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Bernardi L, Mussi N, Grandinetti R, Turco E, Piccolo B, Ormitti F, Principi N, Esposito S. FLAIR Hyperintense Cortical Lesions in a 4-Year-Old Child with Myelin Oligodendrocyte Glycoprotein (MOG)-Associated Encephalitis and Seizures: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2024; 11:778. [PMID: 39062226 PMCID: PMC11275210 DOI: 10.3390/children11070778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 07/28/2024]
Abstract
Myelin oligodendrocyte glycoprotein (MOG)-IgG-associated disease (MOGAD) is a relatively uncommon autoantibody demyelinating disorder of the central nervous system (CNS) with heterogeneous clinical manifestations and magnetic resonance imaging (MRI) findings. In recent years, a rare MOGAD subtype characterized by distinct clinical and MRI findings has been described. Seizures and cortical hyperintensities best seen on MRI T2-weighted fluid-attenuated inversion recovery (FLAIR) sequences, associated with headache and cerebral spine fluid (CSF) pleocytosis, are the most important characteristics of this MOGAD entity that is named FLAMES (FLAIR hyperintense cortical lesions in MOG-associated encephalitis with seizures). Because of its rarity and the peculiarities of the brain damage and clinical manifestations, it can be under-recognized and confused with focal viral encephalitis, meningitis, subarachnoid hemorrhage, CNS vasculitis, or mitochondrial cytopathy. We described the case of a 4-year-old previously healthy girl who was admitted for focal-onset, tonic-clonic seizures, fever, and headache, combined with optic neuritis. MRI was characterized by FLAIR imaging showing hyperintense cortical lesions, and a mild leukocytosis in the CSF was detected. Efficacy and rapid response to steroid therapy was observed, and no recurrences of neurological problems or further seizures were reported in the following 12 months. This case report can help in understanding FLAMES characteristics in pediatrics in order to favor early diagnosis and prompt therapy.
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Affiliation(s)
- Luca Bernardi
- Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (L.B.); (N.M.); (R.G.); (E.T.); (B.P.)
| | - Nicole Mussi
- Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (L.B.); (N.M.); (R.G.); (E.T.); (B.P.)
| | - Roberto Grandinetti
- Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (L.B.); (N.M.); (R.G.); (E.T.); (B.P.)
| | - Emanuela Turco
- Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (L.B.); (N.M.); (R.G.); (E.T.); (B.P.)
| | - Benedetta Piccolo
- Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (L.B.); (N.M.); (R.G.); (E.T.); (B.P.)
| | - Francesca Ormitti
- Unit of Neuroradiology, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy;
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, 43126 Parma, Italy; (L.B.); (N.M.); (R.G.); (E.T.); (B.P.)
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Yang J, Luo H, Ding R, Fang Z, Gui J, Han Z, Yang X, Huang D, Ma J, Jiang L. Autoimmune encephalitis antibody profiles and clinical characteristics of children with suspected autoimmune encephalitis. Dev Med Child Neurol 2024; 66:483-492. [PMID: 37786252 DOI: 10.1111/dmcn.15762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 10/04/2023]
Abstract
AIM To identify the spectrum of autoimmune encephalitis antibody biomarkers (AE-Abs) in children with suspected autoimmune encephalitis and explore the clinical features indicating AE-Abs presence. METHOD We included children with suspected autoimmune encephalitis who underwent AE-Abs tests at the Children's Hospital of Chongqing Medical University between June 2020 and June 2022. Clinical features suggestive of AE-Abs were analysed based on AE-Abs test results. RESULTS A total of 392 children were tested for AE-Abs with suspected autoimmune encephalitis. Of these, 49.5% were male, with a median age of 7 years 11 months (6 months-17 years 11 months); 93.6% (367/392) of all patients had both serum and cerebrospinal fluid (CSF) tests performed. The antibody-positive rate in the cohort was 23.7% (93/392), the serum antibody-positive rate was 21.9% (84/384), and the CSF antibody-positive rate was 20.8% (78/375). Eleven different AE-Abs were detected. Serum analysis revealed that N-methyl-D-aspartate receptor immunoglobulin-G (NMDAR-IgG) (15.1%) was greater than myelin oligodendrocyte glycoprotein (MOG)-IgG (14.6%) and glial fibrillary acidic protein (GFAP)-IgG (3.3%). CSF analysis revealed that NMDAR-IgG (16.3%) was greater than MOG-IgG (13.8%) and GFAP-IgG (3.3%). Compared with antibody-negative patients, antibody-positive patients were more often female (odds ratio [OR] 1.86, p = 0.03), with memory impairment (OR 2.91, p = 0.01) and sleep disorders (OR 2.08, p = 0.02). INTERPRETATION In children, the most frequent AE-Abs detected were NMDAR-IgG and MOG-IgG. Female sex, memory impairment, and sleep disorders predict a higher likelihood of AE-Abs.
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Affiliation(s)
| | | | - Ran Ding
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Zhixu Fang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Jianxiong Gui
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Ziyao Han
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Xiaoyue Yang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
| | - Dishu Huang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Paediatrics, Chongqing, China
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Madani J, Yea C, Mahjoub A, Brna P, Jones K, Longoni G, Nouri MN, Rizk T, Stewart WA, Wilbur C, Yeh EA. Clinical features and outcomes in children with seronegative autoimmune encephalitis. Dev Med Child Neurol 2024. [PMID: 38491729 DOI: 10.1111/dmcn.15896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 02/03/2024] [Accepted: 02/09/2024] [Indexed: 03/18/2024]
Abstract
AIM To characterize the presenting features and outcomes in children with seronegative autoimmune encephalitis, and to evaluate whether scores at nadir for the Modified Rankin Scale (mRS) and Clinical Assessment Scale for Autoimmune Encephalitis (CASE) or its paediatric-specific modification (ped-CASE) are predictive of outcomes. METHOD This observational study included children younger than 18 years of age with seronegative autoimmune encephalitis. Demographics and clinical data were collected. The mRS and CASE/ped-CASE scores were used to evaluate disease severity. Descriptive statistics and logistic regression were used for data analysis and to evaluate associations between scale scores and outcomes. RESULTS Sixty-three children were included (39 [62%] females, median age 7 years, interquartile range [IQR] 4 years 1 months-11 years 6 months), with follow-up available for 56 out of 63 patients (median follow-up 12.2 months, IQR 13.4-17.8). The most frequent presenting neurological manifestation was encephalopathy (81%). Median CASE/ped-CASE and mRS scores at nadir were 12.0 (IQR 7.0-17.0) and 1.0 (IQR 0-2.0) respectively. Thirty-three patients (59%) had persistent neurological deficits at follow-up. Both scoring systems suggested good functional recovery (mRS score ≤2, 95%; CASE/ped-CASE score <5, 91%). CASE/ped-CASE score was more likely than mRS to distinguish children with worse outcomes. INTERPRETATION Children with seronegative autoimmune encephalitis are likely to have neurological deficits at follow-up. CASE/ped-CASE is more likely to distinguish children with worse outcomes than MRS.
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Affiliation(s)
- Jihan Madani
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Yea
- Neurosciences and Mental Health Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Areej Mahjoub
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paula Brna
- Division of Neurology, Dalhousie University IWK Health Center, Halifax, Nova Scotia, Canada
| | - Kevin Jones
- Division of Neurology, McMaster University, Hamilton, Ontario, Canada
| | - Giulia Longoni
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maryam Nabavi Nouri
- Division of Pediatric Neurology, Department of Pediatrics, Children's Hospital, London Health Science Center, London, Ontario, Canada
| | - Tamer Rizk
- Pediatric Neurology, Department of Pediatrics, Saint John Regional Hospital, St. John, New Brunswick, Canada
| | - Wendy A Stewart
- Pediatric Neurology, Department of Pediatrics, Saint John Regional Hospital, St. John, New Brunswick, Canada
| | - Colin Wilbur
- Division of Neurology, Department of Pediatrics, University of Alberta, Alberta, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Neurosciences and Mental Health Program, SickKids Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
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Wang Z, Zhang Q, Wang Y, Zhu M, Li Q. A framework for immunofluorescence image augmentation and classification based on unsupervised attention mechanism. JOURNAL OF BIOPHOTONICS 2023; 16:e202300209. [PMID: 37559356 DOI: 10.1002/jbio.202300209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/16/2023] [Accepted: 08/07/2023] [Indexed: 08/11/2023]
Abstract
Autoimmune encephalitis (AE) is a common neurological disorder. As a standard method for neuroautoantibody detection, pathologists use tissue matrix assays (TBA) for initial disease screening. In this study, microscopic fluorescence imaging was combined with deep learning to improve AE diagnostic accuracy. Due to the inter-class imbalance of medical data, we propose an innovative generative adversarial network supplemented with attention mechanisms to highlight key regions in images to synthesize high-quality fluorescence images. However, securing annotated medical data is both time-consuming and costly. To circumvent this problem, we employ a self-supervised learning approach that utilizes unlabeled fluorescence data to support downstream classification tasks. To better understand the fluorescence properties in the data, we introduce a multichannel input convolutional neural network that adds additional channels of fluorescence intensity. This study builds an AE immunofluorescence dataset and obtains the classification accuracy of 88.5% using our method, thus confirming the effectiveness of the proposed method.
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Affiliation(s)
- Ziyi Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
- Engineering Research Center of Nanophotonics & Advanced Instrument, Ministry of Education, East China Normal University, Shanghai, China
| | - Qing Zhang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
- Engineering Research Center of Nanophotonics & Advanced Instrument, Ministry of Education, East China Normal University, Shanghai, China
| | - Yan Wang
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
- Engineering Center of SHMEC for Space Information and GNSS, Shanghai, China
| | - Min Zhu
- Department of Dermatology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qingli Li
- Shanghai Key Laboratory of Multidimensional Information Processing, East China Normal University, Shanghai, China
- Engineering Research Center of Nanophotonics & Advanced Instrument, Ministry of Education, East China Normal University, Shanghai, China
- Engineering Center of SHMEC for Space Information and GNSS, Shanghai, China
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Pandey R, Bakay M, Hakonarson H. SOCS-JAK-STAT inhibitors and SOCS mimetics as treatment options for autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis. Front Immunol 2023; 14:1271102. [PMID: 38022642 PMCID: PMC10643230 DOI: 10.3389/fimmu.2023.1271102] [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: 08/01/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Autoimmune diseases arise from atypical immune responses that attack self-tissue epitopes, and their development is intricately connected to the disruption of the JAK-STAT signaling pathway, where SOCS proteins play crucial roles. Conditions such as autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis exhibit immune system dysfunctions associated with JAK-STAT signaling dysregulation. Emerging therapeutic strategies utilize JAK-STAT inhibitors and SOCS mimetics to modulate immune responses and alleviate autoimmune manifestations. Although more research and clinical studies are required to assess their effectiveness, safety profiles, and potential for personalized therapeutic approaches in autoimmune conditions, JAK-STAT inhibitors and SOCS mimetics show promise as potential treatment options. This review explores the action, effectiveness, safety profiles, and future prospects of JAK inhibitors and SOCS mimetics as therapeutic agents for psoriasis, autoimmune uveitis, systemic lupus erythematosus, and autoimmune encephalitis. The findings underscore the importance of investigating these targeted therapies to advance treatment options for individuals suffering from autoimmune diseases.
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Affiliation(s)
- Rahul Pandey
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Marina Bakay
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA, United States
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Cheng X, Li Y, Wang Y, Sun Y, Lian Y. Impact of blood-brain barrier disruption on clinical features and treatment response in patients with newly diagnosed autoimmune encephalitis. J Neuroimmunol 2023; 383:578203. [PMID: 37740995 DOI: 10.1016/j.jneuroim.2023.578203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
AIMS Blood-brain barrier (BBB) breakdown is an essential mechanism in inflammatory diseases of the central nervous system. However, the association between BBB integrity and autoimmune encephalitis (AE) has not been investigated. Our study aimed to analyze this relationship in patients with AE between BBB integrity with clinical manifestations and therapeutic responses. METHODS Our study enrolled 147 patients with AE who were newly diagnosed at the First Affiliated Hospital of Zhengzhou University between August 2015 and December 2021. Patients were classified into normal or damaged BBB groups based on cerebrospinal fluid (CSF) albumin/serum albumin (QAlb). To evaluate the severity of the illness, we used the modified Rankin Scale (mRS) and the Clinical Assessment Scale for Autoimmune Encephalitis (CASE). RESULTS We found a higher proportion of males, higher CSF protein, immunoglobulin IgG, and 24-h intrathecal IgG synthesis rate in the damaged BBB group. The improvement rate was lower in the damaged BBB group, but we found that double- or triple-combination immunotherapy had better clinical outcomes than single immunotherapy. In addition, there was a positive correlation between the CASE score and mRS score, and a positive correlation between the CASE score or mRS score and QAlb on admission. CONCLUSIONS BBB integrity is closely related to the clinical features and treatment responses of newly diagnosed AE. Patients with AE and a damaged BBB may benefit from combination immunotherapy.
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Affiliation(s)
- Xuan Cheng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yimeng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaoyao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yidi Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Tyvaert L. How autoimmunity changed our diagnostic practice in epileptology? Rev Neurol (Paris) 2023; 179:316-329. [PMID: 36804011 DOI: 10.1016/j.neurol.2022.11.008] [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: 09/02/2022] [Revised: 11/06/2022] [Accepted: 11/08/2022] [Indexed: 02/17/2023]
Abstract
Since few years, a new etiology of epilepsy emerges with the labelling of new autoantibodies against the central nervous system. In 2017, the International League Against Epilepsy (ILAE) concluded that autoimmunity is one of six etiologies contributing to epilepsy and that autoimmune epilepsy is directly caused by immune disorders in which seizures constitute a core symptom. Epileptic disorders of immune origin are now distinguished in two different entities: acute symptomatic seizures secondary to autoimmune (ASS) and autoimmune-associated epilepsy (AAE) with different expected clinical outcome under immunotherapy. If acute encephalitis is usually related to ASS with a classic good control of the disease under immunotherapy, clinical phenotype characterized by isolated seizures (new onset seizures and chronic focal epilepsy patients) may be due to either ASS or to AAE. Decision of Abs testing and early immunotherapy initiation needs the development of clinical scores able to select patients with high risk of positive Abs testings. If this selection is now included in the usual medical care of encephalitic patients, specifically with NORSE, the actual bigger challenge is in patients with non or only mild encephalitic symptoms followed for new onset seizures or chronic focal epilepsy patients of unknown origin. The emergence of this new entity provides new therapeutic strategies with specific etiologic and probably anti epileptogenic medication rather than the usual and nonspecific ASM. In the world of the epileptology, this new autoimmune entity appears as a big challenge with an exciting chance to improve or even definitely cure patients of their epilepsy. However, the detection of these patients has to be done in the early phase of the disease to offer the best outcome.
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Affiliation(s)
- L Tyvaert
- Department of neurology, hospital central, CHRU Nancy, Nancy, France; UMR 7039 CRAN, Université de Lorraine, Nancy, France.
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Liu X, Sun Y, Zhang X, Liu P, Zhang K, Yu L, Su Y, Yuan Y, Ke Q, Peng G. Prevalence and outcomes of rapidly progressive dementia: a retrospective cohort study in a neurologic unit in China. BMC Geriatr 2023; 23:142. [PMID: 36918794 PMCID: PMC10012734 DOI: 10.1186/s12877-023-03841-1] [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: 09/15/2022] [Accepted: 02/22/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Rapidly progressive dementia (RPD) is a syndrome originating from various diseases. Recent advances have allowed a better understanding of its categories and spectrum; however, it remains challenging to make an accurate differential diagnosis and prognosis prediction. METHODS This study was a retrospective evaluation of all participants admitted to the neurology department of a single center in China from January 2015 to December 2019. The screened patients met the RPD criteria and their characteristics were collected to explore a diagnostic pattern of RPD. In addition, outcomes of RPD were evaluated with the Glasgow Outcome Scale (GOS), activities of daily living scale (ADL), and simplified Mini-Mental State Examination (MMSE), and different prognostic analysis methods were performed to determine the prognostic factors of RPD. RESULTS A total of 149 RPD patients among 15,731 inpatients were identified with an average MMSE value of 13.0 ± 4.6 at baseline. Etiological epidemiology revealed infectious, neurodegenerative and toxic/metabolic diseases as the three largest groups, accounting for 26.2%, 20.8% and 16.8% of all cases, respectively. In particular, prevalence rates of Creutzfeldt-Jakob disease (13.4%), Alzheimer's disease (11.4%), carbon monoxide poisoning (8.1%), neurosyphilis (5.4%) and dementia with Lewy bodies (5.4%) were highest in this series. A recommended diagnostic framework for RPD etiology was thus established. Follow-up evaluations showed a negative correlation between age and GOS scores (r=-0.421, P < 0.001), as well as age and simplified MMSE scores (rs =- 0.393, P < 0.001), and a positive correlation between age and ADL scores (rs =0.503, P < 0.001), and significantly different GOS, ADL and simplified MMSE scores across various etiologies (P = 0.003; F = 9.463, P < 0.001; F = 6.117, P < 0.001). CONCLUSION Infectious, neurodegenerative and toxic-metabolic entities were the most common RPD categories, and establishing a practical approach to RPD etiology would allow better disease management.
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Affiliation(s)
- Xiaoyan Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China.
| | - Yan Sun
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Xuyan Zhang
- Department of Neurology, Haining People's hospital, Jiaxing, China
| | - Ping Liu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Kan Zhang
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Lihua Yu
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Yujie Su
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Yuan Yuan
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Qing Ke
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China
| | - Guoping Peng
- Department of Neurology, the First Affiliated Hospital, Zhejiang University School of Medicine, Qingchun Road No.79, 310009, Hangzhou, China.
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Esposito S, Autore G, Argentiero A, Ramundo G, Principi N. Autoimmune encephalitis after herpes simplex encephalitis: A still undefined condition. Clin Exp Rheumatol 2022; 21:103187. [PMID: 36087700 DOI: 10.1016/j.autrev.2022.103187] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
Herpes simplex encephalitis (HSE) is one of the most common sporadic viral encephalitis. Generally, HSE is characterized by a monophasic short course, although in some patients neurological relapses or worsening of deficits can develop some weeks later, when viral therapy has been discontinued and signs and symptoms of the central nervous system (CNS) damage seem to have stabilized. The second HSE stage is generally identified as autoimmune encephalitis after HSE (AEaHSE). Aim of this paper is to discuss which are the present knowledge in this regard. Literature analysis showed that AEaHSE exists, it is more common in younger children and it has different clinical manifestations according to age. All the patients with AEaHSE are positive for one or more neuronal cell-surface and synaptic antibodies, mainly anti-NMDAR antibodies, and the earlier the appearance of the antibodies the greater the risk of AEaHSE development. This means that a careful monitoring of antibody production starting from anti-NMDAR antibodies in all HSE cases could lead to the early identification of AEaHSE and the prompt administration of a potentially effective therapy. Further studies are needed to clarify which are the main pathogenetic mechanisms, whether there are differences in risk of development and clinical course of AEaHSE according to the type of antibody production, why response to immunosuppressive therapy significantly varies and whether administration of steroids to patients with HSE during the first phase of disease can play a role for reducing the risk of AEaHSE development.
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Affiliation(s)
- Susanna Esposito
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giovanni Autore
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Alberto Argentiero
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Greta Ramundo
- Pediatric Clinic, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Qiao S, Zhang SC, Wang ZH, Wang L, Zhang RR, Li HY, Jin Y, Liu LL, Wang ML, Wang AH, Liu XW. Coexistence of multiple anti-neuronal antibodies in autoimmune encephalitis in China: A multi-center study. Front Immunol 2022; 13:858766. [PMID: 36211351 PMCID: PMC9539812 DOI: 10.3389/fimmu.2022.858766] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Background Given that the combination of multiple antibodies in autoimmune encephalitis (AE) is rare and its clinical significance is unclear, this study aimed to investigate the clinical characteristics and significance of overlapping multiple anti-neuronal antibodies in patients with AE. Methods We conducted a retrospective analysis of the clinical characteristics, treatment, and prognostic details of 22 patients with multiple coexisting antibodies from multiple clinical centers in China. Results Among the 276 patients who were AE antibody-positive, 22 (7.97%) had two or more antibodies. Among the 22 patients with coexisting AE-related antibodies, 14 patients (63.63%) were combined of cell surface and intracellular antibody, and the remaining 8 patients (36.36%) were detected to be cell surface antibody positive only. The main symptoms of the 22 patients in this cohort included fever, seizures, memory impairment, cognitive decline, and sleep disorders. Five (22.73%) patients had tumors, among whom four had small-cell lung cancers, and one had mediastinal tumors. A total of 20 patients were treated with steroids and intravenous immunoglobulin, and 18 showed varying degrees of symptomatic improvement after first-line immunotherapy. Three patients died of tumor progression or chemotherapy complications. Conclusion The coexistence of multiple anti-neuronal antibodies in patients with AE may cause a superimposition and diversification of clinical manifestations. Combined paraneoplastic antibody positivity may be suggestive of an underlying malignancy.
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Affiliation(s)
- Shan Qiao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Medical Genetics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shan-Chao Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhi-Hao Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Lei Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Ran-Ran Zhang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Hai-Yun Li
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Yang Jin
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Ling-Ling Liu
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, China
| | - Mei-Ling Wang
- Department of Neurology, Binzhou Medical University Hospital, Binzhou, China
| | - Ai-Hua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xue-Wu Liu
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
- Institute of Epilepsy, Shandong University, Jinan, China
- *Correspondence: Xue-Wu Liu,
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11
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Dou Q, Yang C, Tian M, Yuan X, Li R, Shu X. Clinical Characteristics and Prognosis of Antibody-Negative Autoimmune Encephalitis in Children: A Single-Center Retrospective Study. Pediatr Neurol 2022; 133:9-14. [PMID: 35716605 DOI: 10.1016/j.pediatrneurol.2022.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/04/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Autoimmune encephalitis (AE) is a group of immune-mediated brain diseases. However, new diagnostic criteria for AE in children indicate that partial pediatric patients with AE may be diagnosed without evidence of positive autoantibodies. Therefore, the clinical characteristics and prognosis of children with antibody-negative but probable AE require further investigation. METHODS Forty-one children with AE admitted to our hospital from April 2014 to January 2021 were retrospectively enrolled in this study. Children were divided into two groups according to positive or negative antibody tests. Clinical characteristics, cerebrospinal fluid, video electroencephalography, brain magnetic resonance imaging, and prognosis were analyzed, and the correlation between modified Rankin scale (mRS) and neutrophil-to-lymphocyte ratio (NLR) was examined. RESULTS Of 41 children, 16 cases tested positive for autoantibodies. The main features were psychiatric symptoms, cognitive disturbances, speech disturbances, movement disorders, and seizures. All the children were given a combination of intravenous methylprednisolone pulses with intravenous immunoglobulin therapy; 26 cases (63%) had a good outcome, and 15 cases (37%) had a poor outcome. Antibody-positive and antibody-negative but probable AE were analyzed by univariate analysis and showed lower lymphocyte counts and higher NLR and mRS scores in the antibody-negative group (P < 0.05). The Spearman rank correlation analysis showed a positive correlation between NLR level and mRS scores (P < 0.05). CONCLUSIONS Antibody-negative but possible AE is frequent in children who may have a more severe neurological impairment and higher NLR than antibody-positive AE. Aggressive immunotherapy in antibody-negative AE is essential to achieve a good prognosis.
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Affiliation(s)
- Qingyang Dou
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China; Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Changjian Yang
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Maoqiang Tian
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xing Yuan
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Renke Li
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiaomei Shu
- Department of Pediatrics, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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12
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Zhang S, Mao C, Li X, Miao W, Teng J. Advances in Potential Cerebrospinal Fluid Biomarkers for Autoimmune Encephalitis: A Review. Front Neurol 2022; 13:746653. [PMID: 35937071 PMCID: PMC9355282 DOI: 10.3389/fneur.2022.746653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 06/20/2022] [Indexed: 12/24/2022] Open
Abstract
Autoimmune encephalitis (AE) is a severe inflammatory disease of the brain. Patients with AE demonstrate amnesia, seizures, and psychosis. Recent studies have identified numerous associated autoantibodies (e.g., against NMDA receptors (NMDARs), LGI1, etc.) involved in the pathogenesis of AE, and the levels of diagnosis and treatment are thus improved dramatically. However, there are drawbacks of clinical diagnosis and treatment based solely on antibody levels, and thus the application of additional biomarkers is urgently needed. Considering the important role of immune mechanisms in AE development, we summarize the relevant research progress in identifying cerebrospinal fluid (CSF) biomarkers with a focus on cytokines/chemokines, demyelination, and nerve damage.
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13
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Liu Z, Li Y, Wang Y, Zhang H, Lian Y, Cheng X. The Neutrophil-to-Lymphocyte and Monocyte-to-Lymphocyte Ratios Are Independently Associated With the Severity of Autoimmune Encephalitis. Front Immunol 2022; 13:911779. [PMID: 35844590 PMCID: PMC9283563 DOI: 10.3389/fimmu.2022.911779] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are biomarkers that may reflect inflammatory status in some immune-related diseases. This study aims to investigate the association of NLR and MLR with the severity and prognosis of autoimmune encephalitis (AE). Methods A total of 199 patients diagnosed with AE in the First Affiliated Hospital of Zhengzhou University from October 2015 to October 2021 were retrospectively analyzed. The Clinical Assessment Scale for Autoimmune Encephalitis (CASE) and the modified Rankin Scale (mRS) were used to evaluate the severity of the patients at admission, and the patients were divided into mild group (CASE ≤ 4) and severe group (CASE ≥ 5) according to the CASE score. Poor prognosis was described as an mRS of 3 or more at 12 months. Binary logistic regression analysis was performed to assess risk factors for the severity and prognosis of AE. Results NLR and MLR of severe group were significantly higher than that of mild group. NLR and MLR were positively correlated with the CASE score (r = 0.659, P < 0.001; r = 0.533, P < 0.001) and the mRS score (r = 0.609, P < 0.001;r = 0.478, P < 0.001) in AE patients. Multivariate logistic analysis showed that NLR (OR = 1.475, 95%CI: 1.211-1.796, P < 0.001) and MLR (OR = 15.228, 95%CI: 1.654-140.232, P = 0.016) were independent risk factors for the severity of AE. In addition, the CASE score and the mRS score were positively correlated (r = 0.849, P < 0.001). Multivariate logistic analysis showed that the CASE at admission (OR = 1.133, 95%CI: 1.043-1.229, P = 0.003) and age (OR = 1.105, 95%CI: 1.062-1.150, P < 0.001) were independent risk factors for the poor prognosis of AE patients. The NLR and MLR at admission and whether they decreased after immunotherapy were not associated with the prognosis of AE patients (P > 0.05). Conclusions NLR and MLR, readily available and widespread inflammatory markers, were helpful for clinicians to monitor disease progression and identify potentially severe patients of AE early to optimize clinical treatment decisions.
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14
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Deng Q, Liu Y, Mao Z, Chen Y, Ping Y, Zhu G, Zhao W, Hu X, Zhou H. The Antibody Assay in Suspected Autoimmune Encephalitis From Positive Rate to Test Strategies. Front Immunol 2022; 13:803854. [PMID: 35280998 PMCID: PMC8904559 DOI: 10.3389/fimmu.2022.803854] [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: 10/28/2021] [Accepted: 01/31/2022] [Indexed: 01/17/2023] Open
Abstract
Objective The aim of this study was to analyze the positive rate and test strategies of suspected autoimmune encephalitis (SAE) based on an antibody assay. Methods Patients who were diagnosed with suspected autoimmune encephalitis in Guizhou Province between June 1, 2020, and June 30, 2021 and who had anti-neuronal autoantibodies detected by Guizhou KingMed Diagnostics Group Co., Ltd. were included in this study. The positive rate and the test strategies were analyzed based on the results of the anti-neuronal antibody assay. Results A total of 263 patients with SAE were included, 58.2% (153/263) of whom were males, with a median age of 33 years (1-84 years). 84% (221/263) of all patients completed both serum and CSF tests. A total of 46.0% (121/263) of SAE patients received the AE-6 examination package. The antibody-positive rate was 9.9% (26/263) in the current cohort, with an observed incidence of antibody positive of 0.2 in 100,000 (26/11,570,000, 95% CI: 0.15-0.30), and the estimated incidence was 0.9 in 100,000 (95% CI: 0.84-0.95) of the total population. A total of 9 different anti-neuronal antibodies were detected. Anti-NMDAR antibody was the most common antibody in 46.2% (12/26) of subjects, 70.0% (7/10) of whom were children, followed by anti-Caspr2 antibody in 30.8% (8/26); the remaining 7 antibodies were detected in 23.1% (6/26) of the population. There were no obvious differences among age, sex or season in the positive rate of anti-neuronal antibodies. The cost of antibody testing per capita was $439.30 (SD±$195.10). The total cost of AE-14 was the highest at $48.016.81 (41.56%) among all examination packages. Conclusions This study described the positive rate associated with AE-related anti-neuronal antibodies and test strategies in the current cohort, which provides a basis for clinicians in clinical practice.
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Affiliation(s)
- Qun Deng
- Department of Pediatric Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Ye Liu
- Department of Otolaryngology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Zhifeng Mao
- Department of Autoimmune Disease, Guangzhou KingMed Diagnostics Group Co., Ltd., Guangzhou, China
| | - Yun Chen
- Department of Pediatric Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Yue Ping
- Department of Pediatric Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Guoqiang Zhu
- Department of Autoimmune Disease, Guizhou KingMed Diagnostics Group Co., Ltd., Guiyang, China
| | - Weiqing Zhao
- Department of Pediatric Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Xiao Hu
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, China
| | - Hao Zhou
- Department of Pediatric Neurology, Guizhou Provincial People's Hospital, Guiyang, China
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15
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Qiao S, Zhang SC, Zhang RR, Wang L, Wang ZH, Jiang J, Wang AH, Liu XW. Thyroid Function and Low Free Triiodothyronine in Chinese Patients With Autoimmune Encephalitis. Front Immunol 2022; 13:821746. [PMID: 35222399 PMCID: PMC8866758 DOI: 10.3389/fimmu.2022.821746] [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: 11/24/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Low free triiodothyronine (FT3) is usually associated with worse functional outcome in critical illness; however, the information on thyroid dysfunction and autoimmune encephalitis (AE) is limited. This study aims to evaluate the clinical prognostic value of thyroid function and low-T3 syndrome in patients with multiple subtypes of AE. Methods In this retrospective study, we identified the hospital records of 319 candidate patients with AE admitted between January 2016 and December 2020. We then extracted the clinical features and outcomes. Modified Rankin scale (mRS) scores were used to evaluate the patients’ neurological function. The serum levels of FT3, free thyroxine (FT4), and thyroid-stimulating hormone (TSH) were measured upon admission. Normal thyroid stimulating hormone level with FT3 below the lower limit of the reference interval (2.63 nmol/L) was defined as low-T3 syndrome. Results A total of 237 AE cases remained after screening. Among these, 57.81% (137/237) were men and the average age at onset was 41 y (interquartile range, 12–61 y). We found that 83.54% (198/237) of the patients had a good prognosis, and 16.46% (39/237) had a poor prognosis. Abnormal thyroid function was observed in 30.80% of these patients, with a relatively greater prevalence in the group with a poor prognosis (p < 0.001). The serum FT3 levels in the poor-prognosis group were significantly lower than those in the good-prognosis group (p < 0.001). Low-T3 syndrome occurred in 15.19% of AE cases and was more frequent in patients with poor prognosis (p < 0.001). Conclusions Abnormal thyroid function in AE is frequent, and serum FT3 levels in patients with poor prognosis are significantly lower than in those with good prognosis. Low-T3 syndrome could be a potential candidate for predicting the prognosis of AE following future research.
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Affiliation(s)
- Shan Qiao
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Department of Medical Genetics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Shan-Chao Zhang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China.,Medical Research and Laboratory Diagnostic Center, Jinan Central Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Medicine, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ran-Ran Zhang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lei Wang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Zhi-Hao Wang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jing Jiang
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ai-Hua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xue-Wu Liu
- Department of Neurology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Institute of Epilepsy, Shandong University, Jinan, China
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16
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Costagliola G, Depietri G, Michev A, Riva A, Foiadelli T, Savasta S, Bonuccelli A, Peroni D, Consolini R, Marseglia GL, Orsini A, Striano P. Targeting Inflammatory Mediators in Epilepsy: A Systematic Review of Its Molecular Basis and Clinical Applications. Front Neurol 2022; 13:741244. [PMID: 35359659 PMCID: PMC8961811 DOI: 10.3389/fneur.2022.741244] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/08/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction Recent studies prompted the identification of neuroinflammation as a potential target for the treatment of epilepsy, particularly drug-resistant epilepsy, and refractory status epilepticus. This work provides a systematic review of the clinical experience with anti-cytokine agents and agents targeting lymphocytes and aims to evaluate their efficacy and safety for the treatment of refractory epilepsy. Moreover, the review analyzes the main therapeutic perspectives in this field. Methods A systematic review of the literature was conducted on MEDLINE database. Search terminology was constructed using the name of the specific drug (anakinra, canakinumab, tocilizumab, adalimumab, rituximab, and natalizumab) and the terms “status epilepticus,” “epilepsy,” and “seizure.” The review included clinical trials, prospective studies, case series, and reports published in English between January 2016 and August 2021. The number of patients and their age, study design, specific drugs used, dosage, route, and timing of administration, and patients outcomes were extracted. The data were synthesized through quantitative and qualitative analysis. Results Our search identified 12 articles on anakinra and canakinumab, for a total of 37 patients with epilepsy (86% febrile infection-related epilepsy syndrome), with reduced seizure frequency or seizure arrest in more than 50% of the patients. The search identified nine articles on the use of tocilizumab (16 patients, 75% refractory status epilepticus), with a high response rate. Only one reference on the use of adalimumab in 11 patients with Rasmussen encephalitis showed complete response in 45% of the cases. Eight articles on rituximab employment sowed a reduced seizure burden in 16/26 patients. Finally, one trial concerning natalizumab evidenced a response in 10/32 participants. Conclusion The experience with anti-cytokine agents and drugs targeting lymphocytes in epilepsy derives mostly from case reports or series. The use of anti-IL-1, anti-IL-6, and anti-CD20 agents in patients with drug-resistant epilepsy and refractory status epilepticus has shown promising results and a good safety profile. The experience with TNF inhibitors is limited to Rasmussen encephalitis. The use of anti-α4-integrin agents did not show significant effects in refractory focal seizures. Concerning research perspectives, there is increasing interest in the potential use of anti-chemokine and anti-HMGB-1 agents.
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Affiliation(s)
- Giorgio Costagliola
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Greta Depietri
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alexandre Michev
- Pediatric Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
- *Correspondence: Alexandre Michev
| | - Antonella Riva
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto “Giannina Gaslini”, Genova, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Salvatore Savasta
- Pediatric Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Alice Bonuccelli
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Rita Consolini
- Pediatric Immunology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Alessandro Orsini
- Pediatric Neurology, Pediatric University Department, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto “Giannina Gaslini”, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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17
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Zhong R, Chen Q, Zhang X, Zhang H, Lin W. Risk Factors for Mortality in Anti-NMDAR, Anti-LGI1, and Anti-GABABR Encephalitis. Front Immunol 2022; 13:845365. [PMID: 35320933 PMCID: PMC8934853 DOI: 10.3389/fimmu.2022.845365] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/11/2022] [Indexed: 12/23/2022] Open
Abstract
ObjectiveWe aimed to investigate the mortality rate and identify the predictors of death in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis.MethodsPatients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis were recruited from the Neurology Department of the First Hospital of Jilin University from March 2015 to November 2021. The primary outcome variable was a binary variable of death vs. survival. The potential risk factors for mortality were evaluated. The mortality rates were determined, and the independent predictors of death were identified using multivariable logistic regression analysis.ResultsA total of 100 hospitalized patients with anti-NMDAR, anti-LGI1, or anti-GABABR encephalitis were included in the final analysis. Fifteen patients (15%) died during a median follow-up period of 18 months. The mortality rates were 10% for anti-NMDAR encephalitis, 2.8% for anti-LGI1 encephalitis, and 41.7% for anti-GABABR encephalitis. The multivariable analysis results showed that older age at onset [adjusted odds ratio (OR) = 1.017, 95% confidence interval (CI) = 1.009–1.136; p = 0.023] was independently associated with an increased risk of death. Antibody type was also associated with mortality. Patients with anti-GABABR encephalitis had 13.458-fold greater odds of dying than patients with anti-LGI1 encephalitis (adjusted OR = 13.458, 95% CI = 1.270–142.631; p = 0.031).ConclusionThe general mortality rate of anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis was 15%. Age at onset and type of autoimmune encephalitis antibody were independent predictors of death in these patients.
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Affiliation(s)
- Rui Zhong
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Qingling Chen
- Department of Hepatology, Second People’s Clinical College of Tianjin Medical University, Tianjin, China
| | - Xinyue Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Hanyu Zhang
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Weihong Lin
- Department of Neurology, The First Hospital of Jilin University, Changchun, China
- *Correspondence: Weihong Lin,
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18
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Wright MA, Trandafir CC, Nelson GR, Hersh AO, Inman CJ, Zielinski BA. Diagnosis and Management of Suspected Pediatric Autoimmune Encephalitis: A Comprehensive, Multidisciplinary Approach and Review of Literature. J Child Neurol 2022; 37:303-313. [PMID: 34927485 DOI: 10.1177/08830738211064673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Autoimmune encephalitis is an increasingly recognized entity in children. When treated promptly, favorable outcomes are seen in a majority of pediatric patients. However, recognition of autoimmune encephalitis in young patients is challenging. Once autoimmune encephalitis is suspected, additional difficulties exist regarding timing of treatment initiation and duration of treatment, as evidence to guide management of these patients is emerging. Here, we review available literature regarding pediatric autoimmune encephalitis and present our institution's comprehensive approach to the evaluation and management of the disease. These guidelines were developed through an iterative process involving both pediatric neurologists and rheumatologists.
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Affiliation(s)
- Melissa A Wright
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Cristina C Trandafir
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA.,Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Gary R Nelson
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - C J Inman
- Division of Pediatric Rheumatology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Brandon A Zielinski
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA.,Department of Neurology, 14434University of Utah, Salt Lake City, UT, USA
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19
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Li J, Jiang J, Lv J, Zhang R, Chen W, Li S, Jin Q, Wang G. Anti-γ-Aminobutyric Acid Type β Receptor Antibody-Associated Encephalitis After 2 Cycles of Durvalumab Therapy in a Patient with Small Cell Lung Cancer: A Case Report. Onco Targets Ther 2021; 14:5227-5236. [PMID: 34764654 PMCID: PMC8573260 DOI: 10.2147/ott.s337331] [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: 09/09/2021] [Accepted: 10/21/2021] [Indexed: 01/21/2023] Open
Abstract
Anti-γ-aminobutyric acid type β receptor (anti-GABABR) antibody-associated encephalitis is a type of autoimmune encephalitis. According to current literature, its pathogenesis is reported to be closely related to tumor factors. However, diagnosis can be difficult because of the rarity of cases, limited clinical understanding, and a lack of specificity in clinical manifestation and imaging presentation. Clinical trials have demonstrated that immunotherapy can prolong the survival of patients with small cell lung cancer; however, in some cases, immunotherapy may induce anti-GABABR antibody-associated encephalitis. Patients who develop this encephalitis during immunotherapy often delay treatment because the cause is not clearly identified. In this study, we report a case of a 61-year-old man with a confirmed diagnosis of small cell lung cancer who had acute onset of cognitive impairment and seizures after two cycles of durvalumab (AstraZeneca UK Limited) combination chemotherapy. This reaction was initially considered as an immune-related adverse event (irAE) caused by durvalumab treatment, and the patient was eventually considered to have a paraneoplastic neurological disorder caused by the primary tumor. This report raises awareness of the symptoms of cognitive impairment and seizures in patients with small cell lung cancer, and the possible adverse events associated with immunotherapy. This case also highlights the importance of detecting anti-GABABR antibodies in patients with small cell lung cancer.
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Affiliation(s)
- Jiamo Li
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China
| | - Jianing Jiang
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China.,The Key Laboratory of Biomarker, High-Throughput Screening and Target Translation of Breast and Gastrointestinal Cancer, Dalian, Liaoning Province, People's Republic of China
| | - Jinyan Lv
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China
| | - Ru Zhang
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China
| | - Wenting Chen
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China.,The Key Laboratory of Biomarker, High-Throughput Screening and Target Translation of Breast and Gastrointestinal Cancer, Dalian, Liaoning Province, People's Republic of China
| | - Shiyi Li
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China
| | - Qianchen Jin
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China
| | - Gang Wang
- Department of Medical Oncology, The Affiliated Zhongshan Hospital of Dalian University, Dalian, Liaoning Province, People's Republic of China.,The Key Laboratory of Biomarker, High-Throughput Screening and Target Translation of Breast and Gastrointestinal Cancer, Dalian, Liaoning Province, People's Republic of China
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20
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Update on Viral Infections Involving the Central Nervous System in Pediatric Patients. CHILDREN-BASEL 2021; 8:children8090782. [PMID: 34572214 PMCID: PMC8470393 DOI: 10.3390/children8090782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Infections of the central nervous system (CNS) are mainly caused by viruses, and these infections can be life-threatening in pediatric patients. Although the prognosis of CNS infections is often favorable, mortality and long-term sequelae can occur. The aims of this narrative review were to describe the specific microbiological and clinical features of the most frequent pathogens and to provide an update on the diagnostic approaches and treatment strategies for viral CNS infections in children. A literature analysis showed that the most common pathogens worldwide are enteroviruses, arboviruses, parechoviruses, and herpesviruses, with variable prevalence rates in different countries. Lumbar puncture (LP) should be performed as soon as possible when CNS infection is suspected, and cerebrospinal fluid (CSF) samples should always be sent for polymerase chain reaction (PCR) analysis. Due to the lack of specific therapies, the management of viral CNS infections is mainly based on supportive care, and empiric treatment against herpes simplex virus (HSV) infection should be started as soon as possible. Some researchers have questioned the role of acyclovir as an empiric antiviral in older children due to the low incidence of HSV infection in this population and observed that HSV encephalitis may be clinically recognizable beyond neonatal age. However, the real benefit-risk ratio of selective approaches is unclear, and further studies are needed to define appropriate indications for empiric acyclovir. Research is needed to find specific therapies for emerging pathogens. Moreover, the appropriate timing of monitoring neurological development, performing neuroimaging evaluations and investigating the effectiveness of rehabilitation during follow-up should be evaluated with long-term studies.
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Cai MT, Lai QL, Zheng Y, Fang GL, Qiao S, Shen CH, Zhang YX, Ding MP. Validation of the Clinical Assessment Scale for Autoimmune Encephalitis: A Multicenter Study. Neurol Ther 2021; 10:985-1000. [PMID: 34476753 PMCID: PMC8412851 DOI: 10.1007/s40120-021-00278-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction A new scale, named the Clinical Assessment Scale for Autoimmune Encephalitis (CASE), has recently been developed for rating the severity of autoimmune encephalitis (AE) with a high level of clinimetric properties. In this study, our primary objective was to validate the performance of CASE through a multicenter study in China. Methods Between July 2014 and December 2019, 143 consecutive patients with definite neuronal surface antibody-associated AE from three tertiary hospitals were enrolled in the study. We validated the reliability, internal consistency, and validity of CASE. We further compared CASE with the modified Rankin scale (mRS) among different subtypes of AE in terms of its sensitivity to disease dynamics. Statistical analyses were performed using GraphPad Prism and R software. Results Our analyses showed that CASE had good inter- and intraobserver reliability (intra-class correlation coefficient 0.96/0.98) and internal consistency (Cronbach α = 0.847) at disease onset. The scores of CASE and mRS remained well correlated in patients at admission and at discharge (both r = 0.80, p < 0.001). From admission to discharge, the scores of CASE changed in 81 (56.6%) patients, in comparison to changes in mRS in 48 (33.6%) patients (p = 0.007 and p < 0.001, respectively). The largest changes in scores occurred for non-motor symptoms, including psychiatric, memory, and language dysfunctions (40.6, 26.6, and 23.1% of patients, respectively); in contrast, scores for motor symptoms, such as dyskinesia, weakness and ataxia, changed the least (7.0, 15.4, and 16.1% of patients, respectively). Conclusion Based on these results, CASE performed well in assessing the severity of neuronal surface antibody-associated AE. In comparison to mRS, it performed better for non-motor symptoms and was more sensitive to changes in severity. Supplementary Information The online version contains supplementary material available at 10.1007/s40120-021-00278-9.
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Affiliation(s)
- Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Yang Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, China
| | - Song Qiao
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
| | - Mei-Ping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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22
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Chen L, Zhu L, Lu D, Dai S, Han Y, Wu Z, Xu P, Chang L, Wu Q. Association between autoimmune encephalitis and epilepsy: Systematic review and meta-analysis. Seizure 2021; 91:346-359. [PMID: 34284303 DOI: 10.1016/j.seizure.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diverse neuronal antibodies are related to autoimmune encephalitis (AE) and AE-related epilepsy. However, the epidemiological characteristics of AE, AE-associated antibodies, and AE-related seizures are still unclear. AIMS This research evaluated the relationship between AE, AE-related seizures, and neuronal antibodies, as well as the morbidity of AE with early incidence. METHODS The PubMed, Embase, Cochrane, and Web of Science databases were searched. Pooled estimates and 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS Of the 4,869 citations identified, 100 articles were reviewed in full, and 42 subgroups were analyzed. The overall incidence of AE patients with seizures was 42% (95% CI: 0.40-0.44), and among them, the incidence of epilepsy in anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients was 73% (95% CI: 0.70-0.77). Subsequently, we found that the prevalence of AE as the cause of epilepsy within the pooled period was 1% (95% CI: 0.01-0.02), while the overall positive rate of neuronal antibodies in epilepsy patients was 4% (95% CI: 0.03-0.05). Additionally, the detection rates of different antibodies among epilepsy patients were as follows: anti-NMDAR, 1%; anti-leucine-rich glioma inactivated 1 (LGI1), 1%; anti-contactin-associated protein-like 2 (CASPR2), 2%. CONCLUSION Based on our findings, neuronal antibodies may serve as a bridge to study AE and immune-related epilepsy. To further understand the differences in outcomes following different treatment measures, and to provide more information for public health policy and prevention, more research is needed to improve the accuracy of estimations.
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Affiliation(s)
- Lu Chen
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Lin Zhu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Di Lu
- Biomedicine Engineering Research Centre, Kunming Medical University, 1168 Chun Rong West Road, Kunming, Yunnan 650032, PR China
| | - Shujuan Dai
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Yanbing Han
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Zhe Wu
- Department of Psychology, The First People's Hospital of Yunnan Province, 157 Jin Bi Road, Kunming, Yunnan 650100, PR China
| | - Puying Xu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Lvhua Chang
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China
| | - Qian Wu
- Department of Neurology, First Affiliated Hospital, Kunming Medical University, 295 Xi Chang Road, Kunming, Yunnan 650032, PR China.
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Khidir H, White BA, Landry A, Cameron AA, Wittels K, Wilcox SR. An Abrupt Change in Mental Status. J Emerg Med 2021; 61:449-452. [PMID: 34127339 DOI: 10.1016/j.jemermed.2021.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Hazar Khidir
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Benjamin A White
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Adaira Landry
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amy A Cameron
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Kathleen Wittels
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Susan R Wilcox
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts; Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts.
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Ding S, Gong J, Lin J, Wang Y, Hua Y, Li X, Du Y, Xia N, Zhu Z, Wang X, Zheng R, Xu H. Validation of Predictive Models for Autoimmune Encephalitis-Related Antibodies to Cell-Surface Proteins Expressed in Neurons: A Retrospective Study Based in a Hospital. Front Neurol 2021; 12:601761. [PMID: 34054682 PMCID: PMC8160246 DOI: 10.3389/fneur.2021.601761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/31/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: Autoimmune encephalitis (AE) is a severe but treatable autoimmune disorder that is diagnosed by antibody (Ab) testing. However, it is unrealistic to obtain an early diagnosis in some areas since the Ab status cannot be immediately determined due to time and technology restrictions. In our study, we aimed to validate the Antibody Prevalence in Epilepsy and Encephalopathy (APE2) score among patients diagnosed with possible AE as a predictive model to screen AE patients with antibodies to cell-surface proteins expressed in neurons. Methods: A total of 180 inpatients were recruited, and antibodies were detected through serological and/or cerebrospinal fluid (CSF) evaluations. The APE2 score was used to validate the predictive models of AE with autoantibodies. Results: The mean APE2 score in the Ab-positive cases was 7.25, whereas the mean APE2 score in the Ab-negative cases was 3.18 (P < 0.001). The APE2 score had a receiver operating characteristic (ROC) area under the curve of 0.924 [P < 0.0001, 95% confidence interval (CI) = 0.875–0.973]. With a cutoff score of 5, the APE2 score had the best psychometric properties, with a sensitivity of 0.875 and a specificity of 0.791. Conclusion: The APE2 score is a predictive model for AE with autoantibodies to cell-surface proteins expressed in neurons and was validated and shown to have high sensitivity and specificity in our study. We suggest that such a model should be used in patients with a suspected diagnosis of AE, which could increase the detection rate of Abs, reduce testing costs, and help patients to benefit from treatment quickly.
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Affiliation(s)
- Siqi Ding
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Jiaoni Gong
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Jiahe Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Yi Wang
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, China
| | - Yingjie Hua
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Xueying Li
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Yanru Du
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Niange Xia
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Zhenguo Zhu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Xinshi Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Rongyuan Zheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
| | - Huiqin Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical, University, Wenzhou, China
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Pediatric inflammatory demyelinating disorders and mimickers: How to differentiate with MRI? Autoimmun Rev 2021; 20:102801. [PMID: 33727154 DOI: 10.1016/j.autrev.2021.102801] [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: 01/16/2021] [Accepted: 01/25/2021] [Indexed: 11/21/2022]
Abstract
Multiple sclerosis (MS) is a chronic, immune-mediated, neurodegenerative disorder of the central nervous system (CNS).While the clinical symptoms of MS most commonly manifest between 20 and 40 years of age, approximately 3 to 10% of all MS patients report that their first inaugural events can occur earlier in life, even in childhood, and thus include the pediatric population. The prevalence of MS onset in childhood/adolescence varies between 2.0% and 4.0% of all MS cases according to several extensive studies. The main imaging patterns of pediatric inflammatory demyelinating disorders and mimicking entities, including multiple sclerosis, neuromyelitis optica spectrum disorders, acute disseminated encephalomyelitis, MOG (myelin oligodendrocyte glycoprotein) antibody-related disorders and differential diagnoses will be addressed in this article, highlighting key points to the differential diagnosis.
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Abstract
Encephalitis is defined as altered mental status for more than 24 hours accompanied by 2 or more findings concerning for inflammation of the brain parenchyma: fever, seizures or other focal neurologic disorders, cerebrospinal fluid pleocytosis, and abnormal neuroimaging and electroencephalographic findings. Herpes simplex virus causes the most severe form of virus-induced encephalitis; the early administration of acyclovir can improve the prognosis of this disease. The rising interest in autoimmune causes of encephalitis, most notably anti-N-methyl-d-aspartate receptor, should prompt the clinician to consider immunomodulatory treatments, which may improve outcomes. A broad testing panel may be necessary to detect the etiologic agent; a few published pediatric cases suggest that infectious and autoimmune causes may occur concurrently in the same patient with encephalitis. More than 40% of children diagnosed as having encephalitis will not return to their previous level of neurologic function after resolution of their disease, although outcomes are highly variable depending on the etiologic agent.
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Affiliation(s)
| | | | - Dawn Nolt
- Division of Pediatric Infectious Diseases, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR
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27
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Stegmayr B, Newman E, Witt V, Derfler K, Leitner G, Eloot S, Dhondt A, Deeren D, Ptak J, Blaha M, Lanska M, Gasova Z, Bhuiyan-Ludvikova Z, Hrdlickova R, Ramlow W, Prophet H, Kielstein JT, Liumbruno G, Mori E, Griskevicius A, Audzijoniene J, Vrielink H, Rombout-Sestrienkova E, Aandahl A, Sikole A, Tomaz J, Lalic K, Bojanic I, Strineholm V, Brink B, Berlin G, Dykes J, Nilsson T, Eich T, Hadimeri H, Welander G, Ortega Sanchez S, Ilhan O, Poole C. Using the World Apheresis Association Registry Helps to Improve the Treatment Quality of Therapeutic Apheresis. Transfus Med Hemother 2021; 48:234-239. [PMID: 34539317 DOI: 10.1159/000513123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
Therapeutic apheresis (TA) is prescribed to patients that suffer from a severe progressive disease that is not sufficiently treated by conventional medications. A way to gain more knowledge about this treatment is usually by the local analysis of data. However, the use of large quality assessment registries enables analyses of even rare findings. Here, we report some of the recent data from the World Apheresis Association (WAA) registry. Data from >104,000 procedures were documented, and TA was performed on >15,000 patients. The main indication for TA was the collection of autologous stem cells (45% of patients) as part of therapy for therapy. Collection of stem cells from donors for allogeneic transplantation was performed in 11% of patients. Patients with indications such as neurological diseases underwent plasma exchange (28%). Extracorporeal photochemotherapy, lipid apheresis, and antibody removal were other indications. Side effects recorded in the registry have decreased significantly over the years, with approximately only 10/10,000 procedures being interrupted for medical reasons. Conclusion Collection of data from TA procedures within a multinational and multicenter concept facilitates the improvement of treatment by enabling the analysis of and feedback on indications, procedures, effects, and side effects.
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Affiliation(s)
- Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elizabeth Newman
- Bone Marrow Transplant and Apheresis, Concord, New South Wales, Australia
| | - Volker Witt
- St. Anna, Pediatric Department, Vienna, Austria
| | | | - Gerda Leitner
- Apheresis Unit, Haematological, AKH, Vienna, Austria
| | - Sunny Eloot
- Department of Nephrology, University Hospital, Ghent, Belgium
| | | | - Dries Deeren
- Department of Hematology, AZ Delta, Roeselare, Belgium
| | - Jan Ptak
- Transfusion Medicine, Frydek-Mistek, Czechia
| | - Milan Blaha
- Hemapheretic Center of the 3rd Department of Medicine, Medical Faculty and University Hospital, Hradec Kralove, Czechia
| | - Mirka Lanska
- Hemapheretic Center of the 3rd Department of Medicine, Medical Faculty and University Hospital, Hradec Kralove, Czechia
| | - Zdenka Gasova
- Institute of Hematology and Blood Transfusion, Prague, Czechia
| | | | | | | | | | - Jan T Kielstein
- Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital, Braunschweig, Germany
| | | | | | | | | | | | | | - Astrid Aandahl
- Center for Immunology and Transfusion, Akers University Hospital, Loerenskog, Norway
| | - Aleksandar Sikole
- Department of Nephrology, University Hospital, Skopje, North Macedonia
| | - Jorge Tomaz
- Apheresis Unit, Coimbra University Hospital, Coimbra, Portugal
| | - Katarina Lalic
- Institute for Endocrinology, University Hospital, Belgrade, Serbia
| | - Ines Bojanic
- Transfusion Medicine and Transplantation Biology, University, Zagreb, Croatia
| | | | - Bo Brink
- Department of Nephrology, University Hospital, Huddinge, Sweden
| | - Gösta Berlin
- Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden
| | | | - Thomas Nilsson
- Department of Nephrology, University Hospital, Uppsala, Sweden
| | - Torsten Eich
- Blood Center, University, Uppsala, Sweden, Uppsala, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | | | | | - Osman Ilhan
- Department Haematology, University Hospital, Ankara, Turkey
| | - Colwyn Poole
- South African National Blood Service, Johannesburg, South Africa
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28
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Lee S, Kim HD, Lee JS, Kang HC, Kim SH. Clinical Features and Treatment Outcomes of Seronegative Pediatric Autoimmune Encephalitis. J Clin Neurol 2021; 17:300-306. [PMID: 33835752 PMCID: PMC8053533 DOI: 10.3988/jcn.2021.17.2.300] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background and Purpose New diagnostic criteria for pediatric autoimmune encephalitis (AIE) have been introduced recently. A substantial proportion of cases of pediatric AIE are diagnosed as seronegative based on these criteria, and so the clinical characteristics of this group remain to be investigated. Methods This study included 46 pediatric patients younger than 18 years with suspected AIE. Clinical features, laboratory or radiological findings, and treatment outcomes were compared between seronegative and seropositive patients. Results Nine (19.6%) of the 46 patients were diagnosed as seropositive AIE. All of the patients with seropositive AIE had anti-N-methyl-D-aspartate receptor antibodies. Commonly identified neuropsychiatric symptoms were altered mental status, cognitive dysfunction, seizure, speech dysfunction, and psychotic disorder in both the seronegative and seropositive groups. Immunotherapy produced favorable treatment outcomes in both the seropositive (n=7, 77.8%) and seronegative (n=35, 94.6%) AIE patients. Treatment outcomes for first-line immunotherapy were better in seronegative AIE than seropositive AIE patients (p=0.003), and hence a smaller proportion of seronegative patients required second-line treatment (p=0.015). Conclusions Pediatric seronegative AIE patients showed clinical presentations similar to those of seropositive AIE patients, with favorable treatment outcomes after immunotherapy.
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Affiliation(s)
- Sangbo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Heung Dong Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Soo Lee
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon Chul Kang
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
| | - Se Hee Kim
- Division of Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
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29
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Tan THL, Perucca P, O'Brien TJ, Kwan P, Monif M. Inflammation, ictogenesis, and epileptogenesis: An exploration through human disease. Epilepsia 2020; 62:303-324. [PMID: 33316111 DOI: 10.1111/epi.16788] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/21/2020] [Accepted: 11/22/2020] [Indexed: 12/14/2022]
Abstract
Epilepsy is seen historically as a disease of aberrant neuronal signaling manifesting as seizures. With the discovery of numerous auto-antibodies and the subsequent growth in understanding of autoimmune encephalitis, there has been an increasing emphasis on the contribution of the innate and adaptive immune system to ictogenesis and epileptogenesis. Pathogenic antibodies, complement activation, CD8+ cytotoxic T cells, and microglial activation are seen, to various degrees, in different seizure-associated neuroinflammatory and autoimmune conditions. These aberrant immune responses are thought to cause disruptions in neuronal signaling, generation of acute symptomatic seizures, and, in some cases, the development of long-term autoimmune epilepsy. Although early treatment with immunomodulatory therapies improves outcomes in autoimmune encephalitides and autoimmune epilepsies, patient identification and treatment selection are not always clear-cut. This review examines the role of the different components of the immune system in various forms of seizure disorders including autoimmune encephalitis, autoimmune epilepsy, Rasmussen encephalitis, febrile infection-related epilepsy syndrome (FIRES), and new-onset refractory status epilepticus (NORSE). In particular, the pathophysiology and unique cytokine profiles seen in these disorders and their links with diagnosis, prognosis, and treatment decision-making are discussed.
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Affiliation(s)
- Tracie Huey-Lin Tan
- 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
| | - Piero Perucca
- 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
| | - 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.,Department of Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Patrick Kwan
- 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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30
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Guo J, Han B, Wang J, Zhang L, Chen N, Sun W, Gao Y. The differential expression and potential roles of circular RNAs in children with anti-NMDA receptor encephalitis. J Neuroimmunol 2020; 348:577381. [PMID: 32911360 DOI: 10.1016/j.jneuroim.2020.577381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
To explore the role of circular RNAs (circRNAs) in pediatric anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, we assessed the profiles of circRNAs and mRNAs in blood leukocytes from anti-NMDA receptor encephalitis patients and healthy controls using microarray analysis. 1196 circRNAs and 719 mRNAs (change ≥2, p < .05) were dysregulated in anti-NMDA receptor encephalitis patients, relative to healthy controls, based on microarray data. Further bioinformatic analysis demonstrated that the host genes of dysregulated circRNAs are primarily associated with receptor internalization. In conclusion, circRNAs may be implicated in the pathogenesis of pediatric anti-NMDA receptor encephalitis.
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Affiliation(s)
- Jiamin Guo
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Bo Han
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China.
| | - Jing Wang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Li Zhang
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Na Chen
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Wenxiu Sun
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Yuxing Gao
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
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Impact of predictive, preventive and precision medicine strategies in epilepsy. Nat Rev Neurol 2020; 16:674-688. [PMID: 33077944 DOI: 10.1038/s41582-020-0409-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2020] [Indexed: 12/15/2022]
Abstract
Over the last decade, advances in genetics, neuroimaging and EEG have enabled the aetiology of epilepsy to be identified earlier in the disease course than ever before. At the same time, progress in the study of experimental models of epilepsy has provided a better understanding of the mechanisms underlying the condition and has enabled the identification of therapies that target specific aetiologies. We are now witnessing the impact of these advances in our daily clinical practice. Thus, now is the time for a paradigm shift in epilepsy treatment from a reactive attitude, treating patients after the onset of epilepsy and the initiation of seizures, to a proactive attitude that is more broadly integrated into a 'P4 medicine' approach. This P4 approach, which is personalized, predictive, preventive and participatory, puts patients at the centre of their own care and, ultimately, aims to prevent the onset of epilepsy. This aim will be achieved by adapting epilepsy treatments not only to a given syndrome but also to a given patient and moving from the usual anti-seizure treatments to personalized treatments designed to target specific aetiologies. In this Review, we present the current state of this ongoing revolution, emphasizing the impact on clinical practice.
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32
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Phinney TA, Kinem DJ, Mayoglou LC, Laghari FJ. AntiGAD65 antibodies encephalitis with lateralized periodic discharges: A case report. J Neuroimmunol 2020; 347:577354. [DOI: 10.1016/j.jneuroim.2020.577354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/28/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022]
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Hashimoto's thyroiditis: An update on pathogenic mechanisms, diagnostic protocols, therapeutic strategies, and potential malignant transformation. Autoimmun Rev 2020; 19:102649. [PMID: 32805423 DOI: 10.1016/j.autrev.2020.102649] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 03/21/2020] [Indexed: 01/01/2023]
Abstract
Hashimoto's thyroiditis, characterized by thyroid-specific autoantibodies, is one of the commonest autoimmune disorders. Although the exact etiology has not been fully elucidated, Hashimoto's thyroiditis is related to an interaction among genetic elements, environmental factors and epigenetic influences. Cellular and humoral immunity play a key role in the development of the disease; thus, a T and B cells inflammatory infiltration is frequently found. Histopathologic features of the disease include lymphoplasmacytic infiltration, lymphoid follicle formation with germinal centers, and parenchymal atrophy. Moreover, the occurrence of large follicular cells and oxyphilic or Askanazy cells is frequently associated to Hashimoto's thyroiditis. Clinically, Hashimoto's thyroiditis is characterized mainly by systemic manifestations due to the damage of the thyroid gland, developing a primary hypothyroidism. Diagnosis of Hashimoto's thyroiditis is clinical and based on clinical characteristics, positivity to serum antibodies against thyroid antigens (thyroid peroxidase and thyroglobulin), and lymphocytic infiltration on cytological examination. The mainstream of treatment is based on the management of the hypothyroidism with a substitution therapy. A relationship between Hashimoto's thyroiditis and a possible malignant transformation has been proposed in several studies and involves immunological/hormonal pathogenic links although specific correlation is still debated and needs to be further investigated with prospective studies.
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34
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Seo JH, Lee YJ, Lee KH, Gireesh E, Skinner H, Westerveld M. Autoimmune encephalitis and epilepsy: evolving definition and clinical spectrum. Clin Exp Pediatr 2020; 63:291-300. [PMID: 31431603 PMCID: PMC7402981 DOI: 10.3345/kjp.2019.00598] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 08/13/2019] [Indexed: 12/11/2022] Open
Abstract
Advances in autoimmune encephalitis studies in the past 10 years have led to the identification of new syndromes and biomarkers that have transformed the diagnostic approach to the disorder. The disorder or syndrome has been linked to a wide variety of pathologic processes associated with the neuron-specific autoantibodies targeting intracellular and plasma membrane antigens. However, current criteria for autoimmune encephalitis are quite dependent on antibody testing and responses to immunotherapy, which might delay the diagnosis. This form of encephalitis can involve the multifaceted presentation of seizures and unexpected behavioral changes. The spectrum of neuropsychiatric symptoms in children is less definitive than that in adults, and the incorporation of clinical, immunological, electrophysiological, and neuroradiological results is critical to the diagnostic approach. In this review, we document the clinical and immunologic characteristics of autoimmune encephalitis known to date, with the goal of helping clinicians in differential diagnosis and to provide prompt and effective treatment.
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Affiliation(s)
- Joo Hee Seo
- Comprehensive Epilepsy Center, AdventHealth for Children, Orlando, FL, USA
| | - Yun-Jin Lee
- Comprehensive Epilepsy Center, AdventHealth for Children, Orlando, FL, USA.,Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University College of Medicine, Yangsan, Korea
| | - Ki Hyeong Lee
- Comprehensive Epilepsy Center, AdventHealth for Children, Orlando, FL, USA
| | - Elakkat Gireesh
- Comprehensive Epilepsy Center, AdventHealth for Children, Orlando, FL, USA
| | - Holly Skinner
- Comprehensive Epilepsy Center, AdventHealth for Children, Orlando, FL, USA
| | - Michael Westerveld
- Comprehensive Epilepsy Center, AdventHealth for Children, Orlando, FL, USA
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35
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Conrad K, Shoenfeld Y, Fritzler MJ. Precision health: A pragmatic approach to understanding and addressing key factors in autoimmune diseases. Autoimmun Rev 2020; 19:102508. [PMID: 32173518 DOI: 10.1016/j.autrev.2020.102508] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 11/06/2019] [Indexed: 02/07/2023]
Abstract
The past decade has witnessed a significant paradigm shift in the clinical approach to autoimmune diseases, lead primarily by initiatives in precision medicine, precision health and precision public health initiatives. An understanding and pragmatic implementation of these approaches require an understanding of the drivers, gaps and limitations of precision medicine. Gaining the trust of the public and patients is paramount but understanding that technologies such as artificial intelligences and machine learning still require context that can only be provided by human input or what is called augmented machine learning. The role of genomics, the microbiome and proteomics, such as autoantibody testing, requires continuing refinement through research and pragmatic approaches to their use in applied precision medicine.
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Affiliation(s)
- Karsten Conrad
- Institute of Immunology, Medical Faculty "Carl Gustav Carus", Technical University of Dresden, Dresden, Germany
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel Hashomer, Israel; Department of Medicine, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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36
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Romoli M, Tuna MA, Li L, Paciaroni M, Giannandrea D, Tordo Caprioli F, Lotti A, Eusebi P, Mosconi MG, Pellizzaro Venti M, Salvadori N, Gili A, Ricci S, Stracci F, Sarchielli P, Parnetti L, Rothwell PM, Calabresi P. Time trends, frequency, characteristics and prognosis of short-duration transient global amnesia. Eur J Neurol 2020; 27:887-893. [PMID: 32012408 PMCID: PMC7115816 DOI: 10.1111/ene.14163] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 01/20/2020] [Indexed: 12/20/2022]
Abstract
Background and purpose Transient global amnesia (TGA) is characterized by a sudden onset of anterograde amnesia lasting up to 24 h. One major differential for TGA is transient epileptic amnesia, which typically lasts < 1 h. However, TGA can also be short in duration and little is known about the time trends, characteristics and prognosis of TGA cases lasting < 1 h. Methods We compared the clinical features of TGA ascertained in two independent cohort studies in Oxfordshire, UK [Oxford cohort 1977–1987 versus Oxford Vascular Study (OXVASC) 2002–2018] to determine the time trends of clinical features of TGA. Results were validated in another independent contemporary TGA cohort in Italy [Northern Umbria TGA registry (NU) 2002–2018]. We compared the risk factors, clinical features and long‐term prognosis (major cardiovascular events, recurrent TGA and seizure/epilepsy) of patients presenting with episodes lasting < 1 h versus those lasting ≥ 1 h. Results Overall, 639 patients with TGA were included (114 Oxford cohort, 100 OXVASC, 425 NU). Compared with the original Oxford cohort, there were more cases with TGA lasting < 1 h in OXVASC [32 (32.0%) vs. 9 (8.8%)] and NU (11.8% vs. 8.8% in Oxford cohort). In both OXVASC and NU, patient age, vascular risk factors and clinical features were largely similar between those with TGA lasting < 1 h versus those lasting ≥ 1 h. Moreover, there was no difference in the long‐term risk of seizure/epilepsy or major cardiovascular events between TGA lasting < 1 h versus TGA lasting ≥ 1 h. Conclusions Short‐duration TGA episodes (<1 h) were not uncommon and were more frequent than in earlier studies. The clinical features and long‐term prognosis of short‐duration TGA did not differ from more typical episodes lasting ≥ 1 h.
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Affiliation(s)
- M Romoli
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia.,Neurology Unit, Rimini 'Infermi' Hospital - AUSL Romagna, Rimini
| | - M A Tuna
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - L Li
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Paciaroni
- Stroke Unit, University of Perugia - S. Maria della Misericordia Hospital of Perugia, Perugia
| | - D Giannandrea
- Neurology and Stroke Unit, USL Umbria 1, Gubbio and Città di Castello Hospital, Perugia, Italy
| | - F Tordo Caprioli
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - A Lotti
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - P Eusebi
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - M G Mosconi
- Stroke Unit, University of Perugia - S. Maria della Misericordia Hospital of Perugia, Perugia
| | - M Pellizzaro Venti
- Stroke Unit, University of Perugia - S. Maria della Misericordia Hospital of Perugia, Perugia.,Stroke Unit, Addenbrooke's Hospital - Cambridge University Hospital, Cambridge, UK
| | - N Salvadori
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - A Gili
- Public Health Department, University of Perugia, Perugia
| | - S Ricci
- Neurology and Stroke Unit, USL Umbria 1, Gubbio and Città di Castello Hospital, Perugia, Italy
| | - F Stracci
- Public Health Department, University of Perugia, Perugia
| | - P Sarchielli
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - L Parnetti
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia
| | - P M Rothwell
- Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - P Calabresi
- Neurology Clinic, University of Perugia - S. Maria della Misericordia Hospital, Perugia.,IRCCS 'Santa Lucia', Rome, Italy
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37
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Schlansky K, Facer B, Tanguturi YC, Cundiff AW, Fuchs DC. Pediatric Acute-Onset Neuropsychiatric Syndrome and Catatonia: A Case Report. PSYCHOSOMATICS 2020; 61:86-91. [PMID: 31079934 DOI: 10.1016/j.psym.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 12/22/2022]
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38
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Jiménez-Zarazúa O, Martínez-Rivera MA, González-Carrillo PL, Vélez-Ramírez LN, Alcocer-León M, Tafoya-Rojas SXL, Becerra-Baez AM, Bravo-Martínez MA, Mondragón JD. Headache, Delirium or Encephalitis? A Case of Residual Mutism Secondary to Anti-NMDA Receptor Encephalitis. Case Rep Neurol 2019; 11:330-343. [PMID: 31911778 DOI: 10.1159/000504016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/08/2019] [Indexed: 12/20/2022] Open
Abstract
Encephalitis is a heterogeneous syndrome that is diagnosed through clinical assessment and the assistance of laboratory, neuroimaging and electroencephalographic workup. Over the past 10 years, autoimmune encephalitis has been more frequently recognized; however, most reports come from highly specialized hospital settings. Anti-N-methyl-D-aspartate receptor (NDMAR) encephalitis has been associated with paraneoplastic encephalitis syndromes and was first recognized in 2005. We present the case of a 34-year-old male patient who debuted clinically with a headache associated with neuropsychiatric symptoms (i.e., visual and auditory hallucinations, anxiety, aggressiveness) and memory deficits, progressing to autonomic dysfunction (i.e., tachycardia and hypertension), seizures, and stupor with catatonic features. Initially, infectious, metabolic, and toxicological etiologies were excluded; followed by the assessment of immunological and paraneoplastic etiologies, yielding positive IgG levels for anti-NMDAR antibodies. The patient was treated successfully with systemic steroid therapy and therapeutic plasmapheresis, while mutism was the only sequela. Although large case series reporting on paraneoplastic and autoimmune anti-NMDAR encephalitis have been reported in the literature in recent years, this case is of particular importance due to the stepwise differential diagnosis and treatment management procedure that was used in a regional but not highly specialized hospital setting.
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Affiliation(s)
- Omar Jiménez-Zarazúa
- Department of Internal Medicine, Hospital General León, León, Mexico.,Department of Medicine and Nutrition, Universidad de Guanajuato, León, Mexico
| | - María Andrea Martínez-Rivera
- Department of Internal Medicine, Hospital General León, León, Mexico.,Department of Medicine and Nutrition, Universidad de Guanajuato, León, Mexico
| | | | - Lourdes N Vélez-Ramírez
- Department of Medicine and Nutrition, Universidad de Guanajuato, León, Mexico.,Department of Radiology, Hospital General León, León, Mexico
| | - María Alcocer-León
- Department of Medicine and Nutrition, Universidad de Guanajuato, León, Mexico.,Department of Internal Medicine, Hospital Regional ISSSTE León, León, Mexico
| | | | | | | | - Jaime D Mondragón
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Alzheimer Research Center Groningen, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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39
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Churilov LP, Sobolevskaia PA, Stroev YI. Thyroid gland and brain: Enigma of Hashimoto's encephalopathy. Best Pract Res Clin Endocrinol Metab 2019; 33:101364. [PMID: 31801687 DOI: 10.1016/j.beem.2019.101364] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The versatile clinical manifestations of the Hashimoto's chronic autoimmune thyroiditis often include psycho-neurological disorders. Although hypothyroidism disturbs significantly the ontogenesis and functions of central nervous system, causing in severe cases of myxedema profound impairment of cognitive abilities and even psychosis, the behavioral, motor and other psychoneurological disorders accompany euthyroid and slightly hypothyroid cases and periods of Hashimoto's disease as well, thus constituting the picture of so called "Hashimoto's encephalopathy". The entity, although discussed and explored for more than 50 years since its initial descriptions, remains an enigma of thyroidology and psychiatry, because its etiology and pathogenesis are obscure. The paper describes the development of current views on the role of thyroid in ontogeny and functions of brain, as well as classical and newest ideas on the etiology and pathogenesis of Hashimot's encephalopathy. The synopsis of the world case reports and research literature on this disorder is added with authors' own results obtained by study of 17 cases of Hashimoto's thyroiditis with schizophrenia-like clinical manifestations. The relation of the disease to adjuvant-like etiological factors is discussed. Three major mechanistic concepts of Hashimoto's encephalopathy are detailed, namely cerebral vasculitis theory, hormone dysregulation theory and concept, explaining the disease via direct action of the autoantibodies against various thyroid (thyroperoxidase, thyroglobulin, and TSH-receptor) and several extrathyroid antigens (alpha-enolase and other enzymes, gangliosides and MOG-protein, onconeuronal antigens) - all of them expressed in the brain. The article demonstrates that all above mentioned concepts intermingle and prone to unification, suggesting the unified scheme of pathogenesis for the Hashimoto's encephalopathy. The clinical manifestations, criteria, forms, course, treatment and prognosis of Hashimoto's encephalopathy and its comorbidity to other diseases - are also discussed in brief. The relation between Hashimoto's encephalopathy and non-vasculitis autoimmune encephalomyelitides of paraneoplastic and non-paraneoplastic origin is emphasized [1 figure, bibliography - 200 references].
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Affiliation(s)
- Leonid P Churilov
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Russia.
| | - Polina A Sobolevskaia
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Russia.
| | - Yuri I Stroev
- Laboratory of the Mosaic of Autoimmunity, Saint Petersburg State University, Russia.
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40
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Palese F, Bonomi E, Nuzzo T, Benussi A, Mellone M, Zianni E, Cisani F, Casamassa A, Alberici A, Scheggia D, Padovani A, Marcello E, Di Luca M, Pittaluga A, Usiello A, Borroni B, Gardoni F. Anti-GluA3 antibodies in frontotemporal dementia: effects on glutamatergic neurotransmission and synaptic failure. Neurobiol Aging 2019; 86:143-155. [PMID: 31784278 DOI: 10.1016/j.neurobiolaging.2019.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/10/2019] [Accepted: 10/26/2019] [Indexed: 11/19/2022]
Abstract
Despite the great effort of the scientific community in the field, the pathogenesis of frontotemporal dementia (FTD) remains elusive. Recently, a role for autoimmunity and altered glutamatergic neurotransmission in triggering disease onset has been put forward. We reported the presence of autoantibodies recognizing the GluA3 subunit of α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptors in about 25% of FTD cases. In this study, we evaluated the mechanisms involved in anti-GluA3 autoimmunity, through molecular/neurochemical analyses conducted on patients' brain specimens with frontotemporal lobar degeneration-tau neuropathology. We then corroborated these results in vivo in FTD patients with transcranial magnetic stimulation and glutamate, D-serine, and L-serine dosages in the cerebrospinal fluid and serum. We observed that GluA3 autoantibodies affect glutamatergic neurotransmission, decreasing glutamate release and altering GluA3-containing α-amino-3-hydroxy-5-methylisoxazole-4-propionic acid receptor levels. These alterations were accompanied by changes of scaffolding proteins involved in receptor synaptic retention/internalization. The above results were confirmed by transcranial magnetic stimulation, suggesting a significant impairment of indirect measures of glutamatergic neurotransmission in FTD patients compared with controls, with further add-on harmful effect in those FTD patients with anti-GluA3 antibodies. Finally, FTD patients showed a significant increase of glutamate, D-serine, and L-serine levels in the cerebrospinal fluid.
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Affiliation(s)
- Francesca Palese
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elisa Bonomi
- Department of Clinical and Experimental Sciences, Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Tommaso Nuzzo
- Translational Neuroscience Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Alberto Benussi
- Department of Clinical and Experimental Sciences, Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Manuela Mellone
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elisa Zianni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Francesca Cisani
- Department of Pharmacy, DiFAR, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Alessia Casamassa
- Translational Neuroscience Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonella Alberici
- Department of Clinical and Experimental Sciences, Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Diego Scheggia
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Elena Marcello
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Monica Di Luca
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Anna Pittaluga
- Department of Pharmacy, DiFAR, School of Medical and Pharmaceutical Sciences, University of Genoa, Genoa, Italy
| | - Alessandro Usiello
- Translational Neuroscience Unit, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy; Department of Environmental, Biological and Pharmaceutical Sciences and Technologies, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Barbara Borroni
- Department of Clinical and Experimental Sciences, Neurology Unit, Centre for Neurodegenerative Disorders, University of Brescia, Brescia, Italy
| | - Fabrizio Gardoni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
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41
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Principi N, Esposito S. Bacterial meningitis: new treatment options to reduce the risk of brain damage. Expert Opin Pharmacother 2019; 21:97-105. [PMID: 31675255 DOI: 10.1080/14656566.2019.1685497] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction: Bacterial meningitis (BM) is a medical emergency and its etiology varies according to the age group and geographic area. Studies have shown that brain damage, sequelae and neuropsychological deficits depend not only on the direct deleterious action of the pathogens, but also on the host defenses themselves.Areas covered: Corticosteroids (CS) were the first drugs used with the intent to limit the exaggerated host response. However, as steroid addition to antibiotics is frequently unsatisfactory, other measures have been suggested. In this study, the most important adjuvant therapies that are potentially useful to limit the neuropsychological damage of BM are discussed.Expert opinion: The pathophysiological mechanisms leading to the development of brain damage are not completely defined. Moreover, the efficacy of adjuvant therapies can vary according to the aetiologic cause of BM, and differences in immune system function of the host can play a relevant role in the expression of inflammation and related problems. It is likely that none of the measures with demonstrated efficacy in animal models can be translated into clinical practice in the next few years, suggesting that to reduce the total burden of BM, the increased use of vaccines seems to be the best solution.
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Affiliation(s)
- Nicola Principi
- Emeritus of Pediatrics, Università degli Studi di Milano, Milan, Italy
| | - Susanna Esposito
- Pietro Barilla Children's Hospital, Department of Medicine and Surgery, University of Parma, Parma, Italy
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42
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Romoli M, Krashia P, Sen A, Franciotta D, Gastaldi M, Nobili A, Mancini A, Nardi Cesarini E, Nigro P, Tambasco N, Mercuri NB, Parnetti L, Di Filippo M, D'Amelio M, Irani SR, Costa C, Calabresi P. Hippocampal epileptogenesis in autoimmune encephalitis. Ann Clin Transl Neurol 2019; 6:2261-2269. [PMID: 31617317 PMCID: PMC6856617 DOI: 10.1002/acn3.50919] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE Autoantibody-mediated forms of encephalitis (AE) include neurological disorders characterized by subacute memory loss, movement disorders, and, often, frequent, focal epileptic seizures. Yet, the electrophysiological effects of these autoantibodies on neuronal function have received little attention. In this study, we assessed the effects of CSF containing autoantibodies on intrinsic and extrinsic properties of hippocampal neurons, to define their epileptogenic potential. METHODS We compared the effects of CSF containing leucine-rich glioma inactivated 1 (LGI1), contactin-associated protein-like 2 (CASPR2), and γ-aminobutyric acid receptor B (GABAB R) antibodies on ex vivo electrophysiological parameters after stereotactic hippocampal inoculation into mice. Whole-cell patch-clamp and extracellular recordings from CA1 pyramidal neurons and CA3-CA1 field recordings in ex vivo murine brain slices were used to study neuronal function. RESULTS By comparison to control CSF, AE CSFs increased the probability of glutamate release from CA3 neurons. In addition, LGI1- and CASPR2 antibodies containing CSFs induced epileptiform activity at a population level following Schaffer collateral stimulation. CASPR2 antibody containing CSF was also associated with higher spontaneous firing of CA1 pyramidal neurons. On the contrary, GABAB R antibody containing CSF did not elicit changes in intrinsic neuronal activity and field potentials. INTERPRETATION Using patient CSF, we have demonstrated that the AE-associated antibodies against LGI1 and CASPR2 are able to increase hippocampal CA1 neuron excitability, facilitating epileptiform activity. These findings provide in vivo pathogenic insights into neuronal dysfunction in these conditions.
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Affiliation(s)
- Michele Romoli
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy.,Neurology Unit, Rimini Infermi Hospital - AUSL Romagna, Rimini, Italy
| | - Paraskevi Krashia
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Medicine, University Campus-Biomedico, Rome, Italy
| | - Arjune Sen
- Oxford Epilepsy Research Group, NIHR Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK.,Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Annalisa Nobili
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Medicine, University Campus-Biomedico, Rome, Italy
| | - Andrea Mancini
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Pasquale Nigro
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy
| | - Nicola Tambasco
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy
| | - Nicola B Mercuri
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.,Neurology Clinic, University of Rome "Tor Vergata", Rome, Italy
| | - Lucilla Parnetti
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Marcello D'Amelio
- Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy.,Department of Medicine, University Campus-Biomedico, Rome, Italy
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy
| | - Paolo Calabresi
- Neurology Clinic, Department of Medicine, University of Perugia, Perugia, Italy.,Department of Experimental Neurosciences, IRCCS Santa Lucia Foundation, Rome, Italy
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