life-threatening complications. Hence, recognizing the symptoms of catatonia early is crucial to initiate appropriate treatment to achieve a favourable outcome. Benzodiazepines such as lorazepam and diazepam, electroconvulsive therapy, and N-methyl-D-aspartate antagonists such as amantadine and memantine, are the cornerstones of catatonia therapy. In addition, dopamine-modulating second-generation antipsychotics (for example, clozapine and aripiprazole) are effective in some patient populations. Early and appropriate treatment combined with new screening assessments has the potential to reduce the high morbidity and mortality associated with catatonia in psychiatric and non-psychiatric settings.
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Affiliation(s)
- Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany.
- German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany.
| | | | - Robert Christian Wolf
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Katharina Maria Kubera
- Center for Psychosocial Medicine, Department of General Psychiatry, Heidelberg University, Heidelberg, Germany
| | - Stefan Fritze
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jo Ellen Wilson
- Critical Illness, Brain Dysfunction, and Survivorship Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Geriatric Research, Education and Clinical Center (GRECC), Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Fabio Sambataro
- Department of Neuroscience (DNS), University of Padova, Padova, Italy
| | - Gregory Fricchione
- Benson-Henry Institute for Mind Body Medicine, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
- German Centre for Mental Health (DZPG), Partner site Mannheim, Mannheim, Germany
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Section of Psychiatry, School of Medicine, University Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Georg Northoff
- Mind, Brain Imaging and Neuroethics Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, Ottawa, Ontario, Canada
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28
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Wright MA, Guasp M, Lachner C, Day GS, Gombolay G, Titulaer MJ, Clardy SL. Electroconvulsive therapy in N-methyl-d-aspartate receptor encephalitis: A retrospective cohort and scoping review of literature. J Neuroimmunol 2024; 392:578369. [PMID: 38823118 DOI: 10.1016/j.jneuroim.2024.578369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/04/2024] [Accepted: 05/12/2024] [Indexed: 06/03/2024]
Abstract
Neuropsychiatric symptoms in N-methyl-d-aspartate receptor encephalitis (NMDARE) have led some to pursue empiric trials of electroconvulsive therapy (ECT). A scoping review identified 39 patients diagnosed with NMDARE undergoing ECT. Separately, a retrospective cohort was reviewed to characterize 21 patients. Clinical improvement was attributed to ECT in 49% of patients in the scoping review and 19% of patients in the retrospective cohort; timing of immunotherapies was a confounding factor. Worsening of clinical course following ECT was reported in 28% of patients in the scoping review and 38% of patient in the retrospective review. There is currently insufficient data supporting a beneficial effect of ECT in NMDARE.
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Affiliation(s)
- Melissa A Wright
- Division of Pediatric Neurology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
| | - Mar Guasp
- Service of Neurology, Hospital Clínic, University of Barcelona, Spain; Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Christian Lachner
- Division of Psychiatry, Mayo Clinic, Jacksonville, FL, USA; Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic, Jacksonville, FL, USA
| | - Grace Gombolay
- Emory University School of Medicine, Children's Healthcare of Atlanta, Department of Pediatrics, Division of Neurology, Atlanta, GA, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, USA; George E. Wahlen Veterans Affairs Health Care System, Salt Lake City, UT, USA
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29
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McCarter SK, Shen KR, Wylam ME. Occult Lung Cancer-Associated Autoimmune Encephalitis Presenting as Acute Psychosis. Mil Med 2024; 189:e1813-e1818. [PMID: 38554268 DOI: 10.1093/milmed/usae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/12/2024] [Accepted: 03/05/2024] [Indexed: 04/01/2024] Open
Abstract
During deployment, a 52-year-old male developed acute behavioral changes. Though initially considered to have PTSD and related agitation and confusional state, his evaluation was consistent with acute encephalopathy. Magnetic resonance imaging of the brain showed T2 hyperintensities, and CSF analysis was positive for anti-N-methyl-D-aspartate receptor antibody. A nuclear protein in testis carcinoma midline carcinoma was discovered in the lung. Immunotherapy and surgical resection led to steady improvement prior to adjuvant chemotherapy. Autoimmune encephalitis due to anti-N-methyl-D-aspartate receptor antibodies is increasingly being recognized as causal of acute behavioral change.
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Affiliation(s)
- Shelly K McCarter
- Department of Surgical Services, Naval Hospital Pensacola, Pensacola, FL 32412, USA
| | - K Robert Shen
- Division of Thoracic Surgery, Department of Surgery, May Mayo Clinic Alix College of Medicine, Rochester, MN 55905, USA
| | - Mark E Wylam
- Division of Pulmonary and Critical Care, Department of Medicine, Mayo Clinic Alix College of Medicine, Rochester, MN 55905, USA
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30
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Santoro JD, Demakakos P, He S, Kumar S, Murton M, Tennigkeit F, Hemingway C. A systematic review of the epidemiology of pediatric autoimmune encephalitis: disease burden and clinical decision-making. Front Neurol 2024; 15:1408606. [PMID: 39040538 PMCID: PMC11262030 DOI: 10.3389/fneur.2024.1408606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/19/2024] [Indexed: 07/24/2024] Open
Abstract
Background Autoimmune encephalitis (AIE) comprises a group of rare, immune system-mediated conditions. Clinical manifestations among children are not well-characterized, and there are challenges in testing and diagnosis. This can result in treatment delays, which has been found to correlate with poorer long-term outcomes. This challenge is exacerbated by the scarcity of epidemiological reporting of AIE. The objective of this systematic literature review (SLR) was to identify studies reporting epidemiological data on AIE in children. Methods MEDLINE, Embase, the Cochrane Library, and the University of York Centre for Reviews and Dissemination (CRD) were searched in May 2023 for studies reporting on the epidemiology of AIE in children. These were supplemented with additional searches of conference proceedings, gray literature, and the reference lists of identified SLRs. Quality of studies was assessed using a modified version of the Joanna Briggs Institute (JBI) Checklist for Prevalence Studies. Results Forty-three publications reporting on 41 unique studies were included. Nine studies reported incidence estimates of different subtypes of AIE, with only one reporting the incidence of overall AIE in children ≤ 18 years, estimated at 1.54 per million children per year in the Netherlands. Three studies reported the incidence of pediatric N-methyl-D-aspartate receptor (NMDAR)-AIE [in United Kingdom (UK), Hong Kong, and Denmark]. The other studies reported incidence data for selected populations. Conclusion This SLR highlights a paucity of epidemiology data for AIE in children, which is likely reflective of difficulties in testing and diagnosis. There is a clear need for further research and awareness of these challenges in clinical practice to avoid treatment delays and improve patient outcomes. A deeper understanding of the epidemiology of AIE will help determine the worldwide burden of disease and inform research, health policies and clinical decision-making.
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Affiliation(s)
- Jonathan D. Santoro
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, United States
| | | | - Shiying He
- Costello Medical Singapore Ltd., Singapore, Singapore
| | - Swati Kumar
- Costello Medical Consulting Ltd., Cambridge, United Kingdom
| | - Molly Murton
- Costello Medical Consulting Ltd., Cambridge, United Kingdom
| | | | - Cheryl Hemingway
- Department of Neurology, Great Ormond Street Hospital for Children, London, United Kingdom
- UCL Queen Square Institute of Neurology, London, United Kingdom
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Gangadin SS, Enthoven AD, van Beveren NJM, Laman JD, Sommer IEC. Immune Dysfunction in Schizophrenia Spectrum Disorders. Annu Rev Clin Psychol 2024; 20:229-257. [PMID: 38996077 DOI: 10.1146/annurev-clinpsy-081122-013201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2024]
Abstract
Evidence from epidemiological, clinical, and biological research resulted in the immune hypothesis: the hypothesis that immune system dysfunction is involved in the pathophysiology of schizophrenia spectrum disorders (SSD). The promising implication of this hypothesis is the potential to use existing immunomodulatory treatment for innovative interventions for SSD. Here, we provide a selective historical review of important discoveries that have shaped our understanding of immune dysfunction in SSD. We first explain the basic principles of immune dysfunction, after which we travel more than a century back in time. Starting our journey with neurosyphilis-associated psychosis in the nineteenth century, we continue by evaluating the role of infections and autoimmunity in SSD and findings from assessment of immune function using new techniques, such as cytokine levels, microglia density, neuroimaging, and gene expression. Drawing from these findings, we discuss anti-inflammatory interventions for SSD, and we conclude with a look into the future.
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Affiliation(s)
- S S Gangadin
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | - A D Enthoven
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
| | - N J M van Beveren
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Parnassia Group for Mental Health Care, The Hague and Rotterdam, The Netherlands
| | - J D Laman
- Department of Pathology and Medical Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - I E C Sommer
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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Alsalek S, Schwarzmann KB, Budhathoki S, Hernandez-Lopez V, Smith JB, Li BH, Langer-Gould A. Racial and Ethnic Disparities in the Incidence of Anti-NMDA Receptor Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200255. [PMID: 38728608 PMCID: PMC11089538 DOI: 10.1212/nxi.0000000000200255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/14/2024] [Indexed: 05/12/2024]
Abstract
OBJECTIVES To estimate the incidence of anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis. METHODS We conducted a retrospective cohort study of >10 million person-years of observation from members of Kaiser Permanente Southern California, 2011-2022. The electronic health record of individuals with text-string mention of NMDA and encephalitis were reviewed to identify persons who met diagnostic criteria for anti-NMDAR encephalitis. Age-standardized and sex-standardized incidences stratified by race and ethnicity were estimated according to the 2020 US Census population. RESULTS We identified 70 patients who met diagnostic criteria for anti-NMDAR encephalitis. The median age at onset was 23.7 years (IQR = 14.2-31.0 years), and 45 (64%) were female patients. The age-standardized and sex-standardized incidence of anti-NMDAR encephalitis per 1 million person-years was significantly higher in Black (2.94, 95% CI 1.27-4.61), Hispanic (2.17, 95% CI 1.51-2.83), and Asian/Pacific Island persons (2.02, 95% CI 0.77-3.28) compared with White persons (0.40, 95% CI 0.08-0.72). Ovarian teratomas were found in 58.3% of Black female individuals and 10%-28.6% in other groups. DISCUSSION Anti-NMDA receptor encephalitis disproportionately affected Black, Hispanic, or Asian/Pacific Island persons. Ovarian teratomas were a particularly common trigger in Black female individuals. Future research should seek to identify environmental and biological risk factors that disproportionately affect minoritized individuals residing in the United States.
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Affiliation(s)
- Samir Alsalek
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Kathryn B Schwarzmann
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Sakar Budhathoki
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Viridiana Hernandez-Lopez
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Jessica B Smith
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Bonnie H Li
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Annette Langer-Gould
- From the Kaiser Permanente Bernard J. Tyson School of Medicine (S.A., K.B.S., S.B., V.H.-L.); Department of Research and Evaluation (J.B.S., B.H.L.); Department of Neurology (A.L.-G.), Los Angeles Medical Center, Southern California Permanente Medical Group; and Department of Clinical Science (A.L.-G.), Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
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Ali M, Naveed H, Sheikh AUR, Ahmad M. Neuropsychiatric manifestations of anti-N-methyl-D-aspartate receptor encephalitis in a 14-year-old female: A case report. Clin Case Rep 2024; 12:e9185. [PMID: 39021485 PMCID: PMC11252013 DOI: 10.1002/ccr3.9185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/22/2024] [Accepted: 07/09/2024] [Indexed: 07/20/2024] Open
Abstract
Key Clinical Message This case underscores the critical importance of timely recognition and management of NMDAR encephalitis in adolescents to mitigate potential long-term sequelae. If a pediatric patient presents with suspected viral encephalitis, autoimmune etiology must be excluded via cerebrospinal fluid antibody assay to guide appropriate immunosuppressive therapy, and improve patient outcomes. Abstract Autoimmune encephalitis particularly involving the n-methyl-d-aspartate receptor (NMDAR) is recognized as a rare cause of acute encephalopathy in pediatric patients. The following case is of a 14-year-old female diagnosed with anti-NMDAR encephalitis who initially presented with fever, episodic convulsions, and loss of consciousness. She subsequently developed right-sided body weakness, expressive aphasia, and visual hallucinations. Clinical examination revealed prominent neuropsychiatric manifestations such as altered sensorium, motor deficits, hallucinations, and visual disturbances. Cerebello-bulbar signs were not appreciable in this particular case. She was treated for viral encephalitis but showed no improvement. Laboratory investigations revealed the presence of NMDAR antibodies in the cerebrospinal fluid confirming the diagnosis of autoimmune etiology. The patient demonstrated notable improvement following immunosuppressive treatment.
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Affiliation(s)
- Masab Ali
- Department of MedicinePunjab Medical CollegeFaisalabadPakistan
| | - Haris Naveed
- Department of MedicinePunjab Medical CollegeFaisalabadPakistan
| | | | - Muhammad Husnain Ahmad
- Department of MedicineTentishev Satkynbai Memorial Asian Medical InstituteKantKyrgyzstan
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Khachatryan A, Tamazyan V, Sargsyan M, Harutyunyan H, Alejandro J, Batikyan A. Anti-N-Methyl-D-Aspartate Receptor Encephalitis and Life-Threatening Sinus Node Dysfunction: A Case Report, Literature Review, and Analysis of 23 Cases. Cureus 2024; 16:e64472. [PMID: 39135820 PMCID: PMC11318722 DOI: 10.7759/cureus.64472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most common form of autoimmune encephalitis, presenting with various psychiatric manifestations, including behavioral and cognitive impairments, movement disorders, decreased consciousness, dysphasia, seizures, and autonomic dysfunction. Autonomic dysfunction may involve hyperthermia, apnea, hypotension, tachycardia, and life-threatening manifestations of sinus node dysfunction (SND), such as bradycardia, sinus pause or arrest, and asystole. The severity and significance of SND are critical, as it is not uncommon for these patients to progress into asystolic cardiac arrest, potentially contributing to morbidity and mortality. Accordingly, we present the case of an 18-year-old female with anti-NMDAR encephalitis who experienced multiple episodes of sinus pause/arrest and asystolic cardiac arrest, achieving a return of spontaneous circulation after successful CPR in all instances, ultimately requiring permanent pacemaker implantation. Additionally, we performed a literature review and analyzed 23 similar anti-NMDAR encephalitis cases with SND manifestations, including sinus pause/arrest or asystolic cardiac arrest, to identify common risk factors and describe management strategies and outcomes. Moreover, we investigated the potential association between teratoma and permanent pacemaker use in SND.
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Affiliation(s)
- Aleksan Khachatryan
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, USA
| | - Vahagn Tamazyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
| | | | - Hakob Harutyunyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
| | - Joel Alejandro
- Department of Internal Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, USA
| | - Ashot Batikyan
- Department of Internal Medicine, North Central Bronx Hospital, New York, USA
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Lenka A, Perera VM, Espay AJ, Pontone GM, Okun MS. Gaps and Controversies in Catatonia as a Movement Disorder. Mov Disord 2024. [PMID: 38924566 DOI: 10.1002/mds.29906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
The term "catatonia" was introduced by German psychiatrist Karl Kahlbaum in 1874. Although historically tied to schizophrenia, catatonia exhibits a diverse range of phenotypes and has been observed in various medical and neuropsychiatric conditions. Its intrinsic movement characteristics and association with hypokinetic and hyperkinetic phenomenologies place catatonia within the purview of movement disorders. Despite the presence of catatonia in psychiatry literature for over 150 years, many gaps and controversies persist regarding its etiopathogenesis, phenomenology, diagnostic criteria, and treatment. The current versions of the International Classification of Diseases (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) require clinicians to identify any three signs of 15 (ICD-11) or 12 (DSM-5) for the diagnosis of catatonia. Catalepsy and waxy flexibility are the only motor features with high specificity for the diagnosis. We highlight the gaps and controversies in catatonia as a movement disorder, emphasize the lack of a clear definition, and discuss the inconsistencies in the description of various catatonic signs. We propose the exploration of a bi-axial classification framework similar to that used for dystonia and tremor to encourage the evaluation of underlying etiologies and to guide therapeutic decisions to improve the outcome of these patients. © 2024 International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Abhishek Lenka
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - Vishal M Perera
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Alberto J Espay
- Department of Neurology, James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, University of Cincinnati, Cincinnati, Ohio, USA
| | - Gregory M Pontone
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
| | - Michael S Okun
- Department of Neurology, Norman Fixel Institute for Neurological Diseases, University of Florida, Gainesville, Florida, USA
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Fujimoto G, Deguchi T, Shirai J, Saito K. Coexisting Sacrococcygeal Teratoma With Mild Encephalitis/Encephalopathy With a Reversible Splenial Lesion: A Case Report. Cureus 2024; 16:e62574. [PMID: 39027779 PMCID: PMC11255537 DOI: 10.7759/cureus.62574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare disease characterized by a reversible lesion in the splenium of the corpus callosum (SCC) observed on MRI. The exact etiology of MERS is unknown, although infections and antiepileptic drugs have been reported as potential causes. Herein, we present the case of a 56-year-old male patient who experienced fever and headache for 3 days. He was referred to our hospital after symptomatic treatment by his primary care physician failed to improve his symptoms. The patient had no psychiatric symptoms or significant neurological findings. Head MRI revealed a high signal on SCC on diffusion-weighted imaging, raising the suspicion of MERS. All examinations to determine the cause of MERS were negative. The patient's symptoms improved with antibiotics and B complex vitamins. Upon admission, abdominal CT incidentally revealed a well-defined mass on the dorsal surface of the rectum suspected to be a tailgut cyst, warranting surgical resection. The cranial margin of the tumor was caudal to the third sacrum, and a trans-sacral approach was used for resection. The fifth sacrum and the coccyx were resected, and the tumor was resected without damaging the rectum. A histopathological examination revealed a mature teratoma without any malignancy. A follow-up CT at four months postoperatively showed no evidence of clinical recurrence of MERS. Adult-onset MERS is relatively rare, and no association with tumors has been reported. The association between encephalitis and teratomas includes ovarian teratomas, which cause anti-N-methyl-D-aspartate receptor encephalitis and paraneoplastic limbic encephalitis. Although the cause of MERS was unknown in this case, we report the coexistence of a sacral teratoma and MERS to contribute to the knowledge of the association between them.
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Affiliation(s)
- Goshi Fujimoto
- Gastroenterological Surgery, Koga Community Hospital, Yaizu, JPN
| | - Takashi Deguchi
- Gastroenterological Surgery, Koga Community Hospital, Yaizu, JPN
| | - Junya Shirai
- Gastroenterological Surgery, Koga Community Hospital, Yaizu, JPN
| | - Kentaro Saito
- Gastroenterological Surgery, Koga Community Hospital, Yaizu, JPN
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Bateman JR, Josephy-Hernandez S, Apostolova LG, Benjamin S, Barrett AM, Boeve BF, Budson AE, Chemali Z, Lin CYR, Daffner KR, Geschwind MD, Heilman KM, Hillis AE, Holden SK, Jaffee MS, Kletenik I, Love MN, Moo LR, Pelak VS, Press DZ, Ramirez-Gomez L, Rosen HJ, Schmahmann JD, Vaishnavi SN, Windon CC, Hamilton RH, Perez DL. Promoting Growth in Behavioral Neurology: A Path Forward. Cogn Behav Neurol 2024; 37:49-56. [PMID: 38717325 DOI: 10.1097/wnn.0000000000000368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 06/04/2024]
Abstract
Behavioral neurology & neuropsychiatry (BNNP) is a field that seeks to understand brain-behavior relationships, including fundamental brain organization principles and the many ways that brain structures and connectivity can be disrupted, leading to abnormalities of behavior, cognition, emotion, perception, and social cognition. In North America, BNNP has existed as an integrated subspecialty through the United Council for Neurologic Subspecialties since 2006. Nonetheless, the number of behavioral neurologists across academic medical centers and community settings is not keeping pace with increasing clinical and research demand. In this commentary, we provide a brief history of BNNP followed by an outline of the current challenges and opportunities for BNNP from the behavioral neurologist's perspective across clinical, research, and educational spheres. We provide a practical guide for promoting BNNP and addressing the shortage of behavioral neurologists to facilitate the continued growth and development of the subspecialty. We also urge a greater commitment to recruit trainees from diverse backgrounds so as to dismantle persistent obstacles that hinder inclusivity in BNNP-efforts that will further enhance the growth and impact of the subspecialty. With rapidly expanding diagnostic and therapeutic approaches across a range of conditions at the intersection of neurology and psychiatry, BNNP is well positioned to attract new trainees and expand its reach across clinical, research, and educational activities.
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Affiliation(s)
- James R Bateman
- Departments of Neurology, Psychiatry and Behavioral Medicine, and Internal Medicine Section on Geriatrics and Gerontology, Wake Forest University School of Medicine, Winston-Salem, North Carolina
- Mental Illness Research, Education, and Clinical Center, Salisbury VA Medical Center, Salisbury, North Carolina
| | - Sylvia Josephy-Hernandez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Mexico Hospital, Costa Rican Social Security, San José, Costa Rica
| | - Liana G Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Sheldon Benjamin
- Departments of Neurology
- Psychiatry, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - A M Barrett
- Departments of Neurology
- Neurology Service Line, Veterans Affairs Medical Center, Central Western Massachusetts Worcester, Massachusetts
| | | | - Andrew E Budson
- Center for Translational Cognitive Neuroscience, Veterans Affairs Boston Healthcare System, Boston, Massachusetts
- Alzheimer's Disease Research Center, Boston University, Boston, Massachusetts
| | - Zeina Chemali
- McCance Center for Brain Health, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chi-Ying R Lin
- Department of Neurology, Baylor College of Medicine, Houston, Texas
| | - Kirk R Daffner
- Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Michael D Geschwind
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Kenneth M Heilman
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Argye E Hillis
- Department of Neurology, Johns Hopkins, Baltimore, Maryland
| | - Samantha K Holden
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
| | - Michael S Jaffee
- Department of Neurology, University of Florida, Gainesville, Florida
| | - Isaiah Kletenik
- Center for Brain Circuit Therapeutics, Division of Cognitive and Behavioral Neurology, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Lauren R Moo
- Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- New England Geriatric Research Education and Clinical Center, Bedford, Massachusetts
| | - Victoria S Pelak
- Department of Neurology, University of Colorado School of Medicine, Aurora, Colorado
- Department of Ophthalmology, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel Z Press
- Division of Cognitive Neurology, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Liliana Ramirez-Gomez
- Division of Memory Disorders, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Howie J Rosen
- Memory and Aging Center, Weill Institute for Neurosciences, Department of Neurology, University of California San Francisco, San Francisco, California
| | - Jeremy D Schmahmann
- Ataxia Center, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sanjeev N Vaishnavi
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Charles C Windon
- Department of Neurology, University of California San Francisco, San Francisco, California
| | - Roy H Hamilton
- Department of Neurology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - David L Perez
- Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Warren N, McKeon G, Scott JG. Replacing universal anti-neuronal antibody screening with clinical assessment and testing of high probability cases in psychotic disorders. Aust N Z J Psychiatry 2024; 58:453-456. [PMID: 38679857 DOI: 10.1177/00048674241249575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Affiliation(s)
- Nicola Warren
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health, Brisbane, QLD, Australia
| | - Gemma McKeon
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD, Australia
- West Moreton Health Psychology, The Park Centre for Mental Health, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - James G Scott
- Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Brisbane, QLD, Australia
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Child and Youth Mental Health Service, Children's Health Queensland, Brisbane, QLD, Australia
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Yang Y, Fu S, Jiang G, Xu G, Tian J, Ma X. Functional connectivity changes of the hippocampal subregions in anti-N-methyl-D-aspartate receptor encephalitis. Brain Imaging Behav 2024; 18:686-697. [PMID: 38363500 DOI: 10.1007/s11682-024-00852-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/17/2024]
Abstract
The hippocampus plays an important role in the pathophysiological mechanism of Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. Nevertheless, the connection between the resting-state activity of the hippocampal subregions and neuropsychiatric disorders in patients remains unclear. This study aimed to explore the changes in functional connectivity (FC) in the hippocampal subregions of patients with anti-NMDAR encephalitis and its association with clinical symptoms and cognitive performance. Twenty-three patients with anti-NMDAR encephalitis and 23 healthy controls (HC) were recruited. All participants underwent resting-state functional magnetic resonance imaging (rs-fMRI) scans and completed clinical cognitive scales. Based on the Brainnetome Atlas, the rostral (anterior) and caudal (posterior) hippocampi of both the left and right hemispheres were selected as regions of interest (ROIs) for FC analysis. First, a one-sample t-test was used to observe the whole-brain connectivity distribution of hippocampal subregions within the patient and HC groups at a threshold of p < 0.05. The two-sample t-test was used to compare the differences in hippocampal ROIs connectivity between groups, followed by a partial correlation analysis between the FC values of brain regions with statistical differences and clinical variables. This study observed that the distribution of whole-brain functional connectivity in the rostral and caudal hippocampi aligned with the connectivity differences between the anterior and posterior hippocampi. Compared to the HC group, the patients showed significantly decreased FC between the bilateral rostral hippocampus and the left inferior orbitofrontal gyrus and between the right rostral hippocampus and the right cerebellum. However, a significant increase in FC was observed between the right rostral hippocampus and left superior temporal gyrus, the left caudal hippocampus and right superior frontal gyrus, and the right caudal hippocampus and left gyrus rectus. Partial correlation analysis showed that FC between the left inferior orbitofrontal gyrus and the right rostral hippocampus was significantly negatively correlated with the California Verbal Learning Test (CVLT) and Brief Visuospatial Memory Test (BVMT) scores. The FC between the right rostral hippocampus and the left superior temporal gyrus was negatively correlated with BVMT scores. FC abnormalities in the hippocampal subregions of patients with anti-NMDAR encephalitis were associated with cognitive impairment, emotional changes, and seizures. These results may help explain the pathophysiological mechanisms and clinical manifestations of anti-NMDAR encephalitis and NMDAR dysfunction-related diseases such as schizophrenia.
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Affiliation(s)
- Yujie Yang
- The Second School of Clinical Medicine, Southern Medial University, Guangzhou City, Guangdong province, PR China
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Shishun Fu
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Guihua Jiang
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Guang Xu
- Department of Neurology, Guangdong Second Provincial General Hospital, No.466 Road Xingang, Guangzhou, 510317, P. R. China
| | - Junzhang Tian
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China.
| | - Xiaofen Ma
- Department of Nuclear Medicine, Guangdong Second Provincial General Hospital, No. 466 Road Xingang, Guangzhou, 510317, P. R. China.
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Kong L, Yang X, Sun A, Yang X, Zhao X, Wang S. Rapamycin alleviates mitochondrial dysfunction in anti-NMDAR encephalitis mice. Int Immunopharmacol 2024; 132:111910. [PMID: 38552295 DOI: 10.1016/j.intimp.2024.111910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/07/2024] [Accepted: 03/19/2024] [Indexed: 05/01/2024]
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is one of the most prevalent forms of autoimmune encephalitis, characterized by a series of neurological and psychiatric symptoms, including cognitive impairment, seizures and psychosis. The underlying mechanism of anti-NMDAR encephalitis remains unclear. In the current study, the mouse model of anti-NMDAR encephalitis with active immunization was performed. We first uncovered excessive mitochondrial fission in the hippocampus and temporal cortex of anti-NMDAR encephalitis mice, indicated by elevated level of Phospho-DRP1 (Ser616) (p-Drp1-S616). Moreover, blockade of the autophagic flux was also demonstrated, leading to the accumulation of fragmented mitochondria, and elevated levels of mitochondrial reactive oxygen species (mtROS) and mitochondrial DNA (mtDNA) in anti-NMDAR encephalitis. More importantly, we found that the mTOR signaling pathway was overactivated, which could aggravate mitochondrial fission and inhibit autophagy, resulting in mitochondrial dysfunction. While rapamycin, the specific inhibitor of the mTOR signaling pathway, significantly alleviated mitochondrial dysfunction by inhibiting mitochondrial fission and enhancing autophagy. Levels of mtROS and mtDNA were markedly reduced after the treatment of rapamycin. In addition, rapamycin also significantly alleviated cognitive dysfunction and anxious behaviors found in anti-NMDAR encephalitis mice. Thus, our study reveals the vital role of mitochondrial dysfunction in pathological mechanism of anti-NMDAR encephalitis and lays a theoretical foundation for rapamycin to become a clinically targeted drug for anti-NMDAR encephalitis.
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Affiliation(s)
- Liangbo Kong
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Xiaxin Yang
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Anqi Sun
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Xue Yang
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China
| | - Xiuhe Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China.
| | - Shengjun Wang
- Department of Neurology, Qilu Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong, China.
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Su Y, Wang Z, Li Y, Wang M. The potential role of tACS in improving cognitive dysfunction associated with anti-NMDAR encephalitis. Asian J Psychiatr 2024; 95:104001. [PMID: 38518536 DOI: 10.1016/j.ajp.2024.104001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024]
Affiliation(s)
- Yang Su
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Zhiyin Wang
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yi Li
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China; Department of Neurology, West China Hospital of Sichuan University, China.
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Ramirez-Bermudez J, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Lopez-Hernandez JC, Hernandez-Vanegas LE, Martinez-Carrillo F, Ruiz-Garcia R, Rivas-Alonso V, Flores-Rivera J, Pollak TA. Examining the Features of Neuroleptic Malignant Syndrome in Anti-NMDA Receptor Encephalitis: A Case-Control Study. J Acad Consult Liaison Psychiatry 2024; 65:222-230. [PMID: 38151160 DOI: 10.1016/j.jaclp.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Anti-N-methyl-D-aspartate receptor encephalitis (ANMDARE) is a neuroimmunological disorder that frequently improves with immunotherapy. Symptomatic treatment with antipsychotics is common in the early stages when psychiatric symptoms predominate, and their use has been associated with serious side effects including neuroleptic malignant syndrome (NMS). The observation of an adverse response to antipsychotics, raising the suspicion of NMS, has been included as a criterion for possible autoimmune psychosis. METHODS This case-control study included patients who received antipsychotics before referral to the National Institute of Neurology and Neurosurgery of Mexico, where they were diagnosed as having definite ANMDARE, and patients with ANMDARE who did not receive antipsychotics before referral. The neurologic and systemic features that are used to measure an adverse response to antipsychotics, raising the suspicion of NMS, were measured in both groups, including akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, and hyperthermia. A logistic regression analysis was used to determine the relationship between the previous use of antipsychotics and the occurrence of NMS-like reactions. RESULTS A total sample of 112 patients with definite ANMDARE were included in the study. Fifty patients received antipsychotics before being referred to our institution. In this group, thirty-six patients (72%) were initially classified as having an adverse response, raising the suspicion of NMS, with the following features: akinesia (64%), autonomic instability (58%), generalized rigidity (52%), elevated concentrations of creatine phosphokinase (50%), and hyperthermia (14%). Six patients fulfilled the criteria for NMS (12%). The comparison with patients who did not receive antipsychotics before the clinical assessment did not show a significant difference between groups regarding the frequency of akinesia, autonomic instability, generalized rigidity, elevated concentrations of creatine phosphokinase, or hyperthermia. Among different antipsychotics, only haloperidol was significantly associated with generalized rigidity as compared to patients who did not receive antipsychotics. CONCLUSIONS Our study supports previous observations about the high frequency of autonomic dysfunction, hyperthermia, tachycardia, rigidity, and elevated creatine phosphokinase levels in patients with anti-NMDAR encephalitis following the administration of antipsychotic medications. Nevertheless, our study does not suggest a causal link between atypical antipsychotics and the onset of these neurological symptoms, as they were equally frequent among the group of patients who did not receive antipsychotic treatment.
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Affiliation(s)
- Jesus Ramirez-Bermudez
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico.
| | - Miguel Restrepo-Martinez
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Mariana Espinola-Nadurille
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Victoria Martinez-Angeles
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Juan Carlos Lopez-Hernandez
- Department of Neurological Emergencies, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Laura E Hernandez-Vanegas
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Francisco Martinez-Carrillo
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Ramiro Ruiz-Garcia
- Departments of Neuropsychiatry, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Veronica Rivas-Alonso
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Jose Flores-Rivera
- Department of Clinical Neurology, National Institute of Neurology and Neurosurgery of Mexico, Mexico City, Mexico
| | - Thomas A Pollak
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London
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Kang MJY, Eratne D, Wannan C, Santillo AF, Velakoulis D, Pantelis C, Cropley V. Plasma neurofilament light chain is not elevated in people with first-episode psychosis or those at ultra-high risk for psychosis. Schizophr Res 2024; 267:269-272. [PMID: 38581830 DOI: 10.1016/j.schres.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 02/02/2024] [Accepted: 04/01/2024] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Neurofilament light chain (NfL), a blood biomarker of neuronal injury, shows promise in distinguishing neurodegenerative disorders from psychiatric conditions. This is especially relevant in psychosis, given neurological conditions such as autoimmune encephalitis and Niemann Pick Type C disease (NPC) may initially present with psychotic symptoms. Whilst NfL levels have been studied in established schizophrenia cases, their levels in first-episode psychosis (FEP) and ultra-high risk (UHR) for psychosis individuals remain largely unexplored. This study aimed to compare plasma NfL in people with FEP or UHR with healthy controls, as well as explore its associations with clinical data. METHOD We retrospectively analysed plasma NfL in 63 participants, consisting of 29 individuals with FEP, 10 individuals with UHR, and 24 healthy controls. We used general linear models (GLM), which were bootstrapped, to compute bias-corrected and accelerated (BCa) 95 % confidence intervals (CIs). RESULTS Mean NfL levels were 5.2 pg/mL in FEP, 4.9 pg/mL in UHR, and 5.9 pg/mL in healthy controls. Compared to healthy controls, there were no significant differences in NfL levels in the FEP group (β = -0.22, 95 % CI [-0.86, 0.39], p = 0.516) nor UHR group (β = -0.37, 95 % CI [-0.90, 0.19], p = 0.182). There were no significant associations between NfL levels and clinical variables in the FEP group. DISCUSSION Our study is the first to demonstrate that plasma NfL levels are not significantly elevated in individuals at UHR for psychosis compared to healthy controls, a finding also observed in the FEP cohort. These findings bolster the potential diagnostic utility of NfL in differentiating between psychiatric and neurodegenerative disorders.
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Affiliation(s)
- Matthew J Y Kang
- Neuropsychiatry Centre, Royal Melbourne Hospital, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Dhamidhu Eratne
- Neuropsychiatry Centre, Royal Melbourne Hospital, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Cassandra Wannan
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
| | | | - Dennis Velakoulis
- Neuropsychiatry Centre, Royal Melbourne Hospital, Australia; Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia.
| | - Vanessa Cropley
- Melbourne Neuropsychiatry Centre & Department of Psychiatry, University of Melbourne, Australia; Orygen, Parkville, Victoria, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
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Liu X, Zheng X, Shu Y, Qu X, Wang Q, Liu X, Hu FY, Liu J, Lian Y, He BM, Li C, Zhou D, Qiu W, Sun L, Hong Z. Genome-Wide Association Study Identifies IFIH1 and HLA-DQB1*05:02 Loci Associated With Anti-NMDAR Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200221. [PMID: 38579189 PMCID: PMC11010247 DOI: 10.1212/nxi.0000000000200221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND AND OBJECTIVES Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a rare autoimmune neurologic disorder, the genetic etiology of which remains poorly understood. Our study aims to investigate the genetic basis of this disease in the Chinese Han population. METHODS We performed a genome-wide association study and fine-mapping study within the major histocompatibility complex (MHC) region of 413 Chinese patients with anti-NMDAR encephalitis recruited from 6 large tertiary hospitals and 7,127 healthy controls. RESULTS Our genome-wide association analysis identified a strong association at the IFIH1 locus on chromosome 2q24.2 (rs3747517, p = 1.06 × 10-8, OR = 1.55, 95% CI, 1.34-1.80), outside of the human leukocyte antigen (HLA) region. Furthermore, through a fine-mapping study of the MHC region, we discovered associations for 3 specific HLA class I and II alleles. Notably, HLA-DQB1*05:02 (p = 1.43 × 10-12; OR, 2.10; 95% CI 1.70-2.59) demonstrates the strongest association among classical HLA alleles, closely followed by HLA-A*11:01 (p = 4.36 × 10-7; OR, 1.52; 95% CI 1.29-1.79) and HLA-A*02:07 (p = 1.28 × 10-8; OR, 1.87; 95% CI 1.50-2.31). In addition, we uncovered 2 main HLA amino acid variation associated with anti-NMDAR encephalitis including HLA-DQβ1-126H (p = 1.43 × 10-12; OR, 2.10; 95% CI 1.70-2.59), exhibiting a predisposing effect, and HLA-B-97R (p = 3.40 × 10-8; OR, 0.63; 95% CI 0.53-0.74), conferring a protective effect. Computational docking analysis suggested a close relationship between the NR1 subunit of NMDAR and DQB1*05:02. DISCUSSION Our findings indicate that genetic variation in IFIH1, involved in the type I interferon signaling pathway and innate immunity, along with variations in the HLA class I and class II genes, has substantial implications for the susceptibility to anti-NMDAR encephalitis in the Chinese Han population.
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Affiliation(s)
- Xu Liu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Xiaodong Zheng
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Yaqing Shu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Xiao Qu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Qun Wang
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Xiao Liu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Fa-Yun Hu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Jie Liu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Yajun Lian
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Bao-Ming He
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Caihua Li
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Dong Zhou
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Wei Qiu
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Liangdan Sun
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
| | - Zhen Hong
- From the Department of Neurology (X. Liu, F.-Y.H., D.Z., Z.H.), West China Hospital, Sichuan University, Chengdu; Department of Dermatology (X.Z., L.S.), the First Affiliated Hospital of Anhui Medical University; Key Laboratory of Dermatology (Anhui Medical University) (X.Z., L.S.), Ministry of Education; Anhui Province Laboratory of Inflammation and Immune Mediated Diseases (X.Z.); Anhui Provincial Institute of Translational Medicine (X.Z.), Hefei; Department of Neurology (Y.S., W.Q.), The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou; Genesky Biotechnologies Inc. (X.Q., C.L.), Shanghai; Department of Neurology (Q.W., X. Liu), Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (J.L., B.-M.H.), Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu; Department of Neurology (Y.L.), First Affiliated Hospital of Zhengzhou University; Institute of Brain Science and Brain-Inspired Technology of West China Hospital (D.Z.), Sichuan University, Chengdu; North China University of Science and Technology Affiliated Hospital (L.S.); Health Science Center (L.S.), North China University of Science and Technology; School of Public Health (L.S.), North China University of Science and Technology, Tangshan; Inflammation and Immune Diseases Laboratory of North China University of Science and Technology (L.S.); and Department of Neurology (Z.H.), Chengdu Shangjin Nanfu Hospital, China
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Li B, Shang X. A case of NMDAR Encephalitis with muscular pain as the main presentation. BMC Neurol 2024; 24:142. [PMID: 38678169 PMCID: PMC11055301 DOI: 10.1186/s12883-024-03652-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/24/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Persistent somatoform pain disorder (PSPD) is often the initial diagnosis in patients seeking treatment in psychiatric departments, making it challenging to consider organic nervous system diseases. However, autoimmune encephalitis can present with atypical initial symptoms, leading to misdiagnosis or missed diagnosis. Lumbar puncture, with antibody support, plays a crucial role in diagnosing autoimmune encephalitis. CASE PRESENTATION This report describes a 40-year-old male adult patient who was initially diagnosed with persistent somatoform pain disorder in 2022. The patient reported a reduction in pain while resting on his back. There were no fever or relevant medical history. Despite 8 months of symptomatic treatment, the symptoms did not improve. Moreover, the patient developed confusion, gibberish speech, non-cooperation during questioning, and increased frequency and amplitude of upper limb convulsions. Lumbar puncture revealed elevated protein levels and protein-cell dissociation. The autoimmune encephalitis antibody NMDAR (+) was detected, leading to a diagnosis of autoimmune encephalitis (NMDAR). CONCLUSION Autoimmune encephalitis (NMDAR), starting with persistent somatoform pain (PSPD), often presents with atypical symptoms and can be easily misdiagnosed. Therefore, it is important to consider the possibility of organic nervous system disease in time, and to test serum or cerebrospinal fluid antibodies to rule out organic nervous system disease after symptomatic treatment of mental disorders is ineffective. This approach facilitates the early diagnosis of autoimmune encephalitis and other underlying organic neurological disorders.
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Affiliation(s)
- Baizhu Li
- The First Affiliated Hospital of China Medical University: The First Hospital of China Medical University CHINA, Shenyang, China
| | - Xiuli Shang
- The First Affiliated Hospital of China Medical University: The First Hospital of China Medical University CHINA, Shenyang, China.
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Song X, Luo Z, Huang D, Lv J, Xiao L, Liang T, Zou K. Global study of anti-NMDA encephalitis: a bibliometric analysis from 2005 to 2023. Front Neurol 2024; 15:1387260. [PMID: 38711554 PMCID: PMC11070467 DOI: 10.3389/fneur.2024.1387260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/08/2024] [Indexed: 05/08/2024] Open
Abstract
Background Autoimmune diseases have always been one of the difficult diseases of clinical concern. Because of the diversity and complexity of its causative factors, unclear occurrence and development process and difficult treatment, it has become a key disease for researchers to study. And the disease explored in this paper, anti-NMDA encephalitis, belongs to a common type of autoimmune encephalitis. However, the quality of articles and research hotspots in this field are not yet known. Therefore, in this field, we completed a bibliometric and visualization analysis from 2005 to 2023 in order to understand the research hotspots and directions of development in this field. Materials and methods We searched the SCI-expanded databases using Web of Science's core databases on January 22, 2024 and used tools such as VOS viewer, Cite Space, and R software to visualize and analyze the authors, countries, journals, institutions, and keywords of the articles. Results A total of 1,161 literatures were retrieved and analyzed in this study. China was the country with the most total publications, and USA and Spain were the most influential countries in the field of anti-NMDA encephalitis. University of Pennsylvania from USA was the institution with the highest number of publications. While Dalmau Josep is the most prolific, influential and contributing author who published one of the most cited articles in Lancet Neurology, which laid the foundation for anti-NMDA encephalitis research, the top three appearances of keyword analysis were: "antibodies", "diagnosis", and "autoimmune encephalitis." Conclusion Bibliometric analysis shows that the number of studies on anti-NMDA encephalitis is generally increasing year by year, and it is a hot disease pursued by researchers. USA and Spain are leading in the field of anti-NMDA encephalitis, while China should continue to improve the quality of its own research. The suspected causes of anti-NMDA encephalitis other than ovarian teratoma and herpes simplex, the specific clinical manifestations that are not masked by psychiatric symptoms, the diagnostic modalities that are faster and more accurate than antibody tests, and the improvement of treatment modalities by evaluating prognosis of various types of patients are the hotspots for future research.
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Affiliation(s)
- Xinyue Song
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Zixin Luo
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Duoqin Huang
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Jialian Lv
- Gannan Medical University, Ganzhou, Jiangxi, China
| | - Li Xiao
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
| | - Ting Liang
- Department of Critical Care Medicine, The Second People's Hospital of Nankang District, Ganzhou, Jiangxi, China
| | - Kang Zou
- Department of Critical Care Medicine, The First Affiliated Hospital of Gannan Medical University, Ganzhou, Jiangxi, China
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Guo X, Yu J, Quan C, Xiao J, Wang J, Zhang B, Hao X, Wu X, Liang J. The effect of N-methyl-D-aspartate receptor antagonists on the mismatch negativity of event-related potentials and its regulatory factors: A systematic review and meta-analysis. J Psychiatr Res 2024; 172:210-220. [PMID: 38402843 DOI: 10.1016/j.jpsychires.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/27/2024]
Abstract
This study investigates the influence of N-methyl-D-aspartate receptor (NMDAR) antagonists on the mismatch negativity (MMN) components of event-related potentials (ERPs) in healthy subjects and explores whether NMDAR antagonists have different effects on MMN components under different types of antagonists, drug dosages, and deviant stimuli. We conducted a comprehensive literature search of PubMed, EMBASE, and the Cochrane Library from inception to August 1, 2023 for studies comparing the MMN components between the NMDAR antagonist intervention group and the control group (or baseline). All statistical analyses were performed using Stata version 12.0 software. Sixteen articles were included in the systematic review: 13 articles were included in the meta-analysis of MMN amplitudes, and seven articles were included in the meta-analysis of MMN latencies. The pooled analysis showed that NMDAR antagonists reduced MMN amplitudes [SMD (95% CI) = 0.32 (0.16, 0.47), P < 0.01, I2 = 47.3%, p < 0.01] and prolonged MMN latencies [SMD (95% CI) = 0.31 (0.13, 0.49), P = 0.16, I2 = 28.3%, p < 0.01]. The type of antagonist drug regulates the effect of NMDAR antagonists on MMN amplitudes. Different antagonists, doses of antagonists, and types of deviant stimuli can also have different effects on MMN. These findings indicate a correlation between NMDAR and MMN, which may provide a foundation for the application of ERP-MMN in the early identification of NMDAR encephalitis.
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Affiliation(s)
- Xin Guo
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Jieyang Yu
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Chunhua Quan
- Central Laboratory, The Affiliated Hospital of Yanbian University, Juzi-St., No.1327, Yanji, 133000, China.
| | - Jinyu Xiao
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Jiangtao Wang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Bo Zhang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Xiaosheng Hao
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Xuemei Wu
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
| | - Jianmin Liang
- Department of Pediatric Neurology, The First Hospital of Jilin University, Changchun, 130021, China; Jilin Provincial Key Laboratory of Pediatric Neurology, Changchun, 130021, China.
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Ghorbani A, Munoz NR, Ahmed S, Yasin S, Ho S, Ghorbani A, Zamiri K. Anti-N-Methyl-D-Aspartate Receptor Encephalopathy in a Young Female. Cureus 2024; 16:e57971. [PMID: 38738105 PMCID: PMC11086659 DOI: 10.7759/cureus.57971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2024] [Indexed: 05/14/2024] Open
Abstract
Widely distributed in the central nervous system (CNS), N-methyl-D-aspartate receptors (NMDARs) are believed to be involved in long-term potentiation, essential in regulating and forming memory. This condition primarily occurs in young females because of autoantibodies forming against the N-methyl-D-aspartate receptor-1 (NR1) or N-methyl-D-aspartate receptor-2 (NR2) subunits of NMDAR in the CNS, ultimately portraying a unique psychoneurological phenomenon. Patients with antibodies against NMDAR present with a combination of neurological and psychiatric signs and symptoms. This article presents a case of a young female with no significant past medical, psychological, or surgical history. While being previously diagnosed with acute psychosis, upon arrival at the emergency department (ED), she also displayed an acute decline in judgment, hallucinations, severe agitation, and peculiar behavior, prompting family members to seek medical attention. Consequently, she was evaluated for metabolic and infectious encephalopathy. Following a thorough examination and extensive laboratory imaging, the patient was found to have NMDAR antibody encephalopathy. After dedicated treatment, her two-month follow-up presented a complete resolution of symptoms.
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Affiliation(s)
- Ali Ghorbani
- Internal Medicine, Southwest Healthcare, Temecula, USA
| | | | - Syed Ahmed
- Internal Medicine, Temecula Valley Hospital, Temecula, USA
| | - Salma Yasin
- Internal Medicine, Temecula Valley Hospital, Temecula, USA
| | - Sophia Ho
- Internal Medicine, Temecula Valley Hospital, Temecula, USA
| | - Aida Ghorbani
- Neurology, University of California, Los Angeles School of Medicine, Los Angeles, USA
| | - Kurosh Zamiri
- Biology, University of California, Los Angeles School of Medicine, Los Angeles, USA
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Zhang W, Ren C, Wu Y. Autoimmune Basal Ganglia Encephalitis Associated With Anti-N-methyl-d-Aspartate Receptor Antibodies in Children. Pediatr Neurol 2024; 153:65-67. [PMID: 38325023 DOI: 10.1016/j.pediatrneurol.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 05/18/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024]
Affiliation(s)
- Weihua Zhang
- Department of Neurology, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China.
| | - Changhong Ren
- Department of Neurology, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yun Wu
- Department of Neurology, National Centre for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
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Depreitere J, Antrop I, Verhelst H. Disease course and psychosocial outcome for children and adolescents with anti-N-methyl-D-aspartate receptor encephalitis. Clin Child Psychol Psychiatry 2024; 29:648-660. [PMID: 37915202 DOI: 10.1177/13591045231211963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Explore psychosocial outcome and impact of persisting deficits on quality of life (QoL) and global functioning after anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) in children and adolescents. METHODS Four female patients (age 7-16y) and their caregivers participated in the study. Information was collected from the medical records and the caregivers via a questionnaire. Both the patients and their caregivers were interviewed by means of the structured clinical interview for DSM-5 disorders, junior version (SCID-5 junior). CGAS and mRS scores were defined and the Pediatric Quality of Life Inventory (PedsQL) was used to assess quality of life of patients and caregivers. RESULTS AND CONCLUSION After the acute phase of the disease patients go through a post-acute phase in which several persisting physical, cognitive and psychiatric symptoms gradually resolve during the following months to a year. In long-term follow up these symptoms partly resolved, but deficits persisted on several domains. Psychiatric symptoms, fatigue and mild cognitive deficits were present in three out of four patients at current assessment. In three patients their academic trajectory was altered. These deficits can have an impact on the quality of life and the global functioning of the patients and caregivers.
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