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Abstract
Limbic encephalitis (LE) is a clinical syndrome defined by subacutely evolving limbic signs and symptoms with structural and functional evidence of mediotemporal damage in the absence of a better explanation than an autoimmune (or paraneoplastic) cause. There are features common to all forms of LE. In recent years, antibody(ab)-defined subtypes have been established. They are distinct regarding underlying pathophysiologic processes, clinical and magnetic resonance imaging courses, cerebrospinal fluid signatures, treatment responsivity, and likelihood of a chronic course. With immunotherapy, LE with abs against surface antigens has a better outcome than LE with abs to intracellular antigens. Diagnostic and treatment challenges are, on the one hand, to avoid overlooking and undertreatment and, on the other hand, to avoid overdiagnoses and overtreatment. LE can be conceptualized as a model disease for the consequences of new onset mediotemporal damage by different mechanisms in adult life. It may be studied as an example of mediotemporal epileptogenesis.
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Affiliation(s)
- Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Bielefeld, Germany; Laboratory Krone, Bad Salzuflen, Germany.
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2
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Liu X, Han Y, Yang L, Wang B, Shao S, Feng Y, Pang Z, Du Y, Lin Y. The exploration of the spectrum of motor manifestations of anti-LGI1 encephalitis beyond FBDS. Seizure 2020; 76:22-27. [PMID: 31972532 DOI: 10.1016/j.seizure.2019.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 01/14/2023] Open
Abstract
PURPOSE The purpose of this study was to characterize the spectrum of motor events in patients with acute anti-leucine-rich glioma-inactivated protein 1 (anti-LGI1) encephalitis through video-electroencephalogram (VEEG) recordings. METHOD We collected data retrospectively from 16 patients diagnosed with anti-LGI1 encephalitis who had completed VEEG recording during hospitalization. RESULTS VEEG monitoring lasted a median of 11.0 h (range 4.5∼20). Fourteen types of seizures were recorded in 9 patients (56.3 %). Eight of the 14 types of seizures demonstrated typical ictal EEG evolution (including 2 subclinical seizures), 3/14 demonstrated EEG electrodecremental events (EDE) at onset but without further evolution, and 3/14 could be only judged by analyzing semiology. FBDS was recorded in 6 patients (37.5 %), and all these attacks were followed by epileptic seizures. Simple hyperkinetic movements (HMs), such as jerk-like or twisting movements, were found in 8 (50 %) patients, and 6 of them had complex HMs, such as manipulating movements or mimics of daily activities, during sleep. CONCLUSIONS 1. Atypical seizures, for instance, seizures without EEG evolution, are not rare but likely to be overlooked. 2. FBDS is closely linked with epileptic seizures, revealing FBDS to be a part of epileptic attacks. 3. HMs could expand the spectrum of motor manifestations, overlapping with sleep disorders. 4. The high prevalence of these motor events might be due to the disrupted cortical-subcortical network, which is critical in motor control and sleep.
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Affiliation(s)
- Xiaoyun Liu
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Yuxiang Han
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Liling Yang
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Bao Wang
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China; Shandong Medical Imaging Research Institue, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Sai Shao
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China; Shandong Medical Imaging Research Institue, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Yabo Feng
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Zaiying Pang
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Yifeng Du
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China
| | - Youting Lin
- Shandong Provincial Hospital Affiliated to Shandong University, Department of Neurology, No 324, Jingwu Road, Huaiyin Zone, Jinan City, Shandong Province, 250012, PR China.
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Rahangdale R, Scott T, Leichliter T, Baser S, Valeriano J. A case of paroxysmal dystonia associated with LGI-1 antibody encephalitis. Clin Neurol Neurosurg 2019; 186:105508. [PMID: 31499420 DOI: 10.1016/j.clineuro.2019.105508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/13/2019] [Accepted: 09/01/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Rahul Rahangdale
- Department of Neurology, Allegheny General Hospital, Pittsburgh PA USA.
| | - Thomas Scott
- Department of Neurology, Allegheny General Hospital, Pittsburgh PA USA
| | | | - Susan Baser
- Department of Neurology, Allegheny General Hospital, Pittsburgh PA USA
| | - James Valeriano
- Department of Neurology, Allegheny General Hospital, Pittsburgh PA USA
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Abstract
PURPOSE OF REVIEW To describe the clinical, laboratory, and MRI features that characterize cognitive decline in the setting of central nervous system (CNS) autoimmunity, and provide an overview of current treatment modalities. RECENT FINDINGS The field of autoimmune neurology is rapidly expanding due to the increasing number of newly discovered autoantibodies directed against specific CNS targets. The clinical syndromes associated with these autoantibodies are heterogeneous but frequently share common, recognizable clinical, and MRI characteristics. While the detection of certain autoantibodies strongly suggest the presence of an underlying malignancy (onconeural autoantibodies), a large proportion of cases remain idiopathic. Cognitive decline and encephalopathy are common manifestations of CNS autoimmunity, and can mimic neurodegenerative disorders. Recent findings suggest that the frequency of autoimmune encephalitis in the population is higher than previously thought, and potentially rivals that of infectious encephalitis. Moreover, emerging clinical scenarios that may predispose to CNS autoimmunity are increasingly been recognized. These include autoimmune dementia/encephalitis post-herpes simplex virus encephalitis, post-transplant and in association with immune checkpoint inhibitor treatment of cancer. Early recognition of autoimmune cognitive impairment is important given the potential for reversibility and disability prevention with appropriate treatment. Autoimmune cognitive impairment is treatable and may arise in a number of different clinical settings, with important treatment implications. Several clinical and para-clinical clues may help to differentiate these disorders from dementia of other etiologies.
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Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA. .,Department Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Fan Z, Feng X, Fan Z, Zhu X, Yin S. Immunotherapy by targeting of VGKC complex for seizure control and prevention of cognitive impairment in a mouse model of epilepsy. Mol Med Rep 2018; 18:169-178. [PMID: 29749462 PMCID: PMC6059666 DOI: 10.3892/mmr.2018.9004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 04/16/2018] [Indexed: 11/13/2022] Open
Abstract
Epilepsy is a type of refractory neurologic disorder mental disease, which is associated with cognitive impairments and memory dysfunction. However, the potential mechanisms of epilepsy are not well understood. Previous evidence has identified the voltage gated potassium channel complex (VGKC) as a target in various cohorts of patients with epilepsy. In the present study, the efficacy of an antibody against VGKC (anti-VGKC) for the treatment of epilepsy in mice was investigated. A mouse model of lithium-pilocarpine temporal lobe epilepsy was established and anti-VGKC treatment was administered for 30 days. Memory impairment, anxiety, visual attention, inhibitory control and neuronal loss were measured in the mouse model of lithium-pilocarpine temporal lobe epilepsy. The results revealed that epileptic mice treated with anti-VGKC were able to learn the task and presented attention impairment, even a tendency toward impulsivity and compulsivity. It was also exhibited that anti-VGKC treatment decreased neuronal loss in structures classically associated with attentional performance in hippocampus. Mice who received Anti-VGKC treatment had inhibited motor seizures and hippocampal damage as compared with control mice. In conclusion, these results indicated that anti-VGKC treatment may present benefits for improvements of the condition of motor attention impairment and cognitive competence, which suggests that VGKC may be a potential target for the treatment of epilepsy.
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Affiliation(s)
- Zhiliang Fan
- The Third Department of Neurology, Xingtai People's Hospital of Hebei Province, Xingtai, Hebei 054001, P.R. China
| | - Xiaojuan Feng
- Department of Ultrasound, Xingtai People's Hospital of Hebei Province, Xingtai, Hebei 054001, P.R. China
| | - Zhigang Fan
- Department of Ultrasound, Xingtai People's Hospital of Hebei Province, Xingtai, Hebei 054001, P.R. China
| | - Xingyuan Zhu
- The Third Department of Neurology, Xingtai People's Hospital of Hebei Province, Xingtai, Hebei 054001, P.R. China
| | - Shaohua Yin
- The Third Department of Neurology, Xingtai People's Hospital of Hebei Province, Xingtai, Hebei 054001, P.R. China
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Haitao R, Huiqin L, Tao Q, Xunzhe Y, Xiaoqiu S, Wei L, Jiewen Z, Liying C, Hongzhi G. Autoimmune encephalitis associated with vitiligo? J Neuroimmunol 2017; 310:14-16. [DOI: 10.1016/j.jneuroim.2017.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 05/24/2017] [Accepted: 05/26/2017] [Indexed: 01/26/2023]
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Iyer RS, Ramakrishnan TCR, Karunakaran, Shinto A, Kamaleshwaran KK. Faciobrachial dystonic seizures result from fronto-temporo-basalganglial network involvement. EPILEPSY & BEHAVIOR CASE REPORTS 2017; 8:47-50. [PMID: 28879090 PMCID: PMC5573798 DOI: 10.1016/j.ebcr.2017.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/19/2017] [Accepted: 06/01/2017] [Indexed: 11/29/2022]
Abstract
•Faciobrachial dystonic seizures (FBDS) are caused by autoantibodies to leucine-rich glioma-inactivated1 proteins, a component of the voltage-gated potassium channel complex (VGKC-complex) and precede the clinical presentation of limbic encephalitis.•The exact pathophysiology of FBDS is not known and whether they are seizures or movement disorder is still debated.•We suggest the fronto-temporo-basal ganglia network involving the medial frontal and temporal regions along with the corpus striatum and substantia nigra being responsible for the clinical phenomenon of FBDS.•The varied clinical, electrical and imaging features of FBDS in our cases and in the literature are best explained by involvement of this network.•Entrainment from any part of this network will result in similar clinical expression of FBDS, whereas other electro-clinical associations and duration depends on the extent of involvement of the network.
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Affiliation(s)
- Rajesh Shankar Iyer
- Department of Neurology, KG Hospital & Post Graduate Medical Institute, Coimbatore, Tamil Nadu, India
| | - T C R Ramakrishnan
- Department of Neurology, KG Hospital & Post Graduate Medical Institute, Coimbatore, Tamil Nadu, India
| | - Karunakaran
- Department of Radiology, KG Hospital & Post Graduate Medical Institute, Coimbatore, Tamil Nadu, India
| | - Ajit Shinto
- Department of Nuclear Medicine, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
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Méneret A, Roze E. Paroxysmal movement disorders: An update. Rev Neurol (Paris) 2016; 172:433-445. [PMID: 27567459 DOI: 10.1016/j.neurol.2016.07.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 04/10/2016] [Accepted: 07/08/2016] [Indexed: 01/08/2023]
Abstract
Paroxysmal movement disorders comprise both paroxysmal dyskinesia, characterized by attacks of dystonic and/or choreic movements, and episodic ataxia, defined by attacks of cerebellar ataxia. They may be primary (familial or sporadic) or secondary to an underlying cause. They can be classified according to their phenomenology (kinesigenic, non-kinesigenic or exercise-induced) or their genetic cause. The main genes involved in primary paroxysmal movement disorders include PRRT2, PNKD, SLC2A1, ATP1A3, GCH1, PARK2, ADCY5, CACNA1A and KCNA1. Many cases remain genetically undiagnosed, thereby suggesting that additional culprit genes remain to be discovered. The present report is a general overview that aims to help clinicians diagnose and treat patients with paroxysmal movement disorders.
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Affiliation(s)
- A Méneret
- Inserm U 1127, CNRS UMR 7225, Sorbonne University Group, UPMC University Paris 06 UMR S 1127, Brain and Spine Institute, ICM, 75013 Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, 75013 Paris, France
| | - E Roze
- Inserm U 1127, CNRS UMR 7225, Sorbonne University Group, UPMC University Paris 06 UMR S 1127, Brain and Spine Institute, ICM, 75013 Paris, France; AP-HP, Pitié-Salpêtrière Hospital, Department of Neurology, 75013 Paris, France.
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Bakpa OD, Reuber M, Irani SR. Antibody-associated epilepsies: Clinical features, evidence for immunotherapies and future research questions. Seizure 2016; 41:26-41. [PMID: 27450643 PMCID: PMC5042290 DOI: 10.1016/j.seizure.2016.07.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/05/2016] [Accepted: 07/08/2016] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The growing recognition of epilepsies and encephalopathies associated with autoantibodies against surface neuronal proteins (LGI1, NMDAR, CASPR2, GABABR, and AMPAR) means that epileptologists are increasingly asking questions about mechanisms of antibody-mediated epileptogenesis, and about the use of immunotherapies. This review summarizes clinical and paraclinical observations related to autoimmune epilepsies, examines the current evidence for the effectiveness of immunotherapy, and makes epilepsy-specific recommendations for future research. METHOD Systematic literature search with summary and review of the identified publications. Studies describing the clinical characteristics of autoantibody-associated epilepsies and treatments are detailed in tables. RESULTS Literature describing the clinical manifestations and treatment of autoimmune epilepsies associated with neuronal cell-surface autoantibodies (NSAbs) is largely limited to retrospective case series. We systematically summarize the features of particular interest to epileptologists dividing patients into those with acute or subacute encephalopathies associated with epilepsy, and those with chronic epilepsy without encephalopathy. Available observational studies suggest that immunotherapies are effective in some clinical circumstances but outcome data collection methods require greater standardization. CONCLUSIONS The clinical experience captured suggests that clusters of clinical features associate well with specific NSAbs. Intensive and early immunotherapy is indicated when patients present with autoantibody-associated encephalopathies. It remains unclear how patients with chronic epilepsy and the same autoantibodies should be assessed and treated. Tables in this paper provide a comprehensive resource for systematic descriptions of both clinical features and treatments, and highlight limitations of current studies.
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Affiliation(s)
- Ochuko D Bakpa
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, UK
| | - Markus Reuber
- Academic Neurology Unit, Royal Hallamshire Hospital, University of Sheffield, Sheffield S10 2JF, UK
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DS, UK.
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10
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Flanagan EP, Kotsenas AL, Britton JW, McKeon A, Watson RE, Klein CJ, Boeve BF, Lowe V, Ahlskog JE, Shin C, Boes CJ, Crum BA, Laughlin RS, Pittock SJ. Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e161. [PMID: 26468474 PMCID: PMC4592539 DOI: 10.1212/nxi.0000000000000161] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/10/2015] [Indexed: 01/12/2023]
Abstract
Objective: To characterize the clinical features and MRI abnormalities of leucine-rich glioma-inactivated 1 (LGI1)-autoantibody (Ab) faciobrachial dystonic seizures (FBDS). Methods: Forty-eight patients with LGI1-Ab encephalopathy were retrospectively identified by searching our clinical and serologic database from January 1, 2002, to June 1, 2015. Of these, 26 met inclusion criteria for this case series: LGI1-Ab seropositivity and FBDS. In a separate analysis of all 48 patients initially identified, the MRIs of patients with (n = 26) and without (n = 22) FBDS were compared by 2 neuroradiologists blinded to the clinical details. Results: The median age of the 26 included patients was 62.5 years (range 37–78); 65% were men. FBDS involved arm (26), face (22), and leg (12). Ten were previously diagnosed as psychogenic. Ictal EEGs were normal in 20 of 23 assessed. Basal ganglia T1 and T2 signal abnormalities were detected in 11 patients (42%), with excellent agreement between neuroradiologists (κ scores of 0.86 and 0.93, respectively), and included T1 hyperintensity alone (2), T2 hyperintensity alone (1), or both (8). The T1 hyperintensities persisted longer than the T2 hyperintensities (median 11 weeks vs 1 week, p = 0.02). Improvement with immunotherapy (18/18) was more frequent than with antiepileptic medications (10/24). A separate analysis of all 48 patients initially identified with LGI1-Ab encephalopathy showed that basal ganglia MRI abnormalities were present in 11 of 26 with FBDS but not present in those without FBDS (0/22) (p < 0.001). In contrast, mesial temporal MRI abnormalities were less common among those with FBDS (42%) than those without (91%) (p < 0.001). Conclusions: Basal ganglia T1 hyperintensity is a clinically useful MRI biomarker of LGI1-Ab FBDS and suggests a basal ganglia localization.
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Affiliation(s)
- Eoin P Flanagan
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Amy L Kotsenas
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Jeffrey W Britton
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Robert E Watson
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Christopher J Klein
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Bradley F Boeve
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Val Lowe
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - J Eric Ahlskog
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Cheolsu Shin
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Christopher J Boes
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Brian A Crum
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Ruple S Laughlin
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Department of Neurology (E.P.F., J.W.B., A.M., C.J.K., B.F.B., J.E.A., C.S., C.J.B., B.A.C., R.S.L., S.J.P.), Department of Radiology (A.L.K., R.E.W., V.L.), and Department of Laboratory Medicine and Pathology (A.M., C.J.K., S.J.P.), Mayo Clinic, Rochester, MN
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Abstract
Paroxysmal dyskinesias represent a group of episodic abnormal involuntary movements manifested by recurrent attacks of dystonia, chorea, athetosis, or a combination of these disorders. Paroxysmal kinesigenic dyskinesia, paroxysmal nonkinesigenic dyskinesia, paroxysmal exertion-induced dyskinesia, and paroxysmal hypnogenic dyskinesia are distinguished clinically by precipitating factors, duration and frequency of attacks, and response to medication. Primary paroxysmal dyskinesias are usually autosomal dominant genetic conditions. Secondary paroxysmal dyskinesias can be the symptoms of different neurologic and medical disorders. This review summarizes the updates on etiology, pathophysiology, genetics, clinical presentation, differential diagnosis, and treatment of paroxysmal dyskinesias and other episodic movement disorders.
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Affiliation(s)
- Olga Waln
- Department of Neurology, Houston Methodist Neurological Institute, 6560 Fannin, Suite 802, Houston, TX 77030, USA
| | - Joseph Jankovic
- Department of Neurology, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine, 6550 Fannin, Suite 1801, Houston, TX 77030, USA.
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Brockmann K. Episodic movement disorders: from phenotype to genotype and back. Curr Neurol Neurosci Rep 2014; 13:379. [PMID: 23963607 DOI: 10.1007/s11910-013-0379-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Episodic dyskinetic movement disorders are a heterogeneous group of rare conditions. Paroxysmal dyskinesias constitute the core of this group and usually exhibit normal interepisodic neurologic findings. Contrariwise, episodic dyskinesias occur as a particular feature of complex chronic neurologic disorders. Conjunction of accurate phenotyping with up-to-date methods of molecular genetics recently provided remarkable new insights concerning the genetic causes of episodic dyskinesia. The identification of heterozygous mutations in the PRRT2 gene in paroxysmal kinesigenic dyskinesia as well as in benign familial infantile seizures linked episodic movement disorders with epilepsy. Alternating hemiplegia of childhood, the prototype of a chronic multisystem disease with episodic dyskinesia as a clinical hallmark, was recently found to be caused by heterozygous de novo mutations in the ATP1A3 gene. The clinical spectra of PRRT2 as well as of ATP1A3 mutations are still expanding. This review summarizes new genetic findings and clinical aspects in episodic dyskinesias.
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Affiliation(s)
- Knut Brockmann
- Interdisciplinary Pediatric Center for Children with Developmental Disabilities and Severe Chronic Disorders, Georg August University Göttingen, Germany.
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Irani SR, Stagg CJ, Schott JM, Rosenthal CR, Schneider SA, Pettingill P, Pettingill R, Waters P, Thomas A, Voets NL, Cardoso MJ, Cash DM, Manning EN, Lang B, Smith SJM, Vincent A, Johnson MR. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype. ACTA ACUST UNITED AC 2013; 136:3151-62. [PMID: 24014519 DOI: 10.1093/brain/awt212] [Citation(s) in RCA: 287] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Voltage-gated potassium channel complex antibodies, particularly those directed against leucine-rich glioma inactivated 1, are associated with a common form of limbic encephalitis that presents with cognitive impairment and seizures. Faciobrachial dystonic seizures have recently been reported as immunotherapy-responsive, brief, frequent events that often predate the cognitive impairment associated with this limbic encephalitis. However, these observations were made from a retrospective study without serial cognitive assessments. Here, we undertook the first prospective study of faciobrachial dystonic seizures with serial assessments of seizure frequencies, cognition and antibodies in 10 cases identified over 20 months. We hypothesized that (i) faciobrachial dystonic seizures would show a differential response to anti-epileptic drugs and immunotherapy; and that (ii) effective treatment of faciobrachial dystonic seizures would accelerate recovery and prevent the development of cognitive impairment. The 10 cases expand both the known age at onset (28 to 92 years, median 68) and clinical features, with events of longer duration, simultaneously bilateral events, prominent automatisms, sensory aura, and post-ictal fear and speech arrest. Ictal epileptiform electroencephalographic changes were present in three cases. All 10 cases were positive for voltage-gated potassium channel-complex antibodies (346-4515 pM): nine showed specificity for leucine-rich glioma inactivated 1. Seven cases had normal clinical magnetic resonance imaging, and the cerebrospinal fluid examination was unremarkable in all seven tested. Faciobrachial dystonic seizures were controlled more effectively with immunotherapy than anti-epileptic drugs (P = 0.006). Strikingly, in the nine cases who remained anti-epileptic drug refractory for a median of 30 days (range 11-200), the addition of corticosteroids was associated with cessation of faciobrachial dystonic seizures within 1 week in three and within 2 months in six cases. Voltage-gated potassium channel-complex antibodies persisted in the four cases with relapses of faciobrachial dystonic seizures during corticosteroid withdrawal. Time to recovery of baseline function was positively correlated with time to immunotherapy (r = 0.74; P = 0.03) but not time to anti-epileptic drug administration (r = 0.55; P = 0.10). Of 10 cases, the eight cases who received anti-epileptic drugs (n = 3) or no treatment (n = 5) all developed cognitive impairment. By contrast, the two who did not develop cognitive impairment received immunotherapy to treat their faciobrachial dystonic seizures (P = 0.02). In eight cases without clinical magnetic resonance imaging evidence of hippocampal signal change, cross-sectional volumetric magnetic resonance imaging post-recovery, after accounting for age and head size, revealed cases (n = 8) had smaller brain volumes than healthy controls (n = 13) (P < 0.001). In conclusion, faciobrachial dystonic seizures can be prospectively identified as a form of epilepsy with an expanding phenotype. Immunotherapy is associated with excellent control of the frequently anti-epileptic drug refractory seizures, hastens time to recovery, and may prevent the subsequent development of cognitive impairment observed in this study.
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Affiliation(s)
- Sarosh R Irani
- 1 Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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