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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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Peris Sempere V, Luo G, Muñiz-Castrillo S, Pinto AL, Picard G, Rogemond V, Titulaer MJ, Finke C, Leypoldt F, Kuhlenbäumer G, Jones HF, Dale RC, Binks S, Irani SR, Bastiaansen AE, de Vries JM, de Bruijn MAAM, Roelen DL, Kim TJ, Chu K, Lee ST, Kanbayashi T, Pollock NR, Kichula KM, Mumme-Monheit A, Honnorat J, Norman PJ, Mignot E. HLA and KIR genetic association and NK cells in anti-NMDAR encephalitis. Front Immunol 2024; 15:1423149. [PMID: 39050850 PMCID: PMC11266021 DOI: 10.3389/fimmu.2024.1423149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 06/06/2024] [Indexed: 07/27/2024] Open
Abstract
Introduction Genetic predisposition to autoimmune encephalitis with antibodies against N-methyl-D-aspartate receptor (NMDAR) is poorly understood. Given the diversity of associated environmental factors (tumors, infections), we hypothesized that human leukocyte antigen (HLA) and killer-cell immunoglobulin-like receptors (KIR), two extremely polymorphic gene complexes key to the immune system, might be relevant for the genetic predisposition to anti-NMDAR encephalitis. Notably, KIR are chiefly expressed by Natural Killer (NK) cells, recognize distinct HLA class I allotypes and play a major role in anti-tumor and anti-infection responses. Methods We conducted a Genome Wide Association Study (GWAS) with subsequent control-matching using Principal Component Analysis (PCA) and HLA imputation, in a multi-ethnic cohort of anti-NMDAR encephalitis (n=479); KIR and HLA were further sequenced in a large subsample (n=323). PCA-controlled logistic regression was then conducted for carrier frequencies (HLA and KIR) and copy number variation (KIR). HLA-KIR interaction associations were also modeled. Additionally, single cell sequencing was conducted in peripheral blood mononuclear cells from 16 cases and 16 controls, NK cells were sorted and phenotyped. Results Anti-NMDAR encephalitis showed a weak HLA association with DRB1*01:01~DQA1*01:01~DQB1*05:01 (OR=1.57, 1.51, 1.45; respectively), and DRB1*11:01 (OR=1.60); these effects were stronger in European descendants and in patients without an underlying ovarian teratoma. More interestingly, we found increased copy number variation of KIR2DL5B (OR=1.72), principally due to an overrepresentation of KIR2DL5B*00201. Further, we identified two allele associations in framework genes, KIR2DL4*00103 (25.4% vs. 12.5% in controls, OR=1.98) and KIR3DL3*00302 (5.3% vs. 1.3%, OR=4.44). Notably, the ligands of these KIR2DL4 and KIR3DL3, respectively, HLA-G and HHLA2, are known to act as immune checkpoint with immunosuppressive functions. However, we did not find differences in specific KIR-HLA ligand interactions or HLA-G polymorphisms between cases and controls. Similarly, gene expression of CD56dim or CD56bright NK cells did not differ between cases and controls. Discussion Our observations for the first time suggest that the HLA-KIR axis might be involved in anti-NMDAR encephalitis. While the genetic risk conferred by the identified polymorphisms appears small, a role of this axis in the pathophysiology of this disease appears highly plausible and should be analyzed in future studies.
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Affiliation(s)
- Vicente Peris Sempere
- Stanford Center for Sleep Science and Medicine, Stanford University, Palo Alto, CA, United States
| | - Guo Luo
- Stanford Center for Sleep Science and Medicine, Stanford University, Palo Alto, CA, United States
| | - Sergio Muñiz-Castrillo
- Stanford Center for Sleep Science and Medicine, Stanford University, Palo Alto, CA, United States
| | - Anne-Laurie Pinto
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, Lyon, France
| | - Géraldine Picard
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, Lyon, France
| | - Véronique Rogemond
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Carsten Finke
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Leypoldt
- Department of Neurology, Christian-Albrechts-University/University Hospital Schleswig-Holstein, Kiel, Germany
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein Kiel/Lübeck, Kiel, Germany
| | - Gregor Kuhlenbäumer
- Department of Neurology, Christian-Albrechts-University/University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Hannah F. Jones
- Starship Hospital, Centre for Brain Research, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Russell C. Dale
- Kids Neuroscience Centre, Children’s Hospital at Westmead clinical school, University of Sydney, Sydney, NSW, Australia
| | - Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sarosh R. Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Departments of Neurology and Neurosciences, Mayo Clinic, Jacksonville, FL, United States
| | | | - Juna M. de Vries
- Department of Neurology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Dave L. Roelen
- Department of Immunogenetics and Transplantation Immunology, Leiden University Medical Center, Leiden, Netherlands
| | - Tae-Joon Kim
- Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | - Nicholas R. Pollock
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Katherine M. Kichula
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Abigail Mumme-Monheit
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, Lyon, France
| | - Paul J. Norman
- Department of Biomedical Informatics, University of Colorado School of Medicine, Aurora, CO, United States
- Department of Immunology and Microbiology, University of Colorado School of Medicine, Aurora, CO, United States
| | - Emmanuel Mignot
- Stanford Center for Sleep Science and Medicine, Stanford University, Palo Alto, CA, United States
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Almeida FC, Pereira AI, Mendes-Pinto C, Lopes J, Moura J, Sousa JM, Videira G, Samões R, Oliveira TG. MR Imaging Findings in Anti-Leucine-Rich Glioma Inactivated Protein 1 Encephalitis: A Systematic Review and Meta-analysis. AJNR Am J Neuroradiol 2024; 45:977-986. [PMID: 38871367 DOI: 10.3174/ajnr.a8256] [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: 11/14/2023] [Accepted: 02/14/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Antibodies against leucine-rich glioma inactivated protein 1 (LGI1) constitute a common form of autoimmune encephalitis. On MR imaging, it may show T2 FLAIR hyperintensities of the medial temporal lobe (T2 FLAIR-MTL), involve the basal ganglia, or be unremarkable. PURPOSE We performed a systematic review and meta-analysis to obtain prevalence estimates of abnormal findings on MR imaging in anti-LGI1 encephalitis. A human brain map of the LGI1 microarray gene expression was derived from the Allen Human Brain Atlas. DATA SOURCES PubMed and Web of Science were searched with the terms "LGI1" and "encephalitis" from inception to April 7, 2022. STUDY SELECTION Thirty-one research publications, encompassing case series and retrospective cohort and case-control studies, with >10 patients with anti-LGI1 encephalitis and MR imaging data were included. DATA ANALYSIS Pooled prevalence estimates were calculated using Freeman-Tukey double-arcsine transformation. Meta-analysis used DerSimonian and Laird random effects models. DATA SYNTHESIS Of 1318 patients in 30 studies, T2 FLAIR-MTL hyperintensities were present in 54% (95% CI, 0.48-0.60; I2 = 76%). Of 394 patients in 13 studies, 27% showed bilateral (95% CI, 0.19-0.36; I2 = 71%) and 24% unilateral T2 FLAIR-MTL abnormalities (95% CI, 0.17-0.32; I2 = 61%). Of 612 patients in 15 studies, basal ganglia abnormalities were present in 10% (95% CI, 0.06-0.15; I2 = 67%). LGI1 expression was highest in the amygdala, hippocampus, and caudate nucleus. LIMITATIONS Only part of the spectrum of MR imaging abnormalities in anti-LGI1 encephalitis could be included in a meta-analysis. MR imaging findings were not the main outcomes in most studies, limiting available information. I2 values ranged from 62% to 76%, representing moderate-to-large heterogeneity. CONCLUSIONS T2 FLAIR-MTL hyperintensities were present in around one-half of patients with anti-LGI1. The prevalence of unilateral and bilateral presentations was similar, suggesting unilaterality should raise the suspicion of this disease in the appropriate clinical context. Around 10% of patients showed basal ganglia abnormalities, indicating that special attention should be given to this region. LGI1 regional expression coincided with the most frequently reported abnormal findings on MR imaging. Regional specificity might be partially determined by expression levels of the target protein.
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Affiliation(s)
- Francisco C Almeida
- From the Department of Neuroradiology (F.C.A., A.I.P., C.M.-P.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Life and Health Sciences Research Institute (F.C.A., T.G.O.), School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute/3B's-PT Government Associate Laboratory (F.C.A., T.G.O.), Braga/Guimarães, Portugal
| | - Ana I Pereira
- From the Department of Neuroradiology (F.C.A., A.I.P., C.M.-P.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Catarina Mendes-Pinto
- From the Department of Neuroradiology (F.C.A., A.I.P., C.M.-P.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Joana Lopes
- Department of Neurology (J.L., J.M., G.V., R.S.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - João Moura
- Department of Neurology (J.L., J.M., G.V., R.S.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - José Maria Sousa
- Department of Neuroradiology (J.M.S.), Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Gonçalo Videira
- Department of Neurology (J.L., J.M., G.V., R.S.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Raquel Samões
- Department of Neurology (J.L., J.M., G.V., R.S.), Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (R.S.), Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Tiago Gil Oliveira
- Life and Health Sciences Research Institute (F.C.A., T.G.O.), School of Medicine, University of Minho, Braga, Portugal
- Life and Health Sciences Research Institute/3B's-PT Government Associate Laboratory (F.C.A., T.G.O.), Braga/Guimarães, Portugal
- Department of Neuroradiology (T.G.O.), Hospital de Braga, Braga, Portugal
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Papi C, Milano C, Spatola M. Mechanisms of autoimmune encephalitis. Curr Opin Neurol 2024; 37:305-315. [PMID: 38667756 DOI: 10.1097/wco.0000000000001270] [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: 04/30/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the pathogenic mechanisms involved in autoimmune encephalitides mediated by antibodies against neuronal surface antigens, with a focus on NMDAR and LGI1 encephalitis. RECENT FINDINGS In antibody-mediated encephalitides, binding of IgG antibodies to neuronal surface antigens results in different pathogenic effects depending on the type of antibody, IgG subclass and epitope specificity. NMDAR IgG1 antibodies cause crosslinking and internalization of the target, synaptic and brain circuitry alterations, as well as alterations of NMDAR expressing oligodendrocytes, suggesting a link with white matter lesions observed in MRI studies. LGI1 IgG4 antibodies, instead, induce neuronal dysfunction by disrupting the interaction with cognate proteins and altering AMPAR-mediated signaling. In-vitro findings have been corroborated by memory and behavioral changes in animal models obtained by passive transfer of patients' antibodies or active immunization. These models have been fundamental to identify targets for innovative therapeutic strategies, aimed at counteracting or preventing antibody effects, such as the use of soluble ephrin-B2, NMDAR modulators (e.g., pregnenolone, SGE-301) or chimeric autoantibody receptor T cells (CAART) in models of NMDAR encephalitis. SUMMARY A deep understanding of the pathogenic mechanisms underlying antibody-mediated encephalitides is crucial for the development of new therapeutic approaches targeting brain autoimmunity.
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Affiliation(s)
- Claudia Papi
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
| | - Chiara Milano
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Spatola
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
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Muñiz-Castrillo S, Honnorat J. Genetic predisposition to autoimmune encephalitis and paraneoplastic neurological syndromes. Curr Opin Neurol 2024; 37:329-337. [PMID: 38483154 DOI: 10.1097/wco.0000000000001263] [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: 04/30/2024]
Abstract
PURPOSE OF REVIEW We summarize the recent discoveries on genetic predisposition to autoimmune encephalitis and paraneoplastic neurological syndromes (PNS), emphasizing clinical and pathophysiological implications. RECENT FINDINGS The human leukocyte antigen (HLA) is the most studied genetic factor in autoimmune encephalitis and PNS. The HLA haplotype 8.1, which is widely known to be related to systemic autoimmunity, has been only weakly associated with a few types of autoimmune encephalitis and PNS. However, the strongest and most specific associations have been reported in a subgroup of autoimmune encephalitis that comprises antileucine-rich glioma-inactivated 1 (LGI1) limbic encephalitis, associated with DRB1∗07 : 01 , anticontactin-associated protein-like 2 (CASPR2) limbic encephalitis, associated with DRB1∗11 : 01 , and anti-IgLON5 disease, associated with DRB1∗10 : 01∼DQA1∗01∼DQB1∗05 . Non-HLA genes have been poorly investigated so far in autoimmune encephalitis, mainly in those lacking HLA associations such as anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, with only a few genome-wide association studies (GWAS) reporting equivocal results principally limited by small sample size. SUMMARY Genetic predisposition seems to be driven mostly by HLA in a group of autoimmune encephalitis characterized by being nonparaneoplastic and having predominantly IgG4 autoantibodies. The contribution of non-HLA genes, especially in those diseases lacking known or strong HLA associations, will require large cohorts enabling GWAS to be powerful enough to render meaningful results.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California, USA
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- MeLiS Institute - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
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Lamblin F, Kerstens J, Muñiz-Castrillo S, Vogrig A, Goncalves D, Rogemond V, Picard G, Villard M, Pinto AL, Van Coevorden-Hameete MH, De Bruijn MA, De Vries JM, Schreurs M, Tyvaert L, Hopes L, Aupy J, Marchal C, Psimaras D, Kremer L, Bourg V, Antoine JCG, Wang A, Kahane P, Demeret S, Ahle G, Sempere VP, Timestit N, Nourredine M, Maureille A, Benaiteau M, Joubert B, Mignot E, Titulaer MJ, Honnorat J. Comparative Study of Paraneoplastic and Nonparaneoplastic Autoimmune Encephalitis With GABA BR Antibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200229. [PMID: 38657198 PMCID: PMC11087025 DOI: 10.1212/nxi.0000000000200229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/29/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND AND OBJECTIVES While patients with paraneoplastic autoimmune encephalitis (AE) with gamma-aminobutyric-acid B receptor antibodies (GABABR-AE) have poor functional outcomes and high mortality, the prognosis of nonparaneoplastic cases has not been well studied. METHODS Patients with GABABR-AE from the French and the Dutch Paraneoplastic Neurologic Syndromes Reference Centers databases were retrospectively included and their data collected; the neurologic outcomes of paraneoplastic and nonparaneoplastic cases were compared. Immunoglobulin G (IgG) isotyping and human leukocyte antigen (HLA) genotyping were performed in patients with available samples. RESULTS A total of 111 patients (44/111 [40%] women) were enrolled, including 84 of 111 (76%) paraneoplastic and 18 of 111 (16%) nonparaneoplastic cases (cancer status was undetermined for 9 patients). Patients presented with seizures (88/111 [79%]), cognitive impairment (54/111 [49%]), and/or behavioral disorders (34/111 [31%]), and 54 of 111 (50%) were admitted in intensive care unit (ICU). Nonparaneoplastic patients were significantly younger (median age 54 years [range 19-88] vs 67 years [range 50-85] for paraneoplastic cases, p < 0.001) and showed a different demographic distribution. Nonparaneoplastic patients more often had CSF pleocytosis (17/17 [100%] vs 58/78 [74%], p = 0.02), were almost never associated with KTCD16-abs (1/16 [6%] vs 61/70 [87%], p < 0.001), and were more frequently treated with second-line immunotherapy (11/18 [61%] vs 18/82 [22%], p = 0.003). However, no difference of IgG subclass or HLA association was observed, although sample size was small (10 and 26 patients, respectively). After treatment, neurologic outcome was favorable (mRS ≤2) for 13 of 16 (81%) nonparaneoplastic and 37 of 84 (48%) paraneoplastic cases (p = 0.03), while 3 of 18 (17%) and 42 of 83 (51%) patients had died at last follow-up (p = 0.008), respectively. Neurologic outcome no longer differed after adjustment for confounding factors but seemed to be negatively associated with increased age and ICU admission. A better survival was associated with nonparaneoplastic cases, a younger age, and the use of immunosuppressive drugs. DISCUSSION Nonparaneoplastic GABABR-AE involved younger patients without associated KCTD16-abs and carried better neurologic and vital prognoses than paraneoplastic GABABR-AE, which might be due to a more intensive treatment strategy. A better understanding of immunologic mechanisms underlying both forms is needed.
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Affiliation(s)
- Florian Lamblin
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Jeroen Kerstens
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Sergio Muñiz-Castrillo
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Alberto Vogrig
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - David Goncalves
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Veronique Rogemond
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Geraldine Picard
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Marine Villard
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Anne-Laurie Pinto
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Marleen H Van Coevorden-Hameete
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Marienke A De Bruijn
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Juna M De Vries
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Marco Schreurs
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Louise Tyvaert
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Lucie Hopes
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Jerome Aupy
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Cecile Marchal
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Dimitri Psimaras
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Laurent Kremer
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Veronique Bourg
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Jean-Christophe G Antoine
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Adrien Wang
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Philippe Kahane
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Sophie Demeret
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Guido Ahle
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Vicente Peris Sempere
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Noemie Timestit
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Mikail Nourredine
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Aurelien Maureille
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Marie Benaiteau
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Bastien Joubert
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Emmanuel Mignot
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Maarten J Titulaer
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
| | - Jerome Honnorat
- From the French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Hospices Civils de Lyon; Institut MeLiS INSERM U1314/CNRS UMR 5284 (F.L., V.R., G.P., M.V., A.-L.P., M.B., B.J., J.H.), Université Claude Bernard Lyon 1; Department of Neurology (F.L.), University Hospital of La Réunion, Saint-Pierre (La Réunion), France; Department of Neurology (J.K., M.H.V.C.-H., M.A.D.B., J.M.V., M.J.T.), Erasmus Medical Center, Rotterdam, The Netherlands; Stanford Center for Sleep Sciences and Medicine (S.M.-C., V.P.S., E.M.), Stanford University, Palo Alto, CA; Clinical Neurology (A.V.), Department of Neurosciences, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine Medical School, Italy; Department of Immunology (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; Department of Immunology (M.S.), Laboratory Medical Immunology, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Neurology (L.T., L.H.), University Hospital of Nancy; Department of Clinical Neurosciences (J.A., C.M.), University Hospital of Bordeaux, Bordeaux, France; Department of Neuro-Oncology (D.P.), Pitié Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (L.K.), University Hospital of Strasbourg; Department of Neurology (V.B.), Côte d'Azur University, Nice; Department of Neurology (J.-C.G.A.), University Hospital of Saint-Etienne; Stroke Center Neurology Division (A.W.), Hopital Foch, Suresnes; University Grenoble Alpes (P.K.), Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences; Neurological Intensive Care Unit (S.D.), Pitié-Salpêtrière Hospital, AP-HP, Paris; Department of Neurology (G.A.), Hôpitaux Civils de Colmar; Department of Public Health (N.T., M.N.), Hospices Civils de Lyon; and Department of Medicine (A.M.), Centre Leon Berard, UNICANCER, Lyon, France
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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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8
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Ünlü S, Sánchez Navarro BG, Cakan E, Berchtold D, Meleka Hanna R, Vural S, Vural A, Meisel A, Fichtner ML. Exploring the depths of IgG4: insights into autoimmunity and novel treatments. Front Immunol 2024; 15:1346671. [PMID: 38698867 PMCID: PMC11063302 DOI: 10.3389/fimmu.2024.1346671] [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: 11/29/2023] [Accepted: 02/29/2024] [Indexed: 05/05/2024] Open
Abstract
IgG4 subclass antibodies represent the rarest subclass of IgG antibodies, comprising only 3-5% of antibodies circulating in the bloodstream. These antibodies possess unique structural features, notably their ability to undergo a process known as fragment-antigen binding (Fab)-arm exchange, wherein they exchange half-molecules with other IgG4 antibodies. Functionally, IgG4 antibodies primarily block and exert immunomodulatory effects, particularly in the context of IgE isotype-mediated hypersensitivity reactions. In the context of disease, IgG4 antibodies are prominently observed in various autoimmune diseases combined under the term IgG4 autoimmune diseases (IgG4-AID). These diseases include myasthenia gravis (MG) with autoantibodies against muscle-specific tyrosine kinase (MuSK), nodo-paranodopathies with autoantibodies against paranodal and nodal proteins, pemphigus vulgaris and foliaceus with antibodies against desmoglein and encephalitis with antibodies against LGI1/CASPR2. Additionally, IgG4 antibodies are a prominent feature in the rare entity of IgG4 related disease (IgG4-RD). Intriguingly, both IgG4-AID and IgG4-RD demonstrate a remarkable responsiveness to anti-CD20-mediated B cell depletion therapy (BCDT), suggesting shared underlying immunopathologies. This review aims to provide a comprehensive exploration of B cells, antibody subclasses, and their general properties before examining the distinctive characteristics of IgG4 subclass antibodies in the context of health, IgG4-AID and IgG4-RD. Furthermore, we will examine potential therapeutic strategies for these conditions, with a special focus on leveraging insights gained from anti-CD20-mediated BCDT. Through this analysis, we aim to enhance our understanding of the pathogenesis of IgG4-mediated diseases and identify promising possibilities for targeted therapeutic intervention.
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Affiliation(s)
- Selen Ünlü
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Türkiye
- Koç University School of Medicine, Istanbul, Türkiye
| | - Blanca G. Sánchez Navarro
- Department of Neurology with Experimental Neurology, Integrated Myasthenia Gravis Center, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Elif Cakan
- Ragon Institute of Massachusetts General Hospital, Massachusetts Institute of Technology and Harvard University, Cambridge, MA, United States
| | - Daniel Berchtold
- Department of Neurology with Experimental Neurology, Integrated Myasthenia Gravis Center, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Rafael Meleka Hanna
- Department of Neurology with Experimental Neurology, Integrated Myasthenia Gravis Center, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Secil Vural
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Türkiye
- Department of Dermatology and Venereology, Koç University School of Medicine, İstanbul, Türkiye
| | - Atay Vural
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Türkiye
- Department of Neurology, Koç University School of Medicine, İstanbul, Türkiye
| | - Andreas Meisel
- Department of Neurology with Experimental Neurology, Integrated Myasthenia Gravis Center, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Miriam L. Fichtner
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Türkiye
- Department of Neurology with Experimental Neurology, Integrated Myasthenia Gravis Center, Neuroscience Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany
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9
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Li S, Hu X, Wang M, Yu L, Zhang Q, Xiao J, Hong Z, Zhou D, Li J. Single-cell RNA sequencing reveals diverse B cell phenotypes in patients with anti-NMDAR encephalitis. Psychiatry Clin Neurosci 2024; 78:197-208. [PMID: 38063052 DOI: 10.1111/pcn.13627] [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: 06/06/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUNDS Anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) is a severe autoimmune disorder characterized by prominent psychiatric symptoms. Although the role of NMDAR antibodies in the disease has been extensively studied, the phenotype of B cell subsets is still not fully understood. METHODS We utilized single-cell RNA sequencing, single-cell B cell receptor sequencing (scBCR-seq), bulk BCR sequencing, flow cytometry, and enzyme-linked immunosorbent assay to analyze samples from both NMDAR-E patients and control individuals. RESULTS The cerebrospinal fluid (CSF) of NMDAR-E patients showed significantly increased B cell counts, predominantly memory B (Bm) cells. CSF Bm cells in NMDAR-E patients exhibited upregulated expression of differential expression genes (DEGs) associated with immune regulatory function (TNFRSF13B and ITGB1), whereas peripheral B cells upregulated DEGs related to antigen presentation. Additionally, NMDAR-E patients displayed higher levels of IgD- CD27- double negative (DN) cells and DN3 cells in peripheral blood (PB). In vitro, DN1 cell subsets from NMDAR-E patients differentiated into DN2 and DN3 cells, while CD27+ and/or IgD+ B cells (non-DN) differentiated into antibody-secreting cells (ASCs) and DN cells. NR1-IgG antibodies were found in B cell culture supernatants from patients. Differential expression of B cell IGHV genes in CSF and PB of NMDAR-E patients suggests potential antigen class switching. CONCLUSION B cell subpopulations in the CSF and PB of NMDAR-E patients exhibit distinct compositions and transcriptomic features. In vitro, non-DN cells from NMDAR-E can differentiate into DN cells and ASCs, potentially producing NR1-IgG antibodies. Further research is necessary to investigate the potential contribution of DN cell subpopulations to NR1-IgG antibody production.
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Affiliation(s)
- Sisi Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Breast Cancer, Chongqing University Cancer Hospital, Chongqing, China
| | - Xiang Hu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Minjin Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Luoting Yu
- State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Xiao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinmei Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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10
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Shim YM, Kim SI, Lim SD, Lee K, Kim EE, Won JK, Park SH. An Autopsy-proven Case-based Review of Autoimmune Encephalitis. Exp Neurobiol 2024; 33:1-17. [PMID: 38471800 PMCID: PMC10938074 DOI: 10.5607/en23036] [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: 10/16/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Autoimmune encephalitis (AIE) is a type of immunoreactive encephalitic disorder and is recognized as the most prevalent noninfectious encephalitis. Nevertheless, the rarity of definitive AIE diagnosis through biopsy or autopsy represents a significant hurdle to understanding and managing the disease. In this article, we present the pathological findings of AIE and review the literature based on a distinct case of AIE presenting as CD8+ T-lymphocyte predominant encephalitis. We describe the clinical progression, diagnostic imaging, laboratory data, and autopsy findings of an 80-year-old deceased male patient. The patient was diagnosed with pulmonary tuberculosis 6 months before death and received appropriate medications. A week before admission to the hospital, the patient manifested symptoms such as a tendency to sleep, decreased appetite, and confusion. Although the patient temporally improved with medication including correction of hyponatremia, the patient progressed rapidly and died in 6 weeks. The brain tissue revealed lymphocytic infiltration in the gray and white matter, leptomeninges, and perivascular infiltration with a predominance of CD8+ T lymphocytes, suggesting a case of AIE. There was no detectable evidence of viral infection or underlying neoplasm. The autopsy revealed that this patient also had Alzheimer's disease, atherosclerosis, arteriolosclerosis, and aging-related tau astrogliopathy. This report emphasizes the pivotal role of pathological examination in the diagnosis of AIE, especially when serological autoantibody testing is not available or when a patient is suspected of having multiple diseases.
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Affiliation(s)
- Yu-Mi Shim
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Seong-Ik Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - So Dug Lim
- Department of Pathology, KonKuk University School of Medicine, Seoul 05029, Korea
| | - Kwanghoon Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Eric Eunshik Kim
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Jae Kyung Won
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University College of Medicine, Seoul 03080, Korea
- Institute of Neuroscience, Seoul National University College of Medicine, Seoul 03080, Korea
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11
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Dalmau J. Changing landscape in the field of paraneoplastic neurology: Personal perspectives over a 35-year career. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:11-32. [PMID: 38494272 DOI: 10.1016/b978-0-12-823912-4.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes are a group of rare disorders that have fascinated neurologists for more than a century. The discovery in the 1980s that many of these disorders occurred in association with antibodies against neuronal proteins revived the interest for these diseases. This chapter first traces the history of the paraneoplastic neurologic syndromes during the era that preceded the discovery of immune mechanisms and then reviews the immunologic period during which many of these syndromes were found to be associated with antibodies against intracellular onconeuronal proteins and pathogenic cytotoxic T-cell mechanisms. Alongside these developments, investigations on the antibody-mediated disorders of the peripheral nervous system, such as the myasthenic syndromes or neuromyotonia, provided suggestions for the study of the central nervous system (CNS) syndromes. These converging areas of research culminated with the groundbreaking discovery of a new category of CNS disorders mediated by antibodies against neuronal surface proteins or receptors. These disorders are not always paraneoplastic, and the understanding of these syndromes and mechanisms has changed the landscape of neurology and neurosciences.
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Affiliation(s)
- Josep Dalmau
- IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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12
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Jang Y, Lee K, Lee C, Chu K, Lee SK, Won J, Lee S. Teratoma pathology and genomics in anti-NMDA receptor encephalitis. Ann Clin Transl Neurol 2024; 11:225-234. [PMID: 37986706 PMCID: PMC10791014 DOI: 10.1002/acn3.51948] [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: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Ovarian teratoma is a common occurrence in patients with anti-NMDA receptor encephalitis (NMDARe), and its removal is crucial for a favorable prognosis. However, the initial pathogenesis of autoimmunity in the encephalitic teratoma remains unclear. In this study, we aimed to investigate the genomic landscape and microscopic findings by comparing NMDARe-associated teratomas and non-encephalitic control teratomas. MATERIALS AND METHODS A prospective consecutive cohort of 84 patients with NMDARe was recruited from January 2014 to April 2020, and among them, patients who received teratoma removal surgery at Seoul National University Hospital were enrolled. We conducted a comparison of whole-exome sequencing data and pathologic findings between NMDARe-associated teratomas and control teratomas. RESULTS We found 18 NMDARe-associated teratomas from 15 patients and compared them with 17 non-encephalitic control teratomas. Interestingly, the genomic analysis revealed no significant differences in mutations between encephalitic and non-encephalitic teratomas. Pathologic analysis showed no discrepancies in terms of the presence of neuronal tissue and lymphocytic infiltration between the encephalitic teratomas (n = 14) and non-encephalitic teratomas (n = 18). However, rituximab-naïve encephalitic teratomas exhibited a higher frequency of germinal center formation compared to non-encephalitic teratomas (80% vs. 16.7%, P = 0.017). Additionally, rituximab-treated encephalitic teratomas demonstrated a reduced number of CD20+ cells and germinal centers in comparison to rituximab-naïve encephalitic teratomas (P = 0.048 and 0.023, respectively). DISCUSSION These results suggest that the initiation of immunopathogenesis in NMDARe-associated teratoma is not primarily attributed to intrinsic tumor mutations, but rather to immune factors present in the encephalitic patient group, ultimately leading to germinal center formation within the teratoma.
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Affiliation(s)
- Yoonhyuk Jang
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Kwanghoon Lee
- Department of PathologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Cheol Lee
- Department of PathologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Kon Chu
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Sang Kun Lee
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Jae‐Kyung Won
- Department of PathologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
| | - Soon‐Tae Lee
- Department of NeurologySeoul National University Hospital, Seoul National University College of MedicineSeoulSouth Korea
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13
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Masciocchi S, Businaro P, Scaranzin S, Morandi C, Franciotta D, Gastaldi M. General features, pathogenesis, and laboratory diagnostics of autoimmune encephalitis. Crit Rev Clin Lab Sci 2024; 61:45-69. [PMID: 37777038 DOI: 10.1080/10408363.2023.2247482] [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: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Autoimmune encephalitis (AE) is a group of inflammatory conditions that can associate with the presence of antibodies directed to neuronal intracellular, or cell surface antigens. These disorders are increasingly recognized as an important differential diagnosis of infectious encephalitis and of other common neuropsychiatric conditions. Autoantibody diagnostics plays a pivotal role for accurate diagnosis of AE, which is of utmost importance for the prompt recognition and early treatment. Several AE subgroups can be identified, either according to the prominent clinical phenotype, presence of a concomitant tumor, or type of neuronal autoantibody, and recent diagnostic criteria have provided important insights into AE classification. Antibodies to neuronal intracellular antigens typically associate with paraneoplastic neurological syndromes and poor prognosis, whereas antibodies to synaptic/neuronal cell surface antigens characterize many AE subtypes that associate with tumors less frequently, and that are often immunotherapy-responsive. In addition to the general features of AE, we review current knowledge on the pathogenic mechanisms underlying these disorders, focusing mainly on the potential role of neuronal antibodies in the most frequent conditions, and highlight current theories and controversies. Then, we dissect the crucial aspects of the laboratory diagnostics of neuronal antibodies, which represents an actual challenge for both pathologists and neurologists. Indeed, this diagnostics entails technical difficulties, along with particularly interesting novel features and pitfalls. The novelties especially apply to the wide range of assays used, including specific tissue-based and cell-based assays. These assays can be developed in-house, usually in specialized laboratories, or are commercially available. They are widely used in clinical immunology and in clinical chemistry laboratories, with relevant differences in analytic performance. Indeed, several data indicate that in-house assays could perform better than commercial kits, notwithstanding that the former are based on non-standardized protocols. Moreover, they need expertise and laboratory facilities usually unavailable in clinical chemistry laboratories. Together with the data of the literature, we critically evaluate the analytical performance of the in-house vs commercial kit-based approach. Finally, we propose an algorithm aimed at integrating the present strategies of the laboratory diagnostics in AE for the best clinical management of patients with these disorders.
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Affiliation(s)
- Stefano Masciocchi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Pietro Businaro
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Morandi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
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14
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Chen K, Yang L, Xu L, Jiang Y, He J. Ofatumumab for the treatment of refractory anti-LGI1 encephalitis with long-term poor blood glucose control in type 1 diabetes. CNS Neurosci Ther 2023; 29:4172-4174. [PMID: 37602875 PMCID: PMC10651958 DOI: 10.1111/cns.14416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/05/2023] [Accepted: 08/07/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Kaili Chen
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Le Yang
- Department of EndocrinologyJilin Province People's HospitalChangchunChina
| | - Lei Xu
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Yan Jiang
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
| | - Jinting He
- Department of NeurologyChina‐Japan Union Hospital of Jilin UniversityChangchunChina
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15
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Stevelink R, Campbell C, Chen S, Abou-Khalil B, Adesoji OM, Afawi Z, Amadori E, Anderson A, Anderson J, Andrade DM, Annesi G, Auce P, Avbersek A, Bahlo M, Baker MD, Balagura G, Balestrini S, Barba C, Barboza K, Bartolomei F, Bast T, Baum L, Baumgartner T, Baykan B, Bebek N, Becker AJ, Becker F, Bennett CA, Berghuis B, Berkovic SF, Beydoun A, Bianchini C, Bisulli F, Blatt I, Bobbili DR, Borggraefe I, Bosselmann C, Braatz V, Bradfield JP, Brockmann K, Brody LC, Buono RJ, Busch RM, Caglayan H, Campbell E, Canafoglia L, Canavati C, Cascino GD, Castellotti B, Catarino CB, Cavalleri GL, Cerrato F, Chassoux F, Cherny SS, Cheung CL, Chinthapalli K, Chou IJ, Chung SK, Churchhouse C, Clark PO, Cole AJ, Compston A, Coppola A, Cosico M, Cossette P, Craig JJ, Cusick C, Daly MJ, Davis LK, de Haan GJ, Delanty N, Depondt C, Derambure P, Devinsky O, Di Vito L, Dlugos DJ, Doccini V, Doherty CP, El-Naggar H, Elger CE, Ellis CA, Eriksson JG, Faucon A, Feng YCA, Ferguson L, Ferraro TN, Ferri L, Feucht M, Fitzgerald M, Fonferko-Shadrach B, Fortunato F, Franceschetti S, Franke A, French JA, Freri E, Gagliardi M, Gambardella A, Geller EB, Giangregorio T, Gjerstad L, Glauser T, Goldberg E, Goldman A, Granata T, Greenberg DA, Guerrini R, Gupta N, Haas KF, Hakonarson H, Hallmann K, Hassanin E, Hegde M, Heinzen EL, Helbig I, Hengsbach C, Heyne HO, Hirose S, Hirsch E, Hjalgrim H, Howrigan DP, Hucks D, Hung PC, Iacomino M, Imbach LL, Inoue Y, Ishii A, Jamnadas-Khoda J, Jehi L, Johnson MR, Kälviäinen R, Kamatani Y, Kanaan M, Kanai M, Kantanen AM, Kara B, Kariuki SM, Kasperavičiūte D, Kasteleijn-Nolst Trenite D, Kato M, Kegele J, Kesim Y, Khoueiry-Zgheib N, King C, Kirsch HE, Klein KM, Kluger G, Knake S, Knowlton RC, Koeleman BPC, Korczyn AD, Koupparis A, Kousiappa I, Krause R, Krenn M, Krestel H, Krey I, Kunz WS, Kurki MI, Kurlemann G, Kuzniecky R, Kwan P, Labate A, Lacey A, Lal D, Landoulsi Z, Lau YL, Lauxmann S, Leech SL, Lehesjoki AE, Lemke JR, Lerche H, Lesca G, Leu C, Lewin N, Lewis-Smith D, Li GHY, Li QS, Licchetta L, Lin KL, Lindhout D, Linnankivi T, Lopes-Cendes I, Lowenstein DH, Lui CHT, Madia F, Magnusson S, Marson AG, May P, McGraw CM, Mei D, Mills JL, Minardi R, Mirza N, Møller RS, Molloy AM, Montomoli M, Mostacci B, Muccioli L, Muhle H, Müller-Schlüter K, Najm IM, Nasreddine W, Neale BM, Neubauer B, Newton CRJC, Nöthen MM, Nothnagel M, Nürnberg P, O’Brien TJ, Okada Y, Ólafsson E, Oliver KL, Özkara C, Palotie A, Pangilinan F, Papacostas SS, Parrini E, Pato CN, Pato MT, Pendziwiat M, Petrovski S, Pickrell WO, Pinsky R, Pippucci T, Poduri A, Pondrelli F, Powell RHW, Privitera M, Rademacher A, Radtke R, Ragona F, Rau S, Rees MI, Regan BM, Reif PS, Rhelms S, Riva A, Rosenow F, Ryvlin P, Saarela A, Sadleir LG, Sander JW, Sander T, Scala M, Scattergood T, Schachter SC, Schankin CJ, Scheffer IE, Schmitz B, Schoch S, Schubert-Bast S, Schulze-Bonhage A, Scudieri P, Sham P, Sheidley BR, Shih JJ, Sills GJ, Sisodiya SM, Smith MC, Smith PE, Sonsma ACM, Speed D, Sperling MR, Stefansson H, Stefansson K, Steinhoff BJ, Stephani U, Stewart WC, Stipa C, Striano P, Stroink H, Strzelczyk A, Surges R, Suzuki T, Tan KM, Taneja RS, Tanteles GA, Taubøll E, Thio LL, Thomas GN, Thomas RH, Timonen O, Tinuper P, Todaro M, Topaloğlu P, Tozzi R, Tsai MH, Tumiene B, Turkdogan D, Unnsteinsdóttir U, Utkus A, Vaidiswaran P, Valton L, van Baalen A, Vetro A, Vining EPG, Visscher F, von Brauchitsch S, von Wrede R, Wagner RG, Weber YG, Weckhuysen S, Weisenberg J, Weller M, Widdess-Walsh P, Wolff M, Wolking S, Wu D, Yamakawa K, Yang W, Yapıcı Z, Yücesan E, Zagaglia S, Zahnert F, Zara F, Zhou W, Zimprich F, Zsurka G, Zulfiqar Ali Q. GWAS meta-analysis of over 29,000 people with epilepsy identifies 26 risk loci and subtype-specific genetic architecture. Nat Genet 2023; 55:1471-1482. [PMID: 37653029 PMCID: PMC10484785 DOI: 10.1038/s41588-023-01485-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2023] [Indexed: 09/02/2023]
Abstract
Epilepsy is a highly heritable disorder affecting over 50 million people worldwide, of which about one-third are resistant to current treatments. Here we report a multi-ancestry genome-wide association study including 29,944 cases, stratified into three broad categories and seven subtypes of epilepsy, and 52,538 controls. We identify 26 genome-wide significant loci, 19 of which are specific to genetic generalized epilepsy (GGE). We implicate 29 likely causal genes underlying these 26 loci. SNP-based heritability analyses show that common variants explain between 39.6% and 90% of genetic risk for GGE and its subtypes. Subtype analysis revealed markedly different genetic architectures between focal and generalized epilepsies. Gene-set analyses of GGE signals implicate synaptic processes in both excitatory and inhibitory neurons in the brain. Prioritized candidate genes overlap with monogenic epilepsy genes and with targets of current antiseizure medications. Finally, we leverage our results to identify alternate drugs with predicted efficacy if repurposed for epilepsy treatment.
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16
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Varley JA, Strippel C, Handel A, Irani SR. Autoimmune encephalitis: recent clinical and biological advances. J Neurol 2023; 270:4118-4131. [PMID: 37115360 PMCID: PMC10345035 DOI: 10.1007/s00415-023-11685-3] [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] [Received: 03/03/2023] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
In 2015, we wrote a review in The Journal of Neurology summarizing the field of autoantibody-associated neurological diseases. Now, in 2023, we present an update of the subject which reflects the rapid expansion and refinement of associated clinical phenotypes, further autoantibody discoveries, and a more detailed understanding of immunological and neurobiological pathophysiological pathways which mediate these diseases. Increasing awareness around distinctive aspects of their clinical phenotypes has been a key driver in providing clinicians with a better understanding as to how these diseases are best recognized. In clinical practice, this recognition supports the administration of often effective immunotherapies, making these diseases 'not to miss' conditions. In parallel, there is a need to accurately assess patient responses to these drugs, another area of growing interest. Feeding into clinical care are the basic biological underpinnings of the diseases, which offer clear pathways to improved therapies toward enhanced patient outcomes. In this update, we aim to integrate the clinical diagnostic pathway with advances in patient management and biology to provide a cohesive view on how to care for these patients in 2023, and the future.
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Affiliation(s)
- James A Varley
- Department of Brain Sciences, Charing Cross Hospital, Imperial College London, Fulham Palace Road, London, W6 8RF, UK
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
| | - Christine Strippel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Adam Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Level 3, West Wing, John Radcliffe Hospital, Oxford, OX3 9DS, UK.
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, OX3 9DU, UK.
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Schiff P, Muñiz-Castrillo S, Do LD, Fantini ML, Chanson E, Rogemond V, Honnorat J, Poncet-Megemont L. Anti-LGI1 Encephalitis With Co-occurring IgLON5 Antibodies: Clinical Features and Human Leukocyte Antigen Haplotypes. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200126. [PMID: 37217310 DOI: 10.1212/nxi.0000000000200126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/31/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVES Autoimmune encephalitis (AE) with antibodies against LGI1 and IgLON5 are clinically distinctive but share some particularities such as a strong association with specific human leukocyte antigen (HLA) class II alleles. METHODS We clinically describe a patient with double positivity for LGI1 and IgLON5 antibodies. In addition, we conducted specific immunodepletion with the patient's serum and HLA typing and investigated the presence of serum IgLON5 antibodies in a cohort of 23 anti-LGI1 patients carrying the HLA predisposing for anti-IgLON5 encephalitis. RESULTS A 70-year-old woman with a history of lymphoepithelial thymoma presented with subacute cognitive impairment and seizures. Investigations included MRI and EEG showing medial temporal involvement, increased CSF protein content, and polysomnography with REM and non-REM motor activity, along with obstructive apnea. Neural antibody testing revealed both LGI1 and IgLON5 antibodies in serum and CSF, and serum immunodepletion ruled out cross-reactivity. The patient carried DRB1*07:01 and DQA1*01:01∼DQB1*05:01, but no other IgLON5-positive case was identified in a cohort of anti-LGI1 patients carrying DQA1*01∼DQB1*05. Nearly full therapeutic response was obtained after intensified immunosuppressive treatment. DISCUSSION We present a case of anti-LGI1 encephalitis with concomitant IgLON5 antibodies. Co-occurring IgLON5 antibodies in anti-LGI1 encephalitis are exceptional, but may appear in genetically predisposed individuals.
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Affiliation(s)
- Pierre Schiff
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Sergio Muñiz-Castrillo
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Le Duy Do
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Maria Livia Fantini
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Eve Chanson
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Veronique Rogemond
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Jerome Honnorat
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France
| | - Louis Poncet-Megemont
- From the Neurology Department (P.S., M.L.F., E.C., L.P.-M.), University Hospital of Clermont-Ferrand; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.D.D., V.R., J.H.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (S.M.-C., L.D.D., V.R., J.H.), Université Claude Bernard Lyon 1, France; Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA; Sleep and EEG (M.L.F.), Neurophysiology Unit, University Hospital and UMR 6602- Université Clermont Auvergne, CNRS, Institute Pascal; and UMR 1107 Inserm (L.P.-M.), Neuro-Dol, Clermont-Ferrand, France.
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Tadros AR, Atteh G, Vargas DL, Cole EF, Feldman RJ. Autoimmune encephalitis associated with autoimmune blistering diseases: A case series and retrospective review. JAAD Case Rep 2023; 37:92-97. [PMID: 37360651 PMCID: PMC10285499 DOI: 10.1016/j.jdcr.2023.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Affiliation(s)
- Andrew R. Tadros
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - George Atteh
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Diana L. Vargas
- Department of Neurology, Emory University School of Medicine, Atlanta, Georgia
| | - Emily F. Cole
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Ron J. Feldman
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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19
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Segal Y, Nisnboym M, Regev K, Arnon K, Kolb H, Fahoum F, Aizenstein O, Paran Y, Louzoun Y, Israeli S, Loewenthal R, Svetlitzky N, Alcalay Y, Raphael I, Gadoth A. New Insights on DR and DQ Human Leukocyte Antigens in Anti-LGI1 Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200103. [PMID: 36973076 PMCID: PMC10042442 DOI: 10.1212/nxi.0000000000200103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 01/26/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND AND OBJECTIVES To explore the clinical characteristics and HLA associations of patients with anti-leucine-rich glioma-inactivated 1 encephalitis (LGI1E) from a large single center in Israel. Anti-LGI1E is the most commonly diagnosed antibody-associated encephalitic syndrome in adults. Recent studies of various populations reveal significant associations with specific HLA genes. We examined the clinical characteristics and HLA associations of a cohort of Israeli patients. METHODS Seventeen consecutive patients with anti-LGI1E diagnosed at Tel Aviv Medical Center between the years 2011 and 2018 were included. HLA typing was performed using next-generation sequencing at the tissue typing laboratory of Sheba Medical Center and compared with data from the Ezer Mizion Bone Marrow Donor Registry, containing over 1,000,000 samples. RESULTS Our cohort displayed a male predominance and median age at onset in the 7th decade, as previously reported. The most common presenting symptom was seizures. Notably, paroxysmal dizziness spells were significantly more common than previously reported (35%), whereas faciobrachial dystonic seizures were found only in 23%. HLA analysis revealed overrepresentation of DRB1*07:01 (OR: 3.18, CI: 20.9 p < 1.e-5) and DRB1*04:02 (OR: 3.8, CI: 20.1 p < 1.e-5), as well as of the DQ allele DQB1*02:02 (OR: 2.8, CI: 14.2 p < 0.0001) as previously reported. A novel overrepresentation observed among our patients was of the DQB1*03:02 allele (OR: 2.3, CI: 6.9 p < 0.008). In addition, we found DR-DQ associations, among patients with anti-LGI1E, that showed complete or near-complete linkage disequilibrium (LD). By applying LD analysis to an unprecedentedly large control cohort, we were able to show that although in the general population, DQB*03:02 is not fully associated with DRB1*04:02, in the patient population, both alleles are always coupled, suggesting the DRB1*04:02 association to be primary to disease predisposition. In silico predictions performed for the overrepresented DQ alleles reveal them to be strong binders of LGI1-derived peptides, similarly to overrepresented DR alleles. These predictions suggest a possible correlation between peptide binding sites of paired DR-DQ alleles. DISCUSSION Our cohort presents distinct immune characteristics with substantially higher overrepresentation of DRB1*04:02 and slightly lower overrepresentation of DQB1*07:01 compared with previous reports implying differences between different populations. DQ-DR interactions found in our cohort may shed additional light on the complex role of immunogenetics in the pathogenesis of anti-LGI1E, implying a possible relevance of certain DQ alleles and DR-DQ interactions.
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Affiliation(s)
- Yahel Segal
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Michal Nisnboym
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Keren Regev
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Karni Arnon
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Hadar Kolb
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Firas Fahoum
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Orna Aizenstein
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Yael Paran
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Yoram Louzoun
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Sapir Israeli
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Ron Loewenthal
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Nina Svetlitzky
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Yifat Alcalay
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Itay Raphael
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA
| | - Avi Gadoth
- From the Department of Neurology (Y.S.Y.S.N., K.R., K.A., H.K., F.F., A.G.), Tel-Aviv Medical Center; Neuroimmunology Unit (K.R., K.A., H.K.), Tel-Aviv Medical Center; Sackler Faculty of Medicine (K.A., O.A.), Tel-Aviv University; Sagol School of Neuroscience (K.A.), Tel-Aviv University; Epilepsy and EEG Unit (F.F.), Tel Aviv Medical Center; Encephalitis Center (O.A., Y.P., Y.A., A.G.), Tel-Aviv Medical Center; Department of Radiology (O.A.), Tel-Aviv Medical Center; Infectious Diseases Department (Y.P.), Tel-Aviv Medical Center; Department of Mathematics (Y.L., S.I.), Bar Ilan University, Ramat Gan; Tissue Typing Laboratory (R.L., N.S.), Sheba Medical Center, Ramat Gan; Immunology Laboratory (Y.A.), Tel Aviv Medical Center, Israel; and Department of Neurological Surgery (I.R.), University of Pittsburgh School of Medicine, PA.
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Ramanathan S, Brilot F, Irani SR, Dale RC. Origins and immunopathogenesis of autoimmune central nervous system disorders. Nat Rev Neurol 2023; 19:172-190. [PMID: 36788293 DOI: 10.1038/s41582-023-00776-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Abstract
The field of autoimmune neurology is rapidly evolving, and recent discoveries have advanced our understanding of disease aetiologies. In this article, we review the key pathogenic mechanisms underlying the development of CNS autoimmunity. First, we review non-modifiable risk factors, such as age, sex and ethnicity, as well as genetic factors such as monogenic variants, common variants in vulnerability genes and emerging HLA associations. Second, we highlight how interactions between environmental factors and epigenetics can modify disease onset and severity. Third, we review possible disease mechanisms underlying triggers that are associated with the loss of immune tolerance with consequent recognition of self-antigens; these triggers include infections, tumours and immune-checkpoint inhibitor therapies. Fourth, we outline how advances in our understanding of the anatomy of lymphatic drainage and neuroimmune interfaces are challenging long-held notions of CNS immune privilege, with direct relevance to CNS autoimmunity, and how disruption of B cell and T cell tolerance and the passage of immune cells between the peripheral and intrathecal compartments have key roles in initiating disease activity. Last, we consider novel therapeutic approaches based on our knowledge of the immunopathogenesis of autoimmune CNS disorders.
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Affiliation(s)
- Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
| | - Fabienne Brilot
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
- TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
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21
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Jang S, Kim SY, Kim WJ, Chae JH, Kim KJ, Lim BC. A case of pediatric anti-leucine-rich glioma inactivated 1 encephalitis with faciobrachial dystonic seizure. Brain Dev 2023; 45:348-353. [PMID: 36858863 DOI: 10.1016/j.braindev.2023.02.003] [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] [Received: 09/14/2022] [Revised: 02/05/2023] [Accepted: 02/13/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is a rare type of autoimmune encephalitis. A characteristic faciobrachial dystonic seizure (FBDS) is also frequently associated with this disease. Although primarily reported in the adult population, reports of its occurrence in the pediatric population are rare. Here, we describe a case of a 6-year-old girl diagnosed with anti-LGI1 encephalitis that presented with cognitive decline and FBDS. CASE PRESENTATION The girl was referred to a pediatric neurology department for uncontrolled seizures and dyskinesia. She initially presented with a memory deficit, abnormal movement of the limbs and trunk, and ataxia. Her cerebrospinal fluid exam was unremarkable, but her brain MRI showed focal T2 high signal intensity in the left anterior putamen and right caudate nucleus. In addition, there were refractory episodes of brief tonic or dystonic movement of the face and arms that were suggestive of FBDS. She was initially treated with intravenous methylprednisolone and phenobarbital, then given another pulse of methylprednisolone and intravenous immunoglobulin as her symptoms persisted. Tests for neuronal autoantibodies revealed the presence of anti-LGI1 antibodies. Subsequent human leukocyte antigen (HLA) typing resulted in the identification of HLA-DRB1 DR7(*07:01 g) DR9(*09:01 g). Screening for thymoma and other neoplasms showed no signs of a tumor. She was treated with rituximab, tocilizumab, and antiseizure medications, including oxcarbazepine, valproic acid, and lamotrigine. Her FBDS and cognitive symptoms showed substantial improvements. CONCLUSION While it is known that anti-LGI1 encephalitis responds well to immunotherapy, our patient showed an incomplete response, requiring further therapy. This is the first report of a pediatric patient with anti-LGI1 encephalitis treated with tocilizumab.
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Affiliation(s)
- Seoyun Jang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Woo Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea.
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22
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Flammer J, Neziraj T, Rüegg S, Pröbstel AK. Immune Mechanisms in Epileptogenesis: Update on Diagnosis and Treatment of Autoimmune Epilepsy Syndromes. Drugs 2023; 83:135-158. [PMID: 36696027 PMCID: PMC9875200 DOI: 10.1007/s40265-022-01826-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 01/26/2023]
Abstract
Seizures and epilepsy can result from various aetiologies, yet the underlying cause of several epileptic syndromes remains unclear. In that regard, autoimmune-mediated pathophysiological mechanisms have been gaining attention in the past years and were included as one of the six aetiologies of seizures in the most recent classification of the International League Against Epilepsy. The increasing number of anti-neuronal antibodies identified in patients with encephalitic disorders has contributed to the establishment of an immune-mediated pathophysiology in many cases of unclear aetiology of epileptic syndromes. Yet only a small number of patients with autoimmune encephalitis develop epilepsy in the proper sense where the brain transforms into a state where it will acquire the enduring propensity to produce seizures if it is not hindered by interventions. Hence, the term autoimmune epilepsy is often wrongfully used in the context of autoimmune encephalitis since most of the seizures are acute encephalitis-associated and will abate as soon as the encephalitis is in remission. Given the overlapping clinical presentation of immune-mediated seizures originating from different aetiologies, a clear distinction among the aetiological entities is crucial when it comes to discussing pathophysiological mechanisms, therapeutic options, and long-term prognosis of patients. Moreover, a rapid and accurate identification of patients with immune-mediated epilepsy syndromes is required to ensure an early targeted treatment and, thereby, improve clinical outcome. In this article, we review our current understanding of pathogenesis and critically discuss current and potential novel treatment options for seizures and epilepsy syndromes of underlying or suspected immune-mediated origin. We further outline the challenges in proper terminology.
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Affiliation(s)
- Julia Flammer
- Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Tradite Neziraj
- Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stephan Rüegg
- Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Anne-Katrin Pröbstel
- Department of Neurology, University Hospital Basel and University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Departments of Biomedicine and Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland. .,Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel and University of Basel, Basel, Switzerland.
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23
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Moon J, Kim H. A case of leucine-rich glioma-inactivated 1 antibody encephalitis with schizophrenia-like symptoms as an initial clinical manifestation. ENCEPHALITIS 2022; 2:116-120. [PMID: 37469993 PMCID: PMC10295921 DOI: 10.47936/encephalitis.2022.00080] [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: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 07/21/2023] Open
Abstract
Leucine-rich glioma-inactivated 1 (LGI-1) antibody encephalitis is a type of limbic encephalitis characterized by faciobrachial dystonic seizure and short-term memory loss as initial clinical symptoms. We present a case initially misdiagnosed as schizophrenia and finally diagnosed as LGI-1 antibody encephalitis. A 41-year-old female presented to the neurology clinic with a 4-month history of anxiety and disoriented speech and a new onset headache. Her explanation of symptoms was unclear, and she was unable to answer questions properly. Her brain magnetic resonance imaging (MRI) showed no specific lesions. After 6 months, depersonalization, place disorientation and memory impairment were noted. Her symptoms continue to progress, experiencing visual/auditory hallucinations. She was diagnosed with schizophrenia and admitted to a closed psychiatric ward. In the hospital, she showed mild fever, and her memory loss worsened faster than her psychiatric symptoms, unlike in schizophrenia. Follow-up MRI scans showed a diffusely enlarged right hippocampus with a 2.5 × 1.3-cm mass lesion. Electroencephalogram showed rhythmic theta activities/interictal spikes in the right frontal lobe, for which she was treated with an antiepileptic drug. Cerebrospinal fluid analysis results showed pleocytosis. Based on this, autoimmune encephalitis was diagnosed, and steroid pulse treatment and immunoglobulin treatment were performed. Positivity for LGI-1 antibody was reported and finally led to diagnosis of LGI-1 antibody encephalitis. Clinical symptoms gradually improved, and the lesion had shrunk considerably on MRI performed 6 months after immunoglobulin treatment. She reports persistent amnesia for 6 months but has returned to her daily life under follow-up observation.
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Affiliation(s)
- Jiyeon Moon
- Department of Neurology and Sleep Medicine Research Center, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Hyeyun Kim
- Department of Neurology and Sleep Medicine Research Center, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
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Anurat K, Watcharakuldilok P, Sakpichaisakul K, Khongkhatithum C, Mahasirimongkol S, Kunhapan P, Inunchot W, Wattanapokayakit S, Munggaranonchai O, Thampratankul L. HLA-DRB1∗1502 Is Associated With Anti-N-Methyl-D-aspartate Receptor Encephalitis in Thai Children. Pediatr Neurol 2022; 134:93-99. [PMID: 35863207 DOI: 10.1016/j.pediatrneurol.2022.06.014] [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] [Received: 01/10/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anti-N-methyl-d-aspartate receptor encephalitis (anti-NMDARE) is one of the most common types of autoimmune encephalitis. Most patients have no apparent immunologic triggers, which suggests a genetic predisposition. This study was conducted to identify human leukocyte antigen (HLA) class II alleles associated with anti-NMDARE in Thai children. METHODS This case-control study enrolled patients younger than 18 years who were diagnosed with anti-NMDARE between January 2010 and December 2020. A "good outcome" was determined as a patient with a modified Rankin scale score of less than 2 at any follow-up visit. HLA genotypes were determined at four-digit alleles using reverse sequence-specific oligonucleotide probe hybridization. The HLA class II allele frequency in patients was compared with that in a database of 101 healthy control Thai children. RESULTS Thirty-four patients were enrolled with a mean age of 12.8 ± 5.6 years (females 85.3%). The HLA-DRB1∗1502 allele frequency was significantly higher in patients than in controls (odds ratio, 2.32; 95% confidence interval, 1.11-4.8, P = 0.023). A good outcome was noted in 14 of 14 (100%) HLA-DRB1∗1502-positive patients (median time to a good outcome, 6 months) and 14 of 17 (82.3%) HLA-DRB1∗1502-negative patients (median time to a good outcome, 3 months). Two (11.8%) HLA-DRB1∗1502-positive patients had one relapse each, and six (35.3%) HLA-DRB1∗1502-negative patients had one to three relapses. CONCLUSIONS HLA-DRB1∗1502 was significantly associated with anti-NMDARE in our patients. Most patients had good outcomes. HLA-DRB1∗1502-positive patients tended to require a longer time to achieve a good outcome but had less frequent relapses than HLA-DRB1∗1502-negative patients.
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Affiliation(s)
- Kingthong Anurat
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan, Thailand
| | | | - Kullasate Sakpichaisakul
- Department of Pediatrics, Queen Sirikit National Institute of Child Health, Ministry of Public Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Chaiyos Khongkhatithum
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Surakameth Mahasirimongkol
- Department of Medical Sciences, Medical Genetics Section, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Punna Kunhapan
- Department of Medical Sciences, Medical Genetics Section, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Wimala Inunchot
- Department of Medical Sciences, Medical Genetics Section, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Sukanya Wattanapokayakit
- Department of Medical Sciences, Medical Genetics Section, National Institute of Health, Ministry of Public Health, Nonthaburi, Thailand
| | - Orathai Munggaranonchai
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lunliya Thampratankul
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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Lancaster E. Autoantibody Encephalitis: Presentation, Diagnosis, and Management. J Clin Neurol 2022; 18:373-390. [PMID: 35796263 PMCID: PMC9262450 DOI: 10.3988/jcn.2022.18.4.373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 02/07/2023] Open
Abstract
Autoantibody encephalitis causes distinct clinical syndromes involving alterations in mentation, abnormal movements, seizures, psychiatric symptoms, sleep disruption, spasms, and neuromyotonia. The diagnoses can be confirmed by specific antibody tests, although some antibodies may be better detected in spinal fluid and others in serum. Each disorder conveys a risk of certain tumors which may inform diagnosis and be important for treatment. Autoantibodies to receptors and other neuronal membrane proteins are generally thought to be pathogenic and result in loss of function of the targets, so understanding the pharmacology of the receptors may inform our understanding of the syndromes. Patients may be profoundly ill but the syndromes usually respond to immune therapy, although there are differences in the types of immune therapy that are thought to be most effective for the various disorders.
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Affiliation(s)
- Eric Lancaster
- Department of Neurology, The University of Pennsylvania, Philadelphia, PA, USA.
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26
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Gill AJ, Venkatesan A. Pathogenic mechanisms in neuronal surface autoantibody-mediated encephalitis. J Neuroimmunol 2022; 368:577867. [DOI: 10.1016/j.jneuroim.2022.577867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/22/2022] [Accepted: 04/09/2022] [Indexed: 11/16/2022]
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Liu X, Guo KD, Lin JF, Gong X, Li AQ, Zhou D, Hong Z. HLA-DRB1*03:01 is associated with female sex and younger age of anti-LGI1 encephalitis. Eur J Neurol 2022; 29:2367-2375. [PMID: 35488492 DOI: 10.1111/ene.15376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/04/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate the association between human leukocyte antigen (HLA) genotype and clinical characteristics of anti-LGI1 encephalitis. METHODS HLA genotyping was performed in 34 patients with anti-LGI1 encephalitis admitted to West China Hospital between April 2014 and May 2021, as well as in 305 healthy controls. The on-line tool NetMHCIIpan 4.0 and AutoDock Vina software were used to predict binding between LGI1 peptide and HLA Class II molecules. RESULTS Risk of anti-LGI1 encephalitis was strongly associated with the DRB1*03:01 allele (OR 4.31, 95% CI 1.96-9.25, Pc = 2.75×10-4 ) and the DRB1*03:01-DQB1*02:01 haplotype (OR 4.45, 95% CI 2.02-9.59, Pc = 2.94×10-4 ). Compared to carriers of the DRB1*07:01 allele, those with the DRB1*03:01 allele were more likely to be female (93.3% vs 33.3%; P = 0.004) and to be younger (median age, 38 vs 65 years; P < 0.001). DRB1*03:01 carriers showed stronger response to immunotherapy than carriers of the DRB1*07:01 allele, based on median score decrease on the modified Rankin scale [2 (interquartile range, 1-2) vs. 1 (interquartile range, 0-1); P = 0.03] at 4 weeks after immunotherapy. Prediction and docking algorithms suggested that the LGI1 peptide can bind to the DRB1*03:01 molecule strongly. CONCLUSIONS The strong association between anti-LGI1 encephalitis and certain HLA class II alleles supports a primary autoimmune origin for the disease. Carriers of the DRB1*03:01 allele in Chinese patients with anti-LGI1 encephalitis are more likely to be female, to suffer earlier disease onset and to respond better to immunotherapy.
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Affiliation(s)
- Xu Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Kun Dian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Jing Fang Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Xue Gong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Ai Qing Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.,Institute of Brain science and Brain-inspired technology of West China Hospital, Sichuan University.,Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, 611730, China
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Ding C, Sun Q, Li R, Li H, Wang Y. The First Case of Familiar Anti-leucine-rich Glioma-Inactivated1 Autoimmune Encephalitis: A Case Report and Literature Review. Front Neurol 2022; 13:855383. [PMID: 35493840 PMCID: PMC9047818 DOI: 10.3389/fneur.2022.855383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/14/2022] [Indexed: 11/26/2022] Open
Abstract
Anti-leucine-rich glioma-inactivated1 (Anti-LGI1) autoimmune encephalitis is a rare autoimmune disease discovered in recent years. It is generally not defined as an inherited disease, though its etiology is still unclear. Herein, we report the first case of adult patients with familial anti-LGI1 encephalitis. Two biological siblings who worked in different regions were successively diagnosed with anti-LGI1 encephalitis in their middle age. The two patients had similar clinical manifestations including imaging results. Their clinical symptoms improved after immunotherapy and antiepileptic therapy. Given that some unique human leukocyte antigen (HLA) subtypes appear at a high frequency, multiple recent studies have revealed that anti-LGI1 encephalitis is associated with genetic susceptibility. One of the patients underwent HLA genotyping and whole-exome sequencing (WES), revealing the same HLA typing as in previous studies and two rare HLA variants. Therefore, further studies involving larger samples and more populations should be conducted to explore the possibility of other influencing factors such as environmental impacts.
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29
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da Silva MK, Azevedo AAC, Campos DMDO, de Souto JT, Fulco UL, Oliveira JIN. Computational vaccinology guided design of multi-epitope subunit vaccine against a neglected arbovirus of the Americas. J Biomol Struct Dyn 2022; 41:3321-3338. [PMID: 35285772 DOI: 10.1080/07391102.2022.2050301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Mayaro virus (MAYV) is an arbovirus found in the Americas that can cause debilitating arthritogenic disease. Although it is an emerging virus, the only current approach is vector control, as there are no approved vaccines to prevent MAYV infection nor therapeutics to treat it. In search of an effective vaccine candidate against MAYV, we used immunoinformatics and molecular modeling to attempt to identify promiscuous T-cell epitopes of the nonstructural polyproteins (nsP1, nsP2, nsP3, and nsP4) from 127 MAYV genomes sequenced in the Americas (08 Bolivia, 72 Brazil, 04 French Guiana, 05 Haiti, 20 Peru, 04 Trinidad and Tobago, and 14 Venezuela). For this purpose, consensus sequences of 360 proteins were used to identify short protein sequences that can bind to MHC I class (MHC II). Our analysis revealed 56 potential MHC-I/TCD8+ (29 MHC-II/TCD4+) epitopes, but only 6 (16) TCD8+ (TCD4+) epitopes showed high antigenicity and conservation, non-allergenicity, non-toxicity, and excellent population coverage. Finally, classical and quantum mechanical calculations (QM:MM) were used to improve the quality of the docking calculations, with the QM part of the simulations performed using the density functional theory formalism (DFT). These results provide insights for the advancement of diagnostic platforms, vaccine development, and immunotherapeutic interventions.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Maria Karolaynne da Silva
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | | | | | - Janeusa Trindade de Souto
- Departamento de Microbiologia e Parasitologia, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Umberto Laino Fulco
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
| | - Jonas Ivan Nobre Oliveira
- Departamento de Biofísica e Farmacologia, Universidade Federal do Rio Grande do Norte, Natal, RN, Brazil
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Seery N, Butzkueven H, O'Brien TJ, Monif M. Contemporary advances in antibody-mediated encephalitis: anti-LGI1 and anti-Caspr2 antibody (Ab)-mediated encephalitides. Autoimmun Rev 2022; 21:103074. [PMID: 35247644 DOI: 10.1016/j.autrev.2022.103074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/27/2022] [Indexed: 01/17/2023]
Abstract
Encephalitides with antibodies directed against leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein-like 2 (Caspr2) represent two increasingly well characterised forms of autoimmune encephalitis. Both share overlapping and distinct clinical features, are mediated by autoantibodies directed against differing proteins complexed with voltage-gated potassium channels, with unique genetic predisposition identified to date. Herein we summarise disease mechanisms, clinical features, treatment considerations, prognostic factors and clinical outcomes regarding these disorders.
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Affiliation(s)
- Nabil Seery
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Terence J O'Brien
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Hospital, Melbourne, Victoria, Australia; Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
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31
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Peris Sempere V, Muñiz-Castrillo S, Ambati A, Binks S, Pinto AL, Rogemond V, Pittock SJ, Dubey D, Geschwind MD, Gelfand JM, Dilwali S, Lee ST, Knight J, Elliott KS, Irani S, Honnorat J, Mignot E. Human Leukocyte Antigen Association Study Reveals DRB1*04:02 Effects Additional to DRB1*07:01 in Anti-LGI1 Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e1140. [PMID: 35115410 PMCID: PMC8815287 DOI: 10.1212/nxi.0000000000001140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES To study human leukocyte antigen (HLA) allele associations in anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis. METHODS A multiethnic cohort of 269 patients with anti-LGI1 encephalitis and 1,359 controls was included. Four-digit HLA sequencing and genome wide association single-nucleotide polymorphism typing imputation (0.99 concordance) were used for HLA typing. Significance of primary and secondary associations was tested using χ2, Fisher exact tests, or logistic regression with the control of population stratification covariates when applicable. RESULTS DRB1*07:01 and DQA1*02:01, 2 alleles in strong linkage disequilibrium, were associated with the disease (90% vs 24%, OR = 27.8, p < 10e-50) across ethnicity independent of variation at DRB3 and DQB1, 2 flanking HLA loci. DRB1*07:01 homozygosity was associated with a doubling of risk (OR = 2.1, p = 0.010), suggesting causality. DRB1*07:01 negative subjects were younger (p = 0.003) and more frequently female (p = 0.015). Three patients with malignant thymomas did not carry DRB1*07:01, whereas patients with other tumors had high DRB1*07:01 frequency, suggesting that the presence of tumors other than thymomas may be coincidental and not causal. In both DRB1*07:01 heterozygous individuals and DRB1*07:01 negative subjects, DRB1*04:02 was associated with anti-LGI1 encephalitis, indicating an independent effect of this allele (OR = 6.85, p = 4.57 × 10-6 and OR = 8.93, p = 2.50 × 10-3, respectively). DRB1*04:02 was also independently associated with younger age at onset (β = -6.68, p = 9.78 × 10-3). Major histocompatibility complex peptide-binding predictions using LGI1-derived peptides revealed divergent binding propensities for DRB1*04:02 and DRB1*07:01 alleles, suggesting independent pathogenic mechanisms. DISCUSSION In addition to the established primary DRB1*07:01 association in anti-LGI1 encephalitis, we observe a secondary effect of DRB1*04:02 with lower age at onset. Our study provides evidence for secondary effects within HLA locus that correlate with clinical phenotypes in anti-LGI1 encephalitis.
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Affiliation(s)
| | | | - Aditya Ambati
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sophie Binks
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Anne-Laurie Pinto
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Veronique Rogemond
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sean J. Pittock
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Divyanshu Dubey
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Michael D. Geschwind
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Jeffrey Marc Gelfand
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sonam Dilwali
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Soon-Tae Lee
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Julian Knight
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Katherine S. Elliott
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - Sarosh Irani
- From the Stanford University Center for Sleep Sciences (V.P.S., A.A., and E.M.), Stanford University School of Medicine, Palo Alto, CA; French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., A.-L.P., V.R., and J.H.), Hospices Civils de Lyon, Hôpital Neurologique; Synatac Team (S.M.-C., A.-L.P., V.R., and J.H.), NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, Université Claude Bernard Lyon 1, Université de Lyon, France; Oxford Autoimmune Neurology Group (S.B. and S.I.), Nuffield Department of Clinical Neurosciences, University of Oxford; Department of Neurology (S.B. and S.I.), John Radcliffe Hospital, Oxford, United Kingdom; Department of Laboratory Medicine and Pathology (S.J.P. and D.D.), and Department of Neurology (S.J.P. and D.D.), Mayo Clinic, Rochester, MN; Department of Neurology (M.D.G., J.M.G., and S.D.), University of California, San Francisco; Department of Neurology (S.-T.L.), Seoul National University Hospital, South Korea; and Wellcome Centre for Human Genetics (J.K. and K.S.E.), Nuffield Department of Medicine, University of Oxford, United Kingdom
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Macher S, Bsteh G, Berger T, Höftberger R. Diagnostic approach and treatment regimens in adult patients suffering from antibody-mediated or paraneoplastic encephalitis. Curr Pharm Des 2022; 28:454-467. [PMID: 35100954 DOI: 10.2174/1381612828666220131093259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022]
Abstract
Identification of patients with antibody-mediated encephalitis poses a diagnostic challenge and any delay in that respect will increase the interval until initiation of immunotherapy and may negatively affect the patient´s clinical outcome. Within this review we focus on therapeutic strategies in antibody-mediated encephalitis and propose how to proceed with patients, who are suspected to have encephalitis of unknown origin. We further briefly outline differences in treatment of paraneoplastic and antibody-mediated encephalitis according to its pathomechanisms.
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Affiliation(s)
- Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria; 2 Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gabriel Bsteh
- Department of Neurology, Medical University of Vienna, Vienna, Austria; 2 Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria; 2 Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Department of Neurology, Medical University of Vienna, Vienna, Austria; 2 Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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Cui LL, Boltze J, Zhang Y. Positive LGI1 Antibodies in CSF and Relapse Relate to Worse Outcome in Anti-LGI1 Encephalitis. Front Immunol 2022; 12:772096. [PMID: 34975858 PMCID: PMC8718904 DOI: 10.3389/fimmu.2021.772096] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/29/2021] [Indexed: 12/27/2022] Open
Abstract
Objective This single-center study was conducted in a cohort of patients with anti-LGI1 encephalitis to investigate the factors related to their functional recovery. Methods We retrospectively collected the clinical information of patients admitted to Xuanwu Hospital from January 2014 until December 2019, and followed up for at least 12 months. Results A total of 67 patients were included, and 57 completed the 12-month follow-up. Most of the patients (55/57, 96.5%) achieved functional improvement after immunotherapy, and 26 (45.6%) became symptom-free. Compared to patients with complete recovery, patients with partial or no recovery had significantly higher incidences of consciousness disorders (25.8% vs. 0%, P<0.05) and positive LGI1 antibodies in cerebrospinal fluid (CSF) (71.0% vs. 46.2%, P<0.05). These patients also had a lower Barthel Index both upon admission and at discharge, as well as a higher incidence of relapse (25.8% vs. 3.8%; P<0.05 each). Univariate logistic regression showed that positive LGI1 antibodies in CSF and relapse were associated with incomplete recovery at 1-year follow-up (both P<0.05), but only relapse remained statistically significant after multivariate logistic regression (P=0.034). Conclusion Patients with LGI1 antibodies in CSF and those who relapsed were more likely to experience worse outcome. Early recognition of these patients, combined with more aggressive immunotherapy may result in better recovery.
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Affiliation(s)
- Li-Li Cui
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Johannes Boltze
- School of Life Sciences, University of Warwick, Coventry, United Kingdom
| | - Yan Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, 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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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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Martín-Aguilar L, Lleixà C, Pascual-Goñi E, Caballero-Ávila M, Martínez-Martínez L, Díaz-Manera J, Rojas-García R, Cortés-Vicente E, Turon-Sans J, de Luna N, Suárez-Calvet X, Gallardo E, Rajabally Y, Scotton S, Jacobs BC, Baars A, Cortese A, Vegezzi E, Höftberger R, Zimprich F, Roesler C, Nobile-Orazio E, Liberatore G, Hiew FL, Martínez-Piñeiro A, Carvajal A, Piñar-Morales R, Usón-Martín M, Albertí O, López-Pérez MÁ, Márquez F, Pardo-Fernández J, Muñoz-Delgado L, Cabrera-Serrano M, Ortiz N, Bartolomé M, Duman Ö, Bril V, Segura-Chávez D, Pitarokoili K, Steen C, Illa I, Querol L. Clinical and Laboratory Features in Anti-NF155 Autoimmune Nodopathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e1098. [PMID: 34728497 PMCID: PMC8564865 DOI: 10.1212/nxi.0000000000001098] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES To study the clinical and laboratory features of antineurofascin-155 (NF155)-positive autoimmune nodopathy (AN). METHODS Patients with anti-NF155 antibodies detected on routine immunologic testing were included. Clinical characteristics, treatment response, and functional scales (modified Rankin Scale [mRS] and Inflammatory Rasch-built Overall Disability Scale [I-RODS]) were retrospectively collected at baseline and at the follow-up. Autoantibody and neurofilament light (NfL) chain levels were analyzed at baseline and at the follow-up. RESULTS Forty NF155+ patients with AN were included. Mean age at onset was 42.4 years. Patients presented with a progressive (75%), sensory motor (87.5%), and symmetric distal-predominant weakness in upper (97.2%) and lower extremities (94.5%), with tremor and ataxia (75%). Patients received a median of 3 (2-4) different treatments in 46 months of median follow-up. Response to IV immunoglobulin (86.8%) or steroids (72.2%) was poor in most patients, whereas 77.3% responded to rituximab. HLA-DRB1*15 was detected in 91.3% of patients. IgG4 anti-NF155 antibodies were predominant in all patients; anti-NF155 titers correlated with mRS within the same patient (r = 0.41, p = 0.004). Serum NfL (sNfL) levels were higher in anti-NF155+ AN than in healthy controls (36.47 vs 7.56 pg/mL, p < 0.001) and correlated with anti-NF155 titers (r = 0.43, p = 0.001), with I-RODS at baseline (r = -0.88, p < 0.001) and with maximum I-RODS achieved (r = -0.58, p = 0.01). Anti-NF155 titers and sNfL levels decreased in all rituximab-treated patients. DISCUSSION Anti-NF155 AN presents a distinct clinical profile and good response to rituximab. Autoantibody titers and sNfL are useful to monitor disease status in these patients. The use of untagged-NF155 plasmids minimizes the detection of false anti-NF155+ cases. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that anti-NF155 antibodies associate with a specific phenotype and response to rituximab.
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Affiliation(s)
| | | | - Elba Pascual-Goñi
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Marta Caballero-Ávila
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Laura Martínez-Martínez
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Jordi Díaz-Manera
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Ricard Rojas-García
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Elena Cortés-Vicente
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Janina Turon-Sans
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Noemi de Luna
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Xavier Suárez-Calvet
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Eduard Gallardo
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Yusuf Rajabally
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Sangeeta Scotton
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Bart C. Jacobs
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Adája Baars
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Andrea Cortese
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Elisa Vegezzi
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Romana Höftberger
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Fritz Zimprich
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Cornelia Roesler
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Eduardo Nobile-Orazio
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Giuseppe Liberatore
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Fu Liong Hiew
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Alicia Martínez-Piñeiro
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Alejandra Carvajal
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Raquel Piñar-Morales
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Mercedes Usón-Martín
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Olalla Albertí
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Maria Ángeles López-Pérez
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Fabian Márquez
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Julio Pardo-Fernández
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Laura Muñoz-Delgado
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Macarena Cabrera-Serrano
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Nicolau Ortiz
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Manuel Bartolomé
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Özgür Duman
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Vera Bril
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Darwin Segura-Chávez
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Kalliopi Pitarokoili
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Claudia Steen
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Isabel Illa
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
| | - Luis Querol
- From the Neuromuscular Diseases Unit (L.M.-A., C.L., E.P.-G., M.C.-Á., R.R.-G., E.C.-V., J.T.-S., E.N.-O., I.I., L.Q.), Department of Neurology, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona; Biomedical Research Institute Sant Pau (IIB Sant Pau) (L.M.-A., C.L., E.P.-G., M.C.-Á., J.D.-M., E.C.-V., X.S.-C., E.G.); Immunology Department (L.M.-M.), Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Spain; Centro para La Investigación Biomédica en Red en Enfermedades Raras (CIBERER) (J.D.-M., R.R.-G., E.C.-V., N.L., X.S.-C., E.G., I.I., L.Q.); University Hospital Birmingham (Y.R., S.S.), UK; Erasmus Medical Center (B.C.J., A.B.), Rotterdam, the Netherlands; IRCCS Mondino Foundation (Andrea Cortese, E.V.), Pavia, Italy; Department of Neurology (R.H., F.Z.), Medical University of Vienna; Paracelsus Medical University (C.R.), Salzburg, Austria; IRCCS Humanitas Research Hospital (G.L.), Milan University, Rozzano, Italy; Kuala Lumpur General Hospital (F.L.H.), Jalan Pahang, Kuala Lumpur, Malaysia; Hospital Universitari Germans Trias I Pujol (A.M.-P.), Badalona; Hospital Universitario Virgen de Las Nieves (Alejandra Carvajal), Granada, Spain; Hospital Universitario Clínico San Cecilio (R.P.-M.), Granada; Hospital Son Llàtzer (M.U.-M.), Palma de Mallorca; Hospital San Jorge (O.A.), Huesca, España; Hospital San Pedro (M.Á.L.-P.), Logroño; Hospital Universitari Josep Trueta (F.M.), Girona; Hospital Clínico Universitario de Santiago (J.P.-F.), Santiago de Compostela; Hospital Universitario Virgen Del Rocío (L.M.-D., M.C.-S.), Sevilla; Hospital Universitari Sant Joan (N.O.), Reus; Complejo Asistencial de Ávila (M.B.), Ávila, Spain; Akdeniz University (Ö.D.), Antalya, Turkey; Toronto General Hospital (V.B.), University Health Network, University of Toronto, Canada; Instituto Nacional de Ciencias Neurológicas. Lima (D.S.-C.), Perú; St. Josef-Hospital (K.P.), Ruhr-University Bochum; and Sant Joseph Hospital (C.S.), Berlin, Germany
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Baudin P, Cousyn L, Navarro V. The LGI1 protein: molecular structure, physiological functions and disruption-related seizures. Cell Mol Life Sci 2021; 79:16. [PMID: 34967933 PMCID: PMC11072701 DOI: 10.1007/s00018-021-04088-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 01/16/2023]
Abstract
Leucine-rich, glioma inactivated 1 (LGI1) is a secreted glycoprotein, mainly expressed in the brain, and involved in central nervous system development and physiology. Mutations of LGI1 have been linked to autosomal dominant lateral temporal lobe epilepsy (ADLTE). Recently auto-antibodies against LGI1 have been described as the basis for an autoimmune encephalitis, associated with specific motor and limbic epileptic seizures. It is the second most common cause of autoimmune encephalitis. This review presents details on the molecular structure, expression and physiological functions of LGI1, and examines how their disruption underlies human pathologies. Knock-down of LGI1 in rodents reveals that this protein is necessary for normal brain development. In mature brains, LGI1 is associated with Kv1 channels and AMPA receptors, via domain-specific interaction with membrane anchoring proteins and contributes to regulation of the expression and function of these channels. Loss of function, due to mutations or autoantibodies, of this key protein in the control of neuronal activity is a common feature in the genesis of epileptic seizures in ADLTE and anti-LGI1 autoimmune encephalitis.
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Affiliation(s)
- Paul Baudin
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Cousyn
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute - Institut du Cerveau, ICM, INSERM, CNRS, AP-HP, Pitié-Salpêtrière Hospital, Paris, France.
- AP-HP, Epilepsy Unit, Pitié-Salpêtrière Hospital, DMU Neurosciences, Paris, France.
- AP-HP, Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
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Ciano-Petersen NL, Cabezudo-García P, Muñiz-Castrillo S, Honnorat J, Serrano-Castro PJ, Oliver-Martos B. Current Status of Biomarkers in Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Int J Mol Sci 2021; 22:13127. [PMID: 34884930 PMCID: PMC8658717 DOI: 10.3390/ijms222313127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
The discovery of biomarkers in rare diseases is of paramount importance to allow a better diagnosis, improve predictions of outcomes, and prompt the development of new treatments. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare autoimmune disorder associated with the presence of antibodies targeting the GluN1 subunit of the NMDAR. Since it was discovered in 2007, large efforts have been made towards the identification of clinical, paraclinical, and molecular biomarkers to better understand the immune mechanisms that govern the course of the disease as well as to define predictors of treatment response and long-term outcomes. However, most of these biomarkers are still in an exploratory phase, with only a few candidates reaching the final phases of the always-complex process of biomarker development, mainly due to the low incidence of the disease and its recent description. Clinical and paraclinical markers are probably the most widely explored in anti-NMDAR encephalitis, five of them combined in a clinical score to predict 1 year outcome. On the contrary, soluble molecules, such as persistent antibody positivity, antibody titers, cytokines, and other inflammatory mediators, have been proposed as biomarkers of clinical activity, inflammation, prognosis, and treatment response, but further studies are required for their clinical validation including larger and more homogenous cohorts of patients. Similarly, genetic susceptibility biomarkers are still in the exploratory phase and, therefore, weak conclusions can for now only be achieved. Thus, further studies are warranted to define biomarkers and unravel the underlying mechanisms driving rare diseases such as anti-NMDAR encephalitis. Future international collaborative studies with prospective designs that enable the enrollment of large cohorts will allow for the identification and validation of novel biomarkers for clinical decision-making.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Pablo Cabezudo-García
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Pedro Jesús Serrano-Castro
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
| | - Begoña Oliver-Martos
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
- Department of Cell Biology, Genetics and Physiology, Physiology Area, University of Malaga, 29010 Málaga, Spain
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Ismail FS, Meuth SG, Melzer N. The role of dendritic cells and their interactions in the pathogenesis of antibody-associated autoimmune encephalitis. J Neuroinflammation 2021; 18:260. [PMID: 34749759 PMCID: PMC8573920 DOI: 10.1186/s12974-021-02310-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 10/28/2021] [Indexed: 01/17/2023] Open
Abstract
Autoimmune encephalitis (AE) is an inflammatory brain disease which is frequently associated with antibodies (Abs) against cell-surface, synaptic or intracellular neuronal proteins. There is increasing evidence that dendritic cells (DCs) are implicated as key modulators in keeping the balance between immune response and tolerance in the CNS. Migratory features of DCs to and from the brain are linked to initiating and maintaining of neuroinflammation. Genetic polymorphisms together with other triggers such as systemic or cerebral viral infection, or systemic malignancies could contribute to the dysbalance of "regulatory" and "encephalitogenic" DCs with subsequent dysregulated T and B cell reactions in AE. Novel in vivo models with implantation of mature DCs containing neuronal antigens could help to study the pathogenesis and perhaps to understand the origin of AE. Investigations of DCs in human blood, lymphoid tissues, CSF, and brain parenchyma of patients with AE are necessary to deepen our knowledge about the complex interactions between DCs, T and B cells during neuroinflammation in AE. This can support developing new therapy strategies.
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Affiliation(s)
- Fatme Seval Ismail
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, In der Schornau 23-25, 44892, Bochum, Germany.
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
| | - Nico Melzer
- Department of Neurology, Heinrich-Heine University of Düsseldorf, Düsseldorf, Germany
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Fels E, Muñiz-Castrillo S, Vogrig A, Joubert B, Honnorat J, Pascual O. Role of LGI1 protein in synaptic transmission: From physiology to pathology. Neurobiol Dis 2021; 160:105537. [PMID: 34695575 DOI: 10.1016/j.nbd.2021.105537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/17/2023] Open
Abstract
Leucine-Rich Glioma Inactivated protein 1 (LGI1) is a secreted neuronal protein highly expressed in the central nervous system and high amount are found in the hippocampus. An alteration of its function has been described in few families of patients with autosomal dominant temporal lobe epilepsy (ADLTE) or with autoimmune limbic encephalitis (LE), both characterized by epileptic seizures. Studies have shown that LGI1 plays an essential role during development, but also in neuronal excitability through an action on voltage-gated potassium Kv1.1 channels, and in synaptic transmission by regulating the surface expression of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPA-R). Over the last decade, a growing number of studies investigating LGI1 functions have been published. They aimed to improve the understanding of LGI1 function in the regulation of neuronal networks using different animal and cellular models. LGI1 appears to be a major actor of synaptic regulation by modulating trans-synaptically pre- and post-synaptic proteins. In this review, we will focus on LGI1 binding partners, "A Disintegrin And Metalloprotease (ADAM) 22 and 23", the complex they form at the synapse, and will discuss the effects of LGI1 on neuronal excitability and synaptic transmission in physiological and pathological conditions. Finally, we will highlight new insights regarding N-terminal Leucine-Rich Repeat (LRR) domain and C-terminal Epitempin repeat (EPTP) domain and their potentially distinct role in LGI1 function.
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Affiliation(s)
- Elodie Fels
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
| | - Sergio Muñiz-Castrillo
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Alberto Vogrig
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Bastien Joubert
- Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Jérôme Honnorat
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France.
| | - Olivier Pascual
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France.
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Karami Fath M, Jahangiri A, Ganji M, Sefid F, Payandeh Z, Hashemi ZS, Pourzardosht N, Hessami A, Mard-Soltani M, Zakeri A, Rahbar MR, Khalili S. SARS-CoV-2 Proteome Harbors Peptides Which Are Able to Trigger Autoimmunity Responses: Implications for Infection, Vaccination, and Population Coverage. Front Immunol 2021; 12:705772. [PMID: 34447375 PMCID: PMC8383889 DOI: 10.3389/fimmu.2021.705772] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/23/2021] [Indexed: 12/16/2022] Open
Abstract
Autoimmune diseases (ADs) could occur due to infectious diseases and vaccination programs. Since millions of people are expected to be infected with SARS-CoV-2 and vaccinated against it, autoimmune consequences seem inevitable. Therefore, we have investigated the whole proteome of the SARS-CoV-2 for its ability to trigger ADs. In this regard, the entire proteome of the SARS-CoV-2 was chopped into more than 48000 peptides. The produced peptides were searched against the entire human proteome to find shared peptides with similar experimentally confirmed T-cell and B-cell epitopes. The obtained peptides were checked for their ability to bind to HLA molecules. The possible population coverage was calculated for the most potent peptides. The obtained results indicated that the SARS-CoV-2 and human proteomes share 23 peptides originated from ORF1ab polyprotein, nonstructural protein NS7a, Surface glycoprotein, and Envelope protein of SARS-CoV-2. Among these peptides, 21 peptides had experimentally confirmed equivalent epitopes. Amongst, only nine peptides were predicted to bind to HLAs with known global allele frequency data, and three peptides were able to bind to experimentally confirmed HLAs of equivalent epitopes. Given the HLAs which have already been reported to be associated with ADs, the ESGLKTIL, RYPANSIV, NVAITRAK, and RRARSVAS were determined to be the most harmful peptides of the SARS-CoV-2 proteome. It would be expected that the COVID-19 pandemic and the vaccination against this pathogen could significantly increase the ADs incidences, especially in populations harboring HLA-B*08:01, HLA-A*024:02, HLA-A*11:01 and HLA-B*27:05. The Southeast Asia, East Asia, and Oceania are at higher risk of AD development.
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Affiliation(s)
- Mohsen Karami Fath
- Department of Cellular and Molecular Biology, Faculty of Biological Sciences, Kharazmi University, Tehran, Iran
| | - Abolfazl Jahangiri
- Applied Microbiology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mahmoud Ganji
- Department of Medical Biotechnology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Fatemeh Sefid
- Department of Medical Genetics, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Zahra Payandeh
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Sadat Hashemi
- Advanced Therapy Medicinal Product (ATMP) Department, Breast Cancer Research Center, Motamed Cancer Institute, Academic Center for Education, Culture and Research (ACECR), Tehran, Iran
| | - Navid Pourzardosht
- Biochemistry Department, Guilan University of Medical Sciences, Rasht, Iran
| | - Anahita Hessami
- School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maysam Mard-Soltani
- Department of Clinical Biochemistry, Faculty of Medical Sciences, Dezful University of Medical Sciences, Dezful, Iran
| | - Alireza Zakeri
- Department of Biology Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran
| | - Mohammad Reza Rahbar
- Pharmaceutical Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Khalili
- Department of Biology Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran
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41
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Etemadifar M, Aghababaei A, Nouri H, Kargaran PK, Mohammadi S, Salari M. Autoimmune encephalitis: the first observational study from Iran. Neurol Sci 2021; 43:1239-1248. [PMID: 34328580 DOI: 10.1007/s10072-021-05400-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Even within the most populous countries in the Middle East, such as Iran, autoimmune encephalitis cases have been rarely reported. OBJECTIVE We aimed to describe the demographic, clinical, and paraclinical characteristics of Iranian patients with autoimmune encephalitis positive for anti-neuronal autoantibodies. METHODS This cross-sectional study included all patients diagnosed with autoimmune encephalitis and referred to our hospital, in Isfahan, Iran, from March 2016 to May 2020. Patients' demographic, clinical, laboratory, radiological, and electroencephalographic features were obtained from their medical records. RESULTS We identified a total of 39 (21 females, 53.8%) patients with autoimmune encephalitis (mean age = 34.9 ± 12.8 years). The most commonly detected antibody was anti-NMDAR (n = 26, 66.7%), followed by anti-GABABR (n = 8, 20.5%), anti-Zic4 (n = 4, 10.3%), and anti-GAD65 (n = 1, 2.6%) antibodies, in descending order of frequency. Two anti-NMDAR-positive patients had a history of systemic lupus erythematosus (SLE), and four had a prior history of herpes simplex encephalitis. Clinical presentations in patients positive for anti-Zic4 antibodies included cognitive decline (n = 4, 100%), seizures (n = 3, 75%), parkinsonism (n = 1, 25%), and stiff-person syndrome (n = 1, 25%). CONCLUSION This was the first case series of Iranian patients with autoimmune encephalitis with some interesting observations, including SLE-associated anti-NMDAR encephalitis, as well as an unusual concurrence of anti-Zic4 antibody positivity and cognitive problems, seizures, parkinsonism, and stiff-person syndrome.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Aghababaei
- Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Hosein Nouri
- Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.,Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - Parisa K Kargaran
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Shaghayegh Mohammadi
- Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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42
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Li Q, Fu N, Han Y, Qin J. Pediatric Autoimmune Encephalitis and Its Relationship With Infection. Pediatr Neurol 2021; 120:27-32. [PMID: 33964702 DOI: 10.1016/j.pediatrneurol.2021.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 04/01/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022]
Abstract
Autoimmune encephalitis (AE) is an increasingly recognized inflammatory disorder of the central nervous system and is most often characterized by antibodies against intracellular and neuronal surface antigens. AE is a devastating disease that may result in developmental delay or regression in children. However, the pathogenesis of AE is not clear, and immune system disorders after infection likely play an important role in AE. Many studies have reported that patients with herpes simplex virus encephalitis develop anti-N-methyl-d-aspartate receptor encephalitis after antiviral treatment. It is critical to recognize pediatric AE early and to distinguish it from infectious forms because AE is treatable and responsive to immunotherapies. In this review, we discuss the clinical features of pediatric AE and focus on the relationship between AE and postinfection status. In addition, we review the probable mechanisms underlying infection-triggered AE, which include molecular mimicry, bystander activation, epitope spreading, immune system disorder, and genetic susceptibility.
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Affiliation(s)
- Qinrui Li
- Department of Pediatrics, Peking University People's Hospital, Beijing, P.R. China
| | - Na Fu
- Department of Pediatrics, Peking University People's Hospital, Beijing, P.R. China
| | - Ying Han
- Department of Pediatrics, Peking University First Hospital, Beijing, P.R. China.
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital, Beijing, P.R. China.
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43
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Zografou C, Vakrakou AG, Stathopoulos P. Short- and Long-Lived Autoantibody-Secreting Cells in Autoimmune Neurological Disorders. Front Immunol 2021; 12:686466. [PMID: 34220839 PMCID: PMC8248361 DOI: 10.3389/fimmu.2021.686466] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
As B cells differentiate into antibody-secreting cells (ASCs), short-lived plasmablasts (SLPBs) are produced by a primary extrafollicular response, followed by the generation of memory B cells and long-lived plasma cells (LLPCs) in germinal centers (GCs). Generation of IgG4 antibodies is T helper type 2 (Th2) and IL-4, -13, and -10-driven and can occur parallel to IgE, in response to chronic stimulation by allergens and helminths. Although IgG4 antibodies are non-crosslinking and have limited ability to mobilize complement and cellular cytotoxicity, when self-tolerance is lost, they can disrupt ligand-receptor binding and cause a wide range of autoimmune disorders including neurological autoimmunity. In myasthenia gravis with predominantly IgG4 autoantibodies against muscle-specific kinase (MuSK), it has been observed that one-time CD20+ B cell depletion with rituximab commonly leads to long-term remission and a marked reduction in autoantibody titer, pointing to a short-lived nature of autoantibody-secreting cells. This is also observed in other predominantly IgG4 autoantibody-mediated neurological disorders, such as chronic inflammatory demyelinating polyneuropathy and autoimmune encephalitis with autoantibodies against the Ranvier paranode and juxtaparanode, respectively, and extends beyond neurological autoimmunity as well. Although IgG1 autoantibody-mediated neurological disorders can also respond well to rituximab induction therapy in combination with an autoantibody titer drop, remission tends to be less long-lasting and cases where titers are refractory tend to occur more often than in IgG4 autoimmunity. Moreover, presence of GC-like structures in the thymus of myasthenic patients with predominantly IgG1 autoantibodies against the acetylcholine receptor and in ovarian teratomas of autoimmune encephalitis patients with predominantly IgG1 autoantibodies against the N‐methyl‐d‐aspartate receptor (NMDAR) confers increased the ability to generate LLPCs. Here, we review available information on the short-and long-lived nature of ASCs in IgG1 and IgG4 autoantibody-mediated neurological disorders and highlight common mechanisms as well as differences, all of which can inform therapeutic strategies and personalized medical approaches.
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Affiliation(s)
- C Zografou
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - A G Vakrakou
- First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - P Stathopoulos
- First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
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44
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Xie Y, Meng H, Maimaiti B, Yu M, Zhao Y. Autoimmune encephalitis associated with anti-LGI1 antibody and Sjögren's syndrome: a case report. Neurol Sci 2021; 42:3915-3918. [PMID: 34110513 DOI: 10.1007/s10072-021-05370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Accepted: 05/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Yinyin Xie
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hongmei Meng
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China.
| | - Buajieerguli Maimaiti
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Miaomiao Yu
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Zhao
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China.
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45
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Kira JI. Anti-Neurofascin 155 Antibody-Positive Chronic Inflammatory Demyelinating Polyneuropathy/Combined Central and Peripheral Demyelination: Strategies for Diagnosis and Treatment Based on the Disease Mechanism. Front Neurol 2021; 12:665136. [PMID: 34177770 PMCID: PMC8222570 DOI: 10.3389/fneur.2021.665136] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/06/2021] [Indexed: 02/02/2023] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated demyelinating disease of the peripheral nervous system (PNS). A small number of CIDP patients harbors autoantibodies against nodal/paranodal proteins, such as neurofascin 155 (NF155), contactin 1, and contactin-associated protein 1. In most cases, the predominant immunoglobulin (IgG) subclass is IgG4. Node/paranode antibody-positive CIDP demonstrates distinct features compared with antibody-negative CIDP, including a poor response to intravenous immunoglobulin. The neuropathology of biopsied sural nerve shows Schwann cell terminal loop detachment from axons without macrophage infiltration or inflammation. This is partly attributable to IgG4, which blocks protein-protein interactions without inducing inflammation. Anti-NF155 antibody-positive (NF155+) CIDP is unique because of the high frequency of subclinical demyelinating lesions in the central nervous system (CNS). This is probably because NF155 coexists in the PNS and CNS. Such cases showing demyelinating lesions in both the CNS and PNS are now termed combined central and peripheral demyelination (CCPD). NF155+ CIDP/CCPD commonly presents hypertrophy of spinal nerve roots and cranial nerves, such as trigeminal and oculomotor nerves, and extremely high levels of cerebrospinal fluid (CSF) protein, which indicates nerve root inflammation. In the CSF, the CXCL8/IL8, IL13, TNFα, CCL11/eotaxin, CCL2/MCP1, and IFNγ levels are significantly higher and the IL1β, IL1ra, and GCSF levels are significantly lower in NF155+ CIDP than in non-inflammatory neurological diseases. Even compared with anti-NF155 antibody-negative (NF155-) CIDP, the CXCL8/IL8 and IL13 levels are significantly higher and the IL1β and IL1ra levels are significantly lower than those in NF155+ CIDP. Canonical discriminant analysis revealed NF155+ and NF155- CIDP to be separable with IL4, IL10, and IL13, the three most significant discriminators, all of which are required for IgG4 class switching. Therefore, upregulation of both Th2 and Th1 cytokines and downregulation of macrophage-related cytokines are characteristic of NF155+ CIDP, which explains spinal root inflammation and the lack of macrophage infiltration in the sural nerves. All Japanese patients with NF155+ CIDP/CCPD have one of two specific human leukocyte antigen (HLA) haplotypes, which results in a significantly higher prevalence of HLA-DRB1 * 15:01-DQB1 * 06:02 compared with healthy Japanese controls. This indicates an involvement of specific HLA class II molecules and relevant T cells in addition to IgG4 anti-NF155 antibodies in the mechanism underlying IgG4 NF155+ CIDP/CCPD.
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Affiliation(s)
- Jun-Ichi Kira
- Translational Neuroscience Center, Graduate School of Medicine, and School of Pharmacy at Fukuoka, International University of Health and Welfare, Fukuoka, Japan.,Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, International University of Health and Welfare, Fukuoka, Japan
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46
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Steriade C, Titulaer MJ, Vezzani A, Sander JW, Thijs RD. The association between systemic autoimmune disorders and epilepsy and its clinical implications. Brain 2021; 144:372-390. [PMID: 33221878 DOI: 10.1093/brain/awaa362] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 08/03/2020] [Accepted: 08/13/2020] [Indexed: 12/12/2022] Open
Abstract
Systemic autoimmune disorders occur more frequently in patients with epilepsy than in the general population, suggesting shared disease mechanisms. The risk of epilepsy is elevated across the spectrum of systemic autoimmune disorders but is highest in systemic lupus erythematosus and type 1 diabetes mellitus. Vascular and metabolic factors are the most important mediators between systemic autoimmune disorders and epilepsy. Systemic immune dysfunction can also affect neuronal excitability, not only through innate immune activation and blood-brain barrier dysfunction in most epilepsies but also adaptive immunity in autoimmune encephalitis. The presence of systemic autoimmune disorders in subjects with acute seizures warrants evaluation for infectious, vascular, toxic and metabolic causes of acute symptomatic seizures, but clinical signs of autoimmune encephalitis should not be missed. Immunosuppressive medications may have antiseizure properties and trigger certain drug interactions with antiseizure treatments. A better understanding of mechanisms underlying the co-existence of epilepsy and systemic autoimmune disorders is needed to guide new antiseizure and anti-epileptogenic treatments. This review aims to summarize the epidemiological evidence for systemic autoimmune disorders as comorbidities of epilepsy, explore potential immune and non-immune mechanisms, and provide practical implications on diagnostic and therapeutic approach to epilepsy in those with comorbid systemic autoimmune disorders.
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Affiliation(s)
- Claude Steriade
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annamaria Vezzani
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Josemir W Sander
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, Bucks, UK.,Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands
| | - Roland D Thijs
- NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London WC1N 3BG, UK.,Stichting Epilepsie Instellingen Nederland - (SEIN), Heemstede, The Netherlands.,Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
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47
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Muñiz-Castrillo S, Hedou JJ, Ambati A, Jones D, Vogrig A, Pinto AL, Benaiteau M, de Broucker T, Fechtenbaum L, Labauge P, Murnane M, Nocon C, Taifas I, Vialatte de Pémille C, Psimaras D, Joubert B, Dubois V, Wucher V, Desestret V, Mignot E, Honnorat J. Distinctive clinical presentation and pathogenic specificities of anti-AK5 encephalitis. Brain 2021; 144:2709-2721. [PMID: 33843981 DOI: 10.1093/brain/awab153] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/10/2021] [Accepted: 03/28/2021] [Indexed: 11/12/2022] Open
Abstract
Limbic encephalitis (LE) with antibodies against adenylate kinase 5 (AK5) has been difficult to characterize because of its rarity. In this study, we identified 10 new cases and reviewed 16 previously reported patients, investigating clinical features, IgG subclasses, human leukocyte antigen (HLA), and CSF proteomic profiles. Patients with anti-AK5 LE were mostly men (20/26, 76.9%) of median age 66 years old (range 48-94). Predominant symptom was severe episodic amnesia in all patients, frequently associated with depression (17/25, 68.0%). Weight loss, asthenia, and anorexia were also highly characteristic, being present in 11/25 (44.0%) patients. Although epilepsy was always lacking at disease onset, seizures developed later in a subset of patients (4/25, 16.0%). All patients presented CSF abnormalities, such as pleocytosis (18/25, 72.0%), oligoclonal bands (18/25, 72.0%), and increased Tau (11/14, 78.6%). Temporal lobe hyper-intensities were almost always present at disease onset (23/26, 88.5%), evolving nearly invariably toward a severe atrophy in subsequent MRIs (17/19, 89.5%). This finding was in line with a poor response to immunotherapy, with only 5/25 (20.0%) patients responding. IgG1 was the predominant subclass, being the most frequently detected and the one with highest titres in nine CSF-serum paired samples. Temporal biopsy from one of our new cases showed massive lymphocytic infiltrates dominated by both CD4+ and CT8+ T-cells, intense granzyme B expression, and abundant macrophages/microglia. HLA analysis in 11 patients showed a striking association with HLA-B*08:01 (7/11, 63.6%; OR = 13.4, 95% CI [3.8-47.4]), C*07:01 (8/11, 72.7%; OR = 11.0, 95% CI [2.9-42.5]), DRB1*03:01 (8/11, 72.7%; OR = 14.4, 95% CI [3.7-55.7]), DQB1*02:01 (8/11, 72.7%; OR = 13.5, 95% CI [3.5-52.0]), and DQA1*05:01 (8/11, 72.7%; OR = 14.4, 95% CI [3.7-55.7]) alleles, which formed the extended haplotype B8-C7-DR3-DQ2 in 6/11 (54.5%) patients (OR = 16.5, 95% CI [4.8-57.1]). Finally, we compared the CSF proteomic profile of five anti-AK5 patients with that of 40 controls and 10 cases with other more common non-paraneoplastic LE (five with antibodies against leucine-rich glioma inactivated 1 and five against contactin-associated protein-like 2), as well as 10 cases with paraneoplastic neurological syndromes (five with antibodies against Yo and five against Ma2). These comparisons revealed, respectively, 31 and seven significantly up-regulated proteins in anti-AK5 LE, mapping to apoptosis pathways and innate/adaptive immune responses. These findings suggest that the clinical manifestations of anti-AK5 LE result from a distinct T-cell mediated pathogenesis, with major cytotoxicity-induced apoptosis leading to a prompt and aggressive neuronal loss, likely explaining the poor prognosis and response to immunotherapy.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Aditya Ambati
- Stanford University Center for Narcolepsy, Palo Alto, CA, USA
| | - David Jones
- Pathology and Laboratory Medicine, Albany Medical Center Hospital, Albany, NY, USA
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Anne-Laurie Pinto
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Benaiteau
- Neurology Department, Hôpital Pierre-Paul Riquet, Toulouse, France
| | - Thomas de Broucker
- Neurology Department, Hôpital Pierre Delafontaine, Centre Hospitalier de Saint-Denis, Saint-Denis, France
| | - Laura Fechtenbaum
- Neurology Department, Centre Hospitalier Henri Mondor, Paris, France
| | - Pierre Labauge
- Neurology Department, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Matthew Murnane
- Neurology Department, Albany Medical Center Hospital, Albany, NY, USA
| | - Claire Nocon
- Neurology Department, Centre Hospitalier de Dax, Dax, France
| | - Irina Taifas
- Neurology Department, Hôpital d´Instruction des Armées Percy, Clamart, France
| | | | - Dimitri Psimaras
- Neurology Department 2-Mazarin, Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP, Paris, France.,Brain and Spinal Cord Institute, INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Valérie Dubois
- HLA Laboratory, French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France
| | - Valentin Wucher
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Virginie Desestret
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Emmanuel Mignot
- Stanford University Center for Narcolepsy, Palo Alto, CA, USA
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.,SynatAc Team, Institute NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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Muñiz-Castrillo S, Haesebaert J, Thomas L, Vogrig A, Pinto AL, Picard G, Blanc C, Do LD, Joubert B, Berzero G, Psimaras D, Alentorn A, Rogemond V, Dubois V, Ambati A, Tamouza R, Mignot E, Honnorat J. Clinical and Prognostic Value of Immunogenetic Characteristics in Anti-LGI1 Encephalitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e974. [PMID: 33848259 PMCID: PMC7938443 DOI: 10.1212/nxi.0000000000000974] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/04/2021] [Indexed: 01/17/2023]
Abstract
Objective Antibodies against leucine-rich glioma-inactivated 1 (LGI1-Abs) characterize a limbic encephalitis (LE) strongly associated with HLA-DRB1*07:01, although some patients lack LGI1-Abs in CSF or do not carry this allele. Whether they represent a different subtype of disease or have different prognoses is unclear. Methods Retrospective analysis of clinical features, IgG isotypes, and outcome according to LGI1-Ab CSF positivity and DRB1*07:01 in a cohort of anti-LGI1 LE patients. Results Patients with LGI1-Abs detected in both CSF and serum (105/134, 78%) were compared with those who were CSF negative (29/134, 22%). Both groups had similar clinical features and serum levels, but CSF-positive patients had shorter diagnostic delay, more frequently hyponatremia, inflammatory CSF, and abnormal MRI (p < 0.05). Human leukocyte antigen (HLA) genotyping was performed in 72/134 (54%) patients and 63/72 (88%) carried DRB1*07:01. Noncarriers (9/72, 12%) were younger, more commonly women, and had less frequently psychiatric and frontal symptoms (p < 0.05). No difference in IgG isotypes according to CSF positivity or HLA was found (p > 0.05). HLA and IgG isotypes were not associated with poor outcome (mRS >2 at last follow-up) in univariate analyses; CSF positivity was only identified as a poor outcome predictor in the multivariate analysis including the complete follow-up, whereas age and female sex also remained when just the first year was considered. Conclusions LE without CSF LGI1-Abs is clinically indistinguishable and likely reflects just a lesser LGI1-Ab production. HLA association is sex and age biased and presents clinical particularities, suggesting subtle differences in the immune response. Long-term outcome depends mostly on demographic characteristics and the intensity of the intrathecal synthesis.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Julie Haesebaert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Laure Thomas
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Alberto Vogrig
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Anne-Laurie Pinto
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Géraldine Picard
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Charlotte Blanc
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Le-Duy Do
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Bastien Joubert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Giulia Berzero
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Dimitri Psimaras
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Agusti Alentorn
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Véronique Rogemond
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Valérie Dubois
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Aditya Ambati
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Ryad Tamouza
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Emmanuel Mignot
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France
| | - Jérôme Honnorat
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; SynatAc Team (S.M.-C., L.T., A.V., A.-L.P., G.P., C.B., L.-D.D., B.J., V.R., J. Honnorat), Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, France; Clinic Research and Epidemiology Department (J. Haesebaert), Hospices Civils de Lyon, Lyon, France, HESPER Team, EA 7425, Medicine School, Université Claude Bernard Lyon 1, France; Neurology Department 2-Mazarin (G.B., D.P., A. Alentorn), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (G.B., D.P., A. Alentorn), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris, France; HLA Laboratory (V.D.), French Blood Service, EFS Auvergne-Rhône-Alpes, Lyon, France; Stanford University Center for Sleep Sciences and Medicine (A. Ambati, E.M.), Palo Alto, CA; and Department of Psychiatry (R.T.), Hôpitaux Universitaires Henri Mondor, Créteil, France, Mondor Institute for Biomedical Research, INSERM U955, Université de Paris-Est-Créteil, France.
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Muñiz-Castrillo S, Vogrig A, Montagnac C, Joubert B, Benaiteau M, Casez O, Chaumont H, Hopes L, Lanoiselée HM, Navarro V, Thomas B, Ursu R, Gonçalves D, Fabien N, Ducray F, Julier C, Honnorat J. Familial autoimmunity in neurological patients with GAD65 antibodies: an interview-based study. J Neurol 2021; 268:2515-2522. [PMID: 33544221 DOI: 10.1007/s00415-021-10424-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
The common co-occurrence of autoimmune systemic diseases in patients with neurological disorders and antibodies against glutamic acid decarboxylase 65 (GAD65) suggests a shared genetic predisposition to these disorders. However, the nature and frequency of familial aggregation of autoimmune diseases, which might also support this hypothesis, have been poorly investigated. Herein, an exploratory, interview-based study was conducted with the aim of describing the autoimmune diseases displayed by the relatives of GAD65 neurological patients, their frequency, kinship, and potential patterns of inheritance. Patients were enrolled only if they had GAD65 antibodies in the cerebrospinal fluid and typical clinical phenotypes associated with such antibodies (stiff-person syndrome, cerebellar ataxia, limbic encephalitis, or temporal lobe epilepsy). A total of 65 patients were included in the study, and 44/65 (67.7%) reported family history of autoimmunity, including first-degree relatives in 36/65 (55.4%); the sibling recurrence risk (λS) was 5.5, reinforcing the hypothesis of an underlying strong genetic predisposition. Most pedigrees with familial autoimmunity (38/44, 86.4%) showed multiple autoimmune diseases, all but 2 of them with diabetes mellitus or autoimmune thyroid disease, therefore resembling autoimmune polyendocrine syndromes. Inheritance patterns were diverse, possibly autosomal dominant in 17/44 (38.6%) pedigrees or autosomal recessive in 5/44 (11.4%), and un-defined or complex in 24/44 (54.5%). However, a total of 21/65 (32.3%) patients had no identified family history of autoimmunity. In conclusion, these results suggest a variable and heterogeneous genetic predisposition to GAD65 neurological disorders, possibly involving multiple loci and modes of inheritance with different contribution in each family.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Clémentine Montagnac
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Benaiteau
- Neurology Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Olivier Casez
- Neurology Department, Centre Hospitalier Universitaire de Grenoble, Grenoble, France
| | - Hugo Chaumont
- Neurology Department, Centre Hospitalier Universitaire de la Guadeloupe, Point-à-Pitre, France
| | - Lucie Hopes
- Neurology Department, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | | | - Vincent Navarro
- Neurology Department, GH Pitié-Salpêtrière-Charles Foix, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Benjamin Thomas
- Neurology Department, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - Renata Ursu
- Neurology Department, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Gonçalves
- Immunology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - Nicole Fabien
- Immunology Department, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Lyon, France
| | - François Ducray
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Cécile Julier
- Institut Cochin, Inserm U1016, CNRS UMR-8104, Université de Paris, Paris, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France.
- SynatAc Team, Institut NeuroMyoGène, Inserm U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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50
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Koneczny I, Yilmaz V, Lazaridis K, Tzartos J, Lenz TL, Tzartos S, Tüzün E, Leypoldt F. Common Denominators in the Immunobiology of IgG4 Autoimmune Diseases: What Do Glomerulonephritis, Pemphigus Vulgaris, Myasthenia Gravis, Thrombotic Thrombocytopenic Purpura and Autoimmune Encephalitis Have in Common? Front Immunol 2021; 11:605214. [PMID: 33584677 PMCID: PMC7878376 DOI: 10.3389/fimmu.2020.605214] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 12/08/2020] [Indexed: 12/20/2022] Open
Abstract
IgG4 autoimmune diseases (IgG4-AID) are an emerging group of autoimmune diseases that are caused by pathogenic autoantibodies of the IgG4 subclass. It has only recently been appreciated, that members of this group share relevant immunobiological and therapeutic aspects even though different antigens, tissues and organs are affected: glomerulonephritis (kidney), pemphigus vulgaris (skin), thrombotic thrombocytopenic purpura (hematologic system) muscle-specific kinase (MuSK) in myasthenia gravis (peripheral nervous system) and autoimmune encephalitis (central nervous system) to give some examples. In all these diseases, patients’ IgG4 subclass autoantibodies block protein-protein interactions instead of causing complement mediated tissue injury, patients respond favorably to rituximab and share a genetic predisposition: at least five HLA class II genes have been reported in individual studies to be associated with several different IgG4-AID. This suggests a role for the HLA class II region and specifically the DRβ1 chain for aberrant priming of autoreactive T-cells toward a chronic immune response skewed toward the production of IgG4 subclass autoantibodies. The aim of this review is to provide an update on findings arguing for a common pathogenic mechanism in IgG4-AID in general and to provide hypotheses about the role of distinct HLA haplotypes, T-cells and cytokines in IgG4-AID.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Konstantinos Lazaridis
- Department of Immunology, Laboratory of Immunology, Hellenic Pasteur Institute, Athens, Greece
| | - John Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,1st Department of Neurology, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Tobias L Lenz
- Research Group for Evolutionary Immunogenomics, Max Planck Institute for Evolutionary Biology, Plön, Germany
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece.,Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
| | - Erdem Tüzün
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Frank Leypoldt
- Neuroimmunology, Institute of Clinical Chemistry and Department of Neurology, Medical Faculty, Christian-Albrechts-University Kiel, Kiel, Germany
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