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Li X, Chen Y, Zhang L, Zhang W, Li B, Baizabal-Carvallo JF, Song X. IgLON5 autoimmunity in a patient with Creutzfeldt-Jakob disease: case report and review of literature. Front Neurol 2024; 15:1367361. [PMID: 38572492 PMCID: PMC10989518 DOI: 10.3389/fneur.2024.1367361] [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: 01/08/2024] [Accepted: 02/16/2024] [Indexed: 04/05/2024] Open
Abstract
Objective We present the case of a patient with clinical and imaging features of sporadic Creutzfeldt-Jakob disease (sCJD) and positive IgLON5 antibodies (Abs) in the serum and CSF. Case report A 66-year-old Chinese man presented to the hospital with a stroke-like episode, followed by rapidly progressive cognitive decline, mutism, and parkinsonism. The MRI results showed a cortical ribboning sign in diffusion-weighted MRI, periodic triphasic waves with a slow background in EEG, and positive protein 14-3-3 in CSF. There were matching IgLON5 Abs in the serum and CSF. A literature review showed positive autoimmune encephalitis Abs or autoimmune inflammatory disease between 0.5 and 8.6% among patients with clinical suspicion of CJD, most commonly anti-voltage-gated potassium channel (VGKC) complex and anti-N-methyl-D-aspartate receptor (NMDAR) Abs; however, IgLON5 autoimmunity in CJD has been rarely reported. This is an intriguing association as both conditions have been associated with brain deposits of phosphorylated tau protein. Conclusion IgLON5 Abs may be observed in patients with a diagnosis of CJD; it is unknown whether a synergistic effect of IgLON5 Abs with CJD exists, increasing neurodegenerative changes.
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Affiliation(s)
- Xiaofeng Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Le Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Wei Zhang
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Bin Li
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | | | - Xingwang Song
- Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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Ouyang S, Tang Z, Duan W, Tang S, Zeng Q, Gu W, Li M, Tan H, Hu J, Yin W. Mapping the global research landscape and trends of autoimmune encephalitis: A bibliometric analysis. Heliyon 2024; 10:e26653. [PMID: 38434060 PMCID: PMC10906412 DOI: 10.1016/j.heliyon.2024.e26653] [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: 07/11/2023] [Revised: 01/22/2024] [Accepted: 02/16/2024] [Indexed: 03/05/2024] Open
Abstract
Background Autoimmune encephalitis (AE) is a neuroautoimmune disease featured by the presence of antibodies targeting neuronal surface, synaptic, or intracellular antigens. An increasing number of articles on its clinical manifestations, treatments, and prognosis have appeared in recent years. The objectives of this study were to summarize this growing body of literature and provide an overview of hotspots and trends in AE research using bibliometric analysis. Methods We retrieved AE-related articles published between 1999 and 2022 from the Web of Science Core Collection. Using bibliometric websites and software, we analyzed the data of AE research, including details about countries, institutions, authors, references, journals, and keywords. Results We analyzed 3348 articles, with an average of 32.83 citations per article and an H-index of 141. The USA (1091, 32.587%), China (531, 15.860%), Germany (447, 13.351%), England (266, 7.945%), and Japan (213, 6.362%) had the greatest numbers of publications. The top five institutions by numbers of publications were Oxford (143, 4.271%), the Udice French Research Universities (135, 4.032%), the University of Pennsylvania (135, 4.032%), l'Institut National de la Sante de la Recherche Medicale Inserm (113, 3.375%), and the University of Barcelona (110, 3.286%). The most productive authors were J. Dalmau (98, 2.927%), A. Vincent (65, 2.479%), H. Pruess (64, 1.912%), C. G. Bien (43, 1.284%), and F. Graus (43, 1.284%). "autoimmune encephalitis" was the most frequently used keyword (430), followed by "antibodies" (420), "NMDA receptor encephalitis" (383), and "limbic encephalitis" (368). In recent years, research hotspots have focused on the diagnosis and immunotherapy of NMDAR encephalitis and on limbic encephalitis. Conclusion Developed Western countries have made significant contributions to this field. China has shown a steady increase in the number of publications in recent years, but the quality and influence of these articles warrant efforts at improvement. Future directions in AE research lie in two key areas: (i) the clinical manifestations, prevalence, and prognosis of AE (enabled by advances in diagnosis); and (ii) the efficacy and safety of targeted, individualized immunotherapy.
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Affiliation(s)
- Song Ouyang
- Department of Neurology, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
- The “Double-First Class” Application Characteristic Discipline of Hunan Province (Clinical Medicine), Changsha Medical University, Changsha, Hunan, PR China
| | - Zhenchu Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Weiwei Duan
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Sizhi Tang
- Department of Neurology, Zhuzhou Hospital Affiliated to Xiangya School of Medicine, Central South University, Zhuzhou, Hunan, PR China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Wenping Gu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, PR China
| | - Miao Li
- Department of Neurology, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
| | - Hong Tan
- Department of Neurology, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
| | - Jiangying Hu
- Department of Neurology, The Affiliated Changsha Hospital of Xiangya School of Medicine, Central South University, Changsha, Hunan, PR China
| | - Weifan Yin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, PR China
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Kitazaki Y, Ikawa M, Hamano T, Sasaki H, Yamaguchi T, Enomoto S, Shirafuji N, Hayashi K, Yamamura O, Tsujikawa T, Okazawa H, Kimura H, Nakamoto Y. Magnetic resonance imaging arterial spin labeling hypoperfusion with diffusion-weighted image hyperintensity is useful for diagnostic imaging of Creutzfeldt-Jakob disease. Front Neurol 2023; 14:1242615. [PMID: 37885479 PMCID: PMC10598551 DOI: 10.3389/fneur.2023.1242615] [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: 06/20/2023] [Accepted: 09/14/2023] [Indexed: 10/28/2023] Open
Abstract
Background and objectives Magnetic resonance imaging with arterial spin labeling (ASL) perfusion imaging is a noninvasive method for quantifying cerebral blood flow (CBF). We aimed to evaluate the clinical utility of ASL perfusion imaging to aid in the diagnosis of Creutzfeldt-Jakob disease (CJD). Methods This retrospective study enrolled 10 clinically diagnosed with probable sporadic CJD (sCJD) based on the National CJD Research & Surveillance Unit and EuroCJD criteria and 18 healthy controls (HCs). Diffusion-weighted images (DWIs), CBF images obtained from ASL, N-isopropyl-(123I)-p-iodoamphetamine (123IMP)-single-photon emission computed tomography (SPECT) images, and 18F-fluorodeoxyglucose (18FDG)-positron emission tomography (PET) images were analyzed. First, the cortical values obtained using volume-of-interest (VOI) analysis were normalized using the global mean in each modality. The cortical regions were classified into DWI-High (≥ +1 SD) and DWI-Normal (< +1 SD) regions according to the DWI-intensity values. The normalized cortical values were compared between the two regions for each modality. Second, each modality value was defined as ASL hypoperfusion (< -1 SD), SPECT hypoperfusion (< -1 SD), and PET low accumulation (< -1 SD). The overall agreement rate of DWIs with ASL-CBF, SPECT, and PET was calculated. Third, regression analyses between the normalized ASL-CBF values and normalized SPECT or PET values derived from the VOIs were performed using a scatter plot. Results The mean values of ASL-CBF (N = 10), 123IMP-SPECT (N = 8), and 18FDG-PET (N = 3) in DWI-High regions were significantly lower than those in the DWI-Normal regions (p < 0.001 for all); however, HCs (N = 18) showed no significant differences in ASL-CBF between the two regions. The overall agreement rate of DWI (high or normal) with ASL-CBF (hypoperfusion or normal) (81.8%) was similar to that of SPECT (85.2%) and PET (78.5%) in CJD. The regression analysis showed that the normalized ASL-CBF values significantly correlated with the normalized SPECT (r = 0.44, p < 0.001) and PET values (r = 0.46, p < 0.001) in CJD. Discussion Patients with CJD showed ASL hypoperfusion in lesions with DWI hyperintensity, suggesting that ASL-CBF could be beneficial for the diagnostic aid of CJD.
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Affiliation(s)
- Yuki Kitazaki
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Masamichi Ikawa
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
- Department of Advanced Medicine for Community Healthcare, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tadanori Hamano
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- Department of Aging and Dementia (DAD), University of Fukui, Fukui, Japan
- Life Science Innovation Center, University of Fukui, Fukui, Japan
| | - Hirohito Sasaki
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tomohisa Yamaguchi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Soichi Enomoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Norimichi Shirafuji
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Kouji Hayashi
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
- Department of Rehabilitation, Faculty of Health Science, Fukui Health Science University, Fukui, Japan
| | - Osamu Yamamura
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Tetsuya Tsujikawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Hidehiko Okazawa
- Biomedical Imaging Research Center, University of Fukui, Fukui, Japan
| | - Hirohiko Kimura
- Department of Radiology, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yasunari Nakamoto
- Second Department of Internal Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
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Hasan SF, Lutfi L, Shukur M, Alemam S, Esmaeel H, Nawaz F. Psychiatric Manifestations in an Adolescent With Voltage-Gated Potassium Channels (VGKC) Autoimmune Encephalitis: A Case Report. Cureus 2023; 15:e39960. [PMID: 37416039 PMCID: PMC10320328 DOI: 10.7759/cureus.39960] [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: 06/04/2023] [Indexed: 07/08/2023] Open
Abstract
Autoimmune encephalitis (AE) is a newly defined group of disorders characterized by psychiatric symptoms such as psychosis and manic or hypomanic symptoms, with or without neurological symptoms. The most common neurological symptoms include seizures, altered mental status, autonomic disability, disorientation, and movement disorders. Our case report describes a type of AE caused by circulating autoantibodies against voltage-gated potassium channels (VGKC), which has not been reported before in the United Arab Emirates. This case report describes the psychiatric manifestations in a 17-year-old female with AE. It aims to shed light on the rare presentations of AE, discuss the various causes and management in greater depth, and the importance of suspecting and diagnosing AE early in the illness course. This rare case highlights the need for further research on the underlying biological, psychological, and social risk factors for developing AE in this region, and to direct further attention to developing early-intervention strategies in the vulnerable patient population.
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Affiliation(s)
- Safa F Hasan
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | - Lubna Lutfi
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | - Mahmood Shukur
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | - Shokry Alemam
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | - Hanan Esmaeel
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
| | - Faisal Nawaz
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, ARE
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Barthel PC, Staabs F, Li LY, Buthut M, Otto C, Ruprecht K, Prüss H, Höltje M. Immunoreactivity to astrocytes in different forms of dementia: High prevalence of autoantibodies to GFAP. Brain Behav Immun Health 2023; 29:100609. [PMID: 36923695 PMCID: PMC10008834 DOI: 10.1016/j.bbih.2023.100609] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 02/21/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Objective To study the prevalence of autoantibodies to glial and neuronal antigens with a focus on glial acidic fibrillary protein (GFAP) in patients with dementia. Methods Sera of 127 patients with different forms of dementia and sera of 82 age-matched patients with various neurological diseases except for dementia, as well as sera from 15 age-matched healthy controls were analyzed for anti-glial or anti-neuronal IgG using 1) primary murine embryonic hippocampus cell cultures, 2) murine brain sections, 3) immunoblotting on mouse brain homogenates and 4) astrocyte cultures. Sera reacting with astrocytes in hippocampus cell cultures were further analyzed using HEK293 cells transfected with human GFAP. Results IgG in serum from 45 of 127 (35.5%) patients with dementia but only 8 of 97 (8.2%, p ≤ 0.001) controls bound to either glial or neuronal structures in cultured murine hippocampus cells. In these cultures antibodies to astrocytes were detected in 35 of 127 (27.5%) of the dementia patients, whereas in controls antibodies to astrocytes were detected in 4 sera only (4.1%, p ≤ 0.001). Among the sera exhibiting reactivity to astrocytes, 14 of 35 (40%) showed immunoreaction to HEK293 cells transfected with GFAP in dementia patients, representing 11% of all sera. Within the 4 immunoreactive control sera reacting with astrocytes one reacted with GFAP (1.0% of total immunoreactivity, p = 0.003). Conclusions Autoantibodies to glial epitopes in general and to GFAP in particular are more frequent in patients with dementia than in age-matched controls without dementia, thus indicating the need for further investigations regarding the potential pathophysiological relevance of these antibodies.
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Affiliation(s)
- Paula Charlotte Barthel
- Institute of Integrative Neuroanatomy Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Finja Staabs
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Lucie Y Li
- Institute of Integrative Neuroanatomy Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maria Buthut
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Carolin Otto
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Harald Prüss
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Markus Höltje
- Institute of Integrative Neuroanatomy Berlin, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Abstract
PURPOSE OF REVIEW This article presents a practical approach to the evaluation of patients with rapidly progressive dementia. RECENT FINDINGS The approach presented in this article builds upon the standard dementia evaluation, leveraging widely available tests and emergent specific markers of disease to narrow the differential diagnosis and determine the cause(s) of rapid progressive decline. The discovery of treatment-responsive causes of rapidly progressive dementia underscores the need to determine the cause early in the symptomatic course when treatments are most likely to halt or reverse cognitive decline. SUMMARY A pragmatic and organized approach to patients with rapidly progressive dementia is essential to mitigate diagnostic and therapeutic challenges and optimize patient outcomes.
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Muthusamy S, Foroush NC, Seneviratne U. Faciobrachial motor seizures: A more apt description? Epilepsy Behav Rep 2021; 16:100476. [PMID: 34505053 PMCID: PMC8411204 DOI: 10.1016/j.ebr.2021.100476] [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: 06/06/2021] [Revised: 08/12/2021] [Accepted: 08/15/2021] [Indexed: 11/03/2022] Open
Abstract
Autoimmune encephalitis associated with antibodies against leucine-rich glioma inactivated protein (LGI1) is classically associated with brief, recurrent, contractions of facial and upper limb muscles, typically on the same side. Commonly described as 'faciobrachial dystonic seizures' (FBDS), these seizures have become the semiological hallmark of anti-LGI1 encephalitis. However, the facial and upper limb contractions observed in patients with anti-LGI1 encephalitis associated seizures are not always dystonic in nature. Here, we briefly highlight the case of a patient who was admitted to our institution with faciobrachial tonic-myoclonic seizures to emphasize the fact that faciobrachial seizures in anti-LGI1 encephalitis are not always dystonic. We also review the literature on the semiology of these seizures in patients diagnosed with anti-LGI1 encephalitis and propose a more apt description for this phenomenon. Our case as well as the literature highlights that in anti-LGI1 encephalitis the typical seizure semiology of faciobrachial distribution includes tonic, clonic, dystonic, and myoclonic activity in isolation or combination with or without plus features. Given that accurate labelling of clinical phenomenology enables a better understanding of the underlying epileptic networks and precise diagnosis, we would suggest a more inclusive term 'faciobrachial motor seizures' instead of 'faciobrachial dystonic seizures' to describe the typical seizure semiology of anti-LGI1 encephalitis. Based on the presence or absence of specific clinical features, these seizures can be further sub-classified as focal aware faciobrachial motor seizures, focal impaired awareness faciobrachial motor seizures or focal faciobrachial motor plus seizures (aware or impaired awareness).
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Affiliation(s)
- Subramanian Muthusamy
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Monash Medical Centre, Clayton, Melbourne, Australia
| | | | - Udaya Seneviratne
- School of Clinical Sciences at Monash Health, Department of Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Neurology, Monash Medical Centre, Clayton, Melbourne, Australia.,Department of Medicine, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia
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8
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Primary Angiitis of the Central Nervous System Mimicking Sporadic Creutzfeldt-Jakob Disease: A Case Study. Alzheimer Dis Assoc Disord 2019; 32:258-261. [PMID: 29369829 DOI: 10.1097/wad.0000000000000242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Urriola N, Soosapilla K, Herkes G, Nogajski J. Heidenhain variant sporadic Creutzfeldt-Jakob disease diagnosed as an autoimmune encephalitis due to a false-positive GAD autoantibody. BMJ Case Rep 2019; 12:12/5/e229018. [PMID: 31061195 DOI: 10.1136/bcr-2018-229018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 64-year-old man presented with a subacute history progressive visual field defects, illusions and misperceptions. An initial MRI brain revealed a right occipital signal abnormality on diffusion-weighted imaging (DWI) with serum glutamic acid decarboxylase (GAD) autoantibodies markedly elevated. A diagnosis of autoimmune encephalitis was made, with the patient being treated with intravenous immunoglobulin. One month after discharge, the patient represented with worsening frank and well-formed visual hallucinations, ataxia and progressive cognitive impairment. Progress MRI displayed characteristic T2 ribboning on diffusion weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences, along with periodic sharp wave complexes on electroencephalogram (EEG) and a raised CSF protein 14-3-3. Repeat serum, as well as cerebrospinal fluid (CSF), GAD antibodies were again markedly elevated as measured by ELISA (RSR, Cardiff, UK), although archival CSF from the original presentation as well as CSF from the second presentation had undetectable GAD autoantibodies as measured via radioimmunoassay (DIAsource, Ottignies-Louvain-la-Neuve, Belgium). Creutzfeldt-Jakob disease was confirmed at autopsy.
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Affiliation(s)
- Nicolás Urriola
- Neurology, Royal North SHore Hospital, Sydney, New South Wales, Australia
| | - Kavie Soosapilla
- Junior Medical Staff Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Geoffrey Herkes
- Neurology, Royal North SHore Hospital, Sydney, New South Wales, Australia
| | - Joseph Nogajski
- Neurology, Royal North SHore Hospital, Sydney, New South Wales, Australia
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Freund B, Probasco JC, Cervenka MC, Sutter R, Kaplan PW. EEG Differences in Two Clinically Similar Rapid Dementias: Voltage-Gated Potassium Channel Complex-Associated Autoimmune Encephalitis and Creutzfeldt-Jakob Disease. Clin EEG Neurosci 2019; 50:121-128. [PMID: 29788790 DOI: 10.1177/1550059418774686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Distinguishing treatable causes for rapidly progressive dementia from those that are incurable is vital. Creutzfeldt-Jakob disease (CJD) and voltage-gated potassium channel complex-associated autoimmune encephalitis (VGKC AE) are 2 such conditions with disparate outcomes and response to treatment. To determine the differences in electroencephalography between CJD and VGKC AE, we performed a retrospective review of medical records and examined clinical data, neuroimaging, and electroencephalographs performed in patients admitted for evaluation for rapidly progressive dementia diagnosed with CJD and VGKC AE at the Johns Hopkins Hospital and Bayview Medical Center between January 1, 2007 and December 31, 2015. More patients in the VGKC AE group had seizures (12/17) than those with CJD (3/14; P = .008). Serum sodium levels were lower in those with VGKC AE (P = .001). Cerebrospinal fluid (CSF) white blood cell count was higher in VGKC AE (P = .008). CSF protein 14-3-3 (P = .018) was more commonly detected in CJD, and tau levels were higher in those with CJD (P < .006). On neuroimaging, diffusion restriction in the cortex (P = .001), caudate (P < .001), and putamen (P = .001) was more frequent in CJD. Periodic sharp wave complexes (P = .001) and generalized suppressed activity (P = .008) were more common on initial EEG in CJD. On serial EEGs, generalized periodic discharges (P = .004), generalized suppressed activity (P=0.008), and periodic sharp wave complexes (P < .001) were detected more in CJD. This study shows that there are a number of differentiating features between CJD and VGKC AE, and electroencephalography can aid in their diagnoses. Performing serial EEGs better delineates these conditions.
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Affiliation(s)
- Brin Freund
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - John C Probasco
- Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Raoul Sutter
- Department of Neurology and Intensive Care Units, University Hospital Basel, Basel, Switzerland
| | - Peter W Kaplan
- Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
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Geschwind MD, Murray K. Differential diagnosis with other rapid progressive dementias in human prion diseases. HANDBOOK OF CLINICAL NEUROLOGY 2018; 153:371-397. [PMID: 29887146 DOI: 10.1016/b978-0-444-63945-5.00020-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Prion diseases are unique in medicine as in humans they occur in sporadic, genetic, and acquired forms. The most common human prion disease is sporadic Creutzfeldt-Jakob disease (CJD), which commonly presents as a rapidly progressive dementia (RPD) with behavioral, cerebellar, extrapyramidal, and some pyramidal features, with the median survival from symptom onset to death of just a few months. Because human prion diseases, as well as other RPDs, are relatively rare, they can be difficult to diagnose, as most clinicians have seen few, if any, cases. Not only can prion diseases mimic many other conditions that present as RPD, but some of those conditions can present similarly to prion disease. In this article, the authors discuss the different etiologic categories of conditions that often present as RPD and also present RPDs that had been misdiagnosed clinically as CJD. Etiologic categories of conditions are presented in order of the mnemonic used for remembering the various categories of RPDs: VITAMINS-D, for vascular, infectious, toxic-metabolic, autoimmune, mitochondrial/metastases, iatrogenic, neurodegenerative, system/seizures/sarcoid, and demyelinating. When relevant, clinical, imaging, or other features of an RPD that overlap with those of CJD are presented.
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Affiliation(s)
- Michael D Geschwind
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, CA, United States.
| | - Katy Murray
- Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, United Kingdom
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12
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Irani SR, Vincent A. Voltage-gated potassium channel-complex autoimmunity and associated clinical syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2017; 133:185-97. [PMID: 27112678 DOI: 10.1016/b978-0-444-63432-0.00011-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Voltage-gated potassium channel (VGKC)-complex antibodies are defined by the radioimmunoprecipitation of Kv1 potassium channel subunits from brain tissue extracts and were initially discovered in patients with peripheral nerve hyperexcitability (PNH). Subsequently, they were found in patients with PNH plus psychosis, insomnia, and dysautonomia, collectively termed Morvan's syndrome (MoS), and in a limbic encephalopathy (LE) with prominent amnesia and frequent seizures. Most recently, they have been described in patients with pure epilepsies, especially in patients with the novel and distinctive semiology termed faciobrachial dystonic seizures (FBDS). In each of these conditions, there is a close correlation between clinical measures and antibody levels. The VGKC-complex is a group of proteins that are strongly associated in situ and after extraction in mild detergent. Two major targets of the autoantibodies are leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein 2 (CASPR2). The patients with PNH or MoS are most likely to have CASPR2 antibodies, whereas LGI1 antibodies are found characteristically in patients with FBDS and LE. Crucially, each of these conditions has a good response to immunotherapies, often corticosteroids and plasma exchange, although optimal regimes require further study. VGKC-complex antibodies have also been described in neuropathic pain syndromes, chronic epilepsies, a polyradiculopathy in porcine abattoir workers, and some children with status epilepticus. Increasingly, however, the antigenic targets in these patients are not defined and in some cases the antibodies may be secondary rather than the primary cause. Future serologic studies should define all the antigenic components of the VGKC-complex, and further inform mechanisms of antibody pathogenicity and related inflammation.
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Affiliation(s)
- Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK.
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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Celliers L, Hung TJ, Al-Ogaili Z, Moschilla G, Knezevic W. Voltage-gated potassium channel antibody limbic encephalitis: a case illustrating the neuropsychiatric and PET/CT features with clinical and imaging follow-up. Australas Psychiatry 2016; 24:538-540. [PMID: 27590077 DOI: 10.1177/1039856216663734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To illustrate the neuropsychiatric and imaging findings in a confirmed case of voltage-gated potassium channel antibody limbic encephalitis. METHOD Case report and review of the literature. RESULTS A 64-year-old man presented with several months' history of obsessive thoughts and compulsions associated with faciobrachial dystonic seizures. He had no significant past medical and psychiatric history. Physical examinations revealed only mildly increased tone in the left upper limb. Bedside cognitive testing was normal. Positron-emission tomography showed intense symmetrical uptake in the corpus striatum. No underlying malignancy was identified on whole body imaging. Magnetic resonance imaging, lumbar puncture and electroencephalogram were normal. Serum voltage-gated potassium channel antibodies were strongly positive. The patient had a favourable response to antiepileptic drugs, oral steroids and immunotherapy. CONCLUSIONS Voltage-gated potassium channel limbic encephalitis characteristically presents with neuropsychiatric symptoms and temporal lobe seizures. Positron-emission tomography-computed tomography can be a useful adjunct to the clinical and biochemical work-up.
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Affiliation(s)
- Liesl Celliers
- Nuclear Medicine Registrar, Fiona Stanley Hospital, Perth, WA, Australia
| | - Te-Jui Hung
- Nuclear Medicine Registrar, Fiona Stanley Hospital, Perth, WA, Australia
| | - Zeyad Al-Ogaili
- Nuclear Medicine Physician and Radiologist, Fiona Stanley Hospital, Perth, WA, Australia
| | - Girolamo Moschilla
- Nuclear Medicine Physician and Radiologist, Fiona Stanley Hospital, Perth, WA, Australia
| | - Wally Knezevic
- Neurologist, Fiona Stanley Hospital, Perth, WA, Australia
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Simabukuro MM, Nóbrega PR, Pitombeira M, Cavalcante WCP, Grativvol RS, Pinto LF, Castro LHM, Nitrini R. The importance of recognizing faciobrachial dystonic seizures in rapidly progressive dementias. Dement Neuropsychol 2016; 10:351-357. [PMID: 29213481 PMCID: PMC5619277 DOI: 10.1590/s1980-5764-2016dn1004016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 11/07/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Creutzfeldt-Jakob Disease (CJD) is the prototypical cause of rapidly progressive dementia (RPD). Nonetheless, efforts to exclude reversible causes of RPD that mimic prion disease are imperative. The recent expanding characterization of neurological syndromes associated with antibodies directed against neuronal cell surface or sympathic antigens, namely autoimmune encephalitis is shifting paradigms in neurology. Such antigens are well known proteins and receptors involved in synaptic transmission. Their dysfunction results in neuropsychiatric symptoms, psychosis, seizures, movement disorders and RPD. Faciobrachial dystonic seizure (FBDS) is a novel characterized type of seizure, specific for anti-LGI1 encephalitis. OBJECTIVE In order to improve clinical recognition we report the cases of two Brazilian patients who presented with characteristic FDBS (illustrated by videos) and anti-LGI1 encephalitis. METHODS We have included all patients with FBDS and confirmed anti-LGI1 encephalitis and video records of FDBS in two tertiary Brazilian centers: Department of Neurology of Hospital das Clínicas, Sao Paulo University, Sao Paulo, Brazil and Hospital Geral de Fortaleza, Fortaleza, Brazil between January 1, 2011 and December 31, 2015. RESULTS Both patients presented with clinical features of limbic encephalitis associated with FBDS, hyponatremia and normal CSF. None of them presented with tumor and both showed a good response after immunotherapy. CONCLUSION FBDSs may be confounded with myoclonus and occurs simultaneously with rapid cognitive decline. Unawareness of FDBS may induce to misdiagnosing a treatable cause of RPD as CJD.
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Affiliation(s)
- Mateus Mistieri Simabukuro
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Paulo Ribeiro Nóbrega
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Milena Pitombeira
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
- Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | | | - Ronnyson Susano Grativvol
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | - Lécio Figueira Pinto
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
| | | | - Ricardo Nitrini
- Neurology Division, Hospital das Clínicas da
Faculdade de Medicina da Universidade de São Paulo, SP, Brazil
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15
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Chen Y, Xing XW, Zhang JT, Wang RX, Zhao W, Tan QC, Liu RZ, Wang XQ, Huang XS, Yu SY. Autoimmune encephalitis mimicking sporadic Creutzfeldt-Jakob disease: A retrospective study. J Neuroimmunol 2016; 295-296:1-8. [PMID: 27235341 DOI: 10.1016/j.jneuroim.2016.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 11/29/2022]
Abstract
Autoimmune encephalitis associated with anti-voltage-gated potassium channel antibodies are most likely to be misdiagnosed as sporadic Creutzfeldt-Jakob disease (sCJD). Our goal was to delineate patients who were initially suspected to have CJD but were later found to have AE. We performed a retrospective clinical review of cases of individuals and made a comparison between groups of patients diagnosed with sCJD and AE. Patients who had rapidly progressing dementia and focal neurological impairment, such as aphasia, gait disturbance, visual disturbance, and depression, at onset were diagnosed with sCJD, whereas epilepsy, hyponatremia and dysautonomia were strong hints for AE. Fluoroscope-positron emission tomography (PET) of patients with AE revealed variable metabolism and normative and long-term immunosuppression were less likely to relapse.
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Affiliation(s)
- Yu Chen
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Xiao-Wei Xing
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Jia-Tang Zhang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Ruo-Xi Wang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Wei Zhao
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Qing-Che Tan
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Ruo-Zhuo Liu
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Xiang-Qing Wang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Xu-Sheng Huang
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
| | - Sheng-Yuan Yu
- Department of Neurology, General Hospital of People's Liberation Army, No. 28, Fuxing Road, Haidian District, Beijing 100853, China.
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16
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Cognitive Impairments Preceding and Outlasting Autoimmune Limbic Encephalitis. Case Rep Neurol Med 2016; 2016:7247235. [PMID: 26881156 PMCID: PMC4736906 DOI: 10.1155/2016/7247235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/10/2015] [Accepted: 12/16/2015] [Indexed: 01/17/2023] Open
Abstract
Mild cognitive impairment (MCI) can be the initial manifestation of autoimmune limbic encephalitis (ALE), a disorder that at times presents a diagnostic challenge. In addition to memory impairment, clinical features that might suggest this disorder include personality changes, agitation, insomnia, alterations of consciousness, and seizures. Once recognized, ALE typically responds to treatment with immune therapies, but long-term cognitive deficits may remain. We report two cases of patients with MCI who were ultimately diagnosed with ALE with antibodies against the voltage gated potassium channel complex. Months after apparent resolution of their encephalitides, both underwent neuropsychological testing, which demonstrated persistent cognitive deficits, primarily in the domains of memory and executive function, for cases 1 and 2, respectively. A brief review of the literature is included.
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17
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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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18
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Lin Q, Wang X. Differences in epileptic symptoms depending on the type of autoimmune-mediated limbic encephalitis. Expert Rev Clin Immunol 2015; 11:897-910. [PMID: 26163176 DOI: 10.1586/1744666x.2015.1055253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Limbic encephalitis (LE) is an inflammatory disease of the central nervous system that is characterized by the selective involvement of limbic structures. The clinical manifestations of LE include the acute or sub-acute onset of recent memory disorders, mental disorders and seizures. Autoimmune-mediated LE is a major type of non-infectious LE; seizure is a hallmark of this type of LE. The treatment of epilepsy, which is a key factor that affects the prognosis of LE patients, warrants special attention. Understanding the characteristics of epilepsy caused by autoimmune-mediated LE and providing the appropriate treatment will help to improve patients' outcomes. In this article, we extensively review the literature related to autoimmune-mediated LE epidemiology, mechanisms, characteristics and seizure frequency and onset, and we discuss the possible diagnosis and treatment of this disease.
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Affiliation(s)
- Qingxia Lin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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Varley J, Vincent A, Irani SR. Clinical and experimental studies of potentially pathogenic brain-directed autoantibodies: current knowledge and future directions. J Neurol 2014; 262:1081-95. [PMID: 25491076 PMCID: PMC4412383 DOI: 10.1007/s00415-014-7600-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 11/27/2014] [Indexed: 02/06/2023]
Abstract
The field of neuronal surface-directed antibody-mediated diseases of the central nervous system has dramatically expanded in the last few years and now forms an important cluster of treatable neurological conditions. In this review, we focus on three areas. First, we review the demographics, clinical features and treatment responses of these conditions. Second, we consider their pathophysiology and compare autoantibody mechanisms and their effects to genetic or pharmacological disruptions of the target antigens. Third, we discuss areas of controversy within the field, propose possible resolutions, and explore new directions for neuronal surface antibody-mediated diseases.
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Affiliation(s)
- James Varley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, West Wing, Level 6, Oxford, OX3 9DU UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, West Wing, Level 6, Oxford, OX3 9DU UK
| | - Sarosh R. Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, West Wing, Level 6, Oxford, OX3 9DU UK
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20
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Zuhorn F, Hübenthal A, Rogalewski A, Dogan Onugoren M, Glatzel M, Bien CG, Schäbitz WR. Creutzfeldt-Jakob disease mimicking autoimmune encephalitis with CASPR2 antibodies. BMC Neurol 2014; 14:227. [PMID: 25434587 PMCID: PMC4255969 DOI: 10.1186/s12883-014-0227-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 11/18/2014] [Indexed: 11/14/2022] Open
Abstract
Background Differential diagnosis of severe progressive dementia includes a wide spectrum of inflammatory and neurodegenerative diseases. Particularly challenging is the differentiation of potentially treatable autoimmune encephalitis and Creutzfeldt-Jakob disease. Such a coincidence may indeed complicate the correct diagnosis and influence subsequent treatment. Case presentation A 75-year-old woman was admitted due to rapid progressive cognitive impairment. Her husband observed a temporal disorientation and confusion. The initial neurological examination and an extensive neuropsychological evaluation showed significant impairments in almost all tested cognitive domains. All other neurological functions including motor, sensory and coordinative function were intact. Initial diagnostics included EEG, MRI and lumbar puncture with unspecific results. Complementary blood testing revealed a positive result for antineural antibodies to Contactin-associated protein 2 (CASPR2) and the patient received treatment for CASPR2 autoimmune encephalitis. Further symptoms and results, including 14-3-3 proteins, led to suspected Creutzfeldt-Jakob disease. The postmortem examination supported the diagnosis of a definitive Creutzfeldt-Jakob disease. Conclusion One could argue that global screening for antineural antibodies may lead to a false diagnosis triggering intense and potentially dangerous procedures. We believe, however, that potentially treatable causes of dementia should aggressively sought out and subsequently treated in an attempt to curtail the course of disease and ultimately reduce the rate of mortality.
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Affiliation(s)
- Frédéric Zuhorn
- Department of Neurology, Evangelisches Krankenhaus, Burgsteig 13, Bielefeld, 33617, Germany.
| | - Almut Hübenthal
- Department of Neurology, Evangelisches Krankenhaus, Burgsteig 13, Bielefeld, 33617, Germany.
| | - Andreas Rogalewski
- Department of Neurology, Evangelisches Krankenhaus, Burgsteig 13, Bielefeld, 33617, Germany.
| | | | - Markus Glatzel
- Institute of Neuropathology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| | - Christian G Bien
- Epilepsy Center Bethel, Krankenhaus Mara, Maraweg 17-21, Bielefeld, 33617, Germany.
| | - Wolf-Rüdiger Schäbitz
- Department of Neurology, Evangelisches Krankenhaus, Burgsteig 13, Bielefeld, 33617, Germany.
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22
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Irani SR, Gelfand JM, Al-Diwani A, Vincent A. Cell-surface central nervous system autoantibodies: clinical relevance and emerging paradigms. Ann Neurol 2014; 76:168-84. [PMID: 24930434 PMCID: PMC4141019 DOI: 10.1002/ana.24200] [Citation(s) in RCA: 139] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Revised: 06/13/2014] [Accepted: 06/13/2014] [Indexed: 01/17/2023]
Abstract
The recent discovery of several potentially pathogenic autoantibodies has helped identify patients with clinically distinctive central nervous system diseases that appear to benefit from immunotherapy. The associated autoantibodies are directed against the extracellular domains of cell-surface-expressed neuronal or glial proteins such as LGI1, N-methyl-D-aspartate receptor, and aquaporin-4. The original descriptions of the associated clinical syndromes were phenotypically well circumscribed. However, as availability of antibody testing has increased, the range of associated patient phenotypes and demographics has expanded. This in turn has led to the recognition of more immunotherapy-responsive syndromes in patients presenting with cognitive and behavioral problems, seizures, movement disorders, psychiatric features, and demyelinating disease. Although antibody detection remains diagnostically important, clinical recognition of these distinctive syndromes should ensure early and appropriate immunotherapy administration. We review the emerging paradigm of cell-surface-directed antibody-mediated neurological diseases, describe how the associated disease spectrums have broadened since the original descriptions, discuss some of the methodological issues regarding techniques for antibody detection and emphasize considerations surrounding immunotherapy administration. As these disorders continue to reach mainstream neurology and even psychiatry, more cell-surface-directed antibodies will be discovered, and their possible relevance to other more common disease presentations should become more clearly defined.
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Affiliation(s)
- Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Multiple Sclerosis and Neuroinflammation Center, Department of Neurology, University of California, San Francisco, San Francisco, CA
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