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Redenbaugh V, Fryer JP, Cacciaguerra L, Chen JJ, Greenwood TM, Gilligan M, Thakolwiboon S, Majed M, Chia NH, McKeon A, Mills JR, Lopez Chiriboga AS, Tillema JM, Yang B, Abdulrahman Y, Guo K, Vorasoot N, Sanchez CV, Tajfirouz DA, Toledano M, Zekeridou A, Dubey D, Gombolay GY, Caparó-Zamalloa C, Kister I, Pittock SJ, Flanagan EP. Diagnostic Utility of MOG Antibody Testing in Cerebrospinal Fluid. Ann Neurol 2024; 96:34-45. [PMID: 38591875 PMCID: PMC11186718 DOI: 10.1002/ana.26931] [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: 08/23/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic utility of cerebrospinal fluid (CSF) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) testing. METHODS We retrospectively identified patients for CSF MOG-IgG testing from January 1, 1996, to May 1, 2023, at Mayo Clinic and other medical centers that sent CSF MOG-IgG for testing including: controls, 282; serum MOG-IgG positive MOG antibody-associated disease (MOGAD), 74; serum MOG-IgG negative high-risk phenotypes, 73; serum false positive MOG-IgG with alternative diagnoses, 18. A live cell-based assay assessed CSF MOG-IgG positivity (IgG-binding-index [IBI], ≥2.5) using multiple anti-human secondary antibodies and end-titers were calculated if sufficient sample volume. Correlation of CSF MOG-IgG IBI and titer was assessed. RESULTS The pan-IgG Fc-specific secondary was optimal, yielding CSF MOG-IgG sensitivity of 90% and specificity of 98% (Youden's index 0.88). CSF MOG-IgG was positive in: 4/282 (1.4%) controls; 66/74 (89%) serum MOG-IgG positive MOGAD patients; and 9/73 (12%) serum MOG-IgG negative patients with high-risk phenotypes. Serum negative but CSF positive MOG-IgG accounted for 9/83 (11%) MOGAD patients, and all fulfilled 2023 MOGAD diagnostic criteria. Subgroup analysis of serum MOG-IgG low-positives revealed CSF MOG-IgG positivity more in MOGAD (13/16[81%]) than other diseases with false positive serum MOG-IgG (3/15[20%]) (p = 0.01). CSF MOG-IgG IBI and CSF MOG-IgG titer (both available in 29 samples) were correlated (Spearman's r = 0.64, p < 0.001). INTERPRETATION CSF MOG-IgG testing has diagnostic utility in patients with a suspicious phenotype but negative serum MOG-IgG, and those with low positive serum MOG-IgG results and diagnostic uncertainty. These findings support a role for CSF MOG-IgG testing in the appropriate clinical setting. ANN NEUROL 2024;96:34-45.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - James P. Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura Cacciaguerra
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John J. Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Tammy M. Greenwood
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michael Gilligan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Neurology, St Vincent’s University Hospital, Dublin, Ireland
| | - Smathorn Thakolwiboon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Masoud Majed
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nicholas H Chia
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John R. Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | - Jan-Mendelt Tillema
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Binxia Yang
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Yahya Abdulrahman
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kai Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nisa Vorasoot
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Deena A. Tajfirouz
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Michel Toledano
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Anastasia Zekeridou
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Divyanshu Dubey
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Grace Y Gombolay
- Emory University, Children’s Healthcare of Atlanta: Pediatrics Institute, USA
| | - César Caparó-Zamalloa
- Basic Research Center in Dementia and Central Nervous System Demyelinating Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, New York, USA
| | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eoin P. Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Clinical features and outcomes of opsoclonus myoclonus ataxia syndrome. Eur J Paediatr Neurol 2022; 41:19-26. [PMID: 36155293 DOI: 10.1016/j.ejpn.2022.09.002] [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: 04/12/2022] [Revised: 08/14/2022] [Accepted: 09/14/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES AND METHODS Opsoclonus myoclonus ataxia syndrome (OMAS) is a rare neuroinflammatory disorder. We aimed to retrospectively evaluate clinical and laboratory data and outcomes of 23 children diagnosed with OMAS in two children's hospitals between 2010 and 2021. RESULTS There were 14 boys and 9 girls aged 4-113 months, median 24 months. Ten (43.5%) children had paraneoplastic causes: neuroblastoma/ganglioneuroblastoma (n = 9), acute lymphoblastic leukemia (n = 1). Three children had a postinfectious cause (upper respiratory tract infection in 2, EBV infection in 1) and two had a history of vaccination (varicella in 1, hepatitis A and meningococcal in 1). No underlying factor was identified in 8 (34.8%) children. Speech disorders were more frequent in patients with neural tumors than in those without (p = 0.017). Intravenous immunoglobulin and steroids were effective as initial treatment in most children. Rituximab resulted in at least mild improvement in all 6 children with persistent or recurrent symptoms. Nine (39%) children experienced at least one relapse. Neurological sequelae were detected in 13 (57%) children. There was no significant correlation between clinical characteristics and outcome, except for higher risk of relapse in case of incomplete recovery after first attack (p = 0.001). CONCLUSIONS Acute lymphoblastic leukemia, vaccines against hepatitis A and meningococci can be included among antecedent factors in OMAS. Among clinical symptoms, speech problems might point to the likelihood of an underlying neoplasm in OMAS. Intravenous immunoglobulin and steroids may be chosen for initial treatment while rituximab can increase the chance of recovery in case of persistent or recurrent symptoms. The presence of relapse was associated with poor outcome.
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Yasuda N, Nishikawa M, Shimosaka H, Ono Y, Yatomi Y. Effect of administration of immunoglobulin preparations on the results of tests for autoantibodies. Mod Rheumatol 2021; 32:946-952. [PMID: 34918126 DOI: 10.1093/mr/roab085] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/06/2021] [Accepted: 09/27/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES We encountered the case in whom the results of autoantibodies tests became transiently positive after high-dose immunoglobulin therapy and investigated the effect of administration of these preparations on autoantibodies tests in subjects with autoimmune diseases who had received high-dose immunoglobulin therapy. METHODS We measured the autoantibodies in residual serum samples after routine clinical testing from eight subjects with autoimmune diseases who had received high-dose immunoglobulin therapy. We also measured the autoantibodies in available immunoglobulin preparations. RESULTS Tests for autoantibodies conducted before and after immunoglobulin therapy revealed a positive conversion of the results for anti-Sjogren's syndrome antigen A (SS-A) antibody, anti-glutamic acid decarboxylase (GAD) antibody, anti-thyroglobulin (Tg) antibody, and anti-thyroid peroxidase (TPO) antibody. In five cases in which changes in the antibody titres of anti-SS-A antibody after the high-dose immunoglobulin administration, it was found that the titres decreased by about 50% from 10 to 20 days after and the test result became negative 25- 30 days later. CONCLUSIONS In patients receiving high-dose immunoglobulin therapy, there appears to be a high likelihood of positive conversion of tests for anti-SS-A antibody, GAD antibody, Tg antibody, and TPO antibody after the treatment, so that cautious interpretation of the results is of importance.
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Affiliation(s)
- Naomi Yasuda
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Masako Nishikawa
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Hironori Shimosaka
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshikazu Ono
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, University of Tokyo Hospital, Tokyo, Japan.,Department of Clinical Laboratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Detection of Antibodies Against Human Leukocyte Antigen Class II in the Sera of Patients Receiving Intravenous Immunoglobulin. Transplant Direct 2021; 7:e697. [PMID: 34036167 PMCID: PMC8133174 DOI: 10.1097/txd.0000000000001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/11/2021] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. IVIG is occasionally used for preventing and treating severe infections of patients who are to undergo transplantation. Administration of IVIG, which includes high-titer antibodies (Abs) against HLA class I and II, might have a substantial influence on the HLA Ab test results of these patients. However, this issue has remained unreported.
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Dimitriadou MM, Alexopoulos H, Akrivou S, Gola E, Dalakas MC. Anti-Neuronal Antibodies Within the IVIg Preparations: Importance in Clinical Practice. Neurotherapeutics 2020; 17:235-242. [PMID: 31673865 PMCID: PMC7007490 DOI: 10.1007/s13311-019-00796-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Our study objective was testing for anti-neuronal autoantibodies within commercially available intravenous immunoglobulin (IVIg) preparations. Sixteen samples from 5 different commercially available IVIg preparations were tested with cell-based assays (CBA) and enzyme-linked immunosorbent assay (ELISA) to detect and characterize common neuronal autoantibodies, and with immunohistochemistry on teased fibers from mouse sciatic nerve and on mouse brain sections to screen for nodal and not yet identified neuronal antigens. In 15/16 IVIg preparations, anti-GAD antibodies were detected in titers ranging from 40 to 1507 IU/mL, as typically seen in type 1 diabetes, but not in the range (> 2000 IU/mL) seen in GAD-positive neurological patients. None of the preparations was however positive with anti-GAD CBA. Antibodies to AQP4 were also detected by ELISA in 15/16 IVIg preparations with titers comparable to those seen in AQP4-seropositive NMO patients; with CBA, however, all IVIg samples were AQP4-negative. IVIg preparations contained IgG-anti-MAG antibodies by ELISA at statistically significant higher titers compared to controls. Two of the 16 IVIg samples were positive for human 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibodies. All IVIg preparations were negative for antibodies to MOG, NMDAR, anti-nodal, and other neuronal-specific proteins. IVIg preparations contain antibodies against GAD and AQP4 in titers comparable to those seen in autoimmune patients when tested by ELISA, but not by CBA or tissue immunohistochemistry, suggesting that the autoantibodies within the IVIg are against linear rather than structural epitopes, as part of the natural antibody immune repertoire. The information is clinically important for diagnosis when testing patients' sera after they have received therapy with IVIg to avoid false interpretation.
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Affiliation(s)
- Maria M Dimitriadou
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Haris Alexopoulos
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Sofia Akrivou
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Eleni Gola
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece
| | - Marinos C Dalakas
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, 11527, Greece.
- Department of Neurology, Thomas Jefferson University, Philadelphia, 19107, USA.
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Grüter T, Ott A, Meyer W, Jarius S, Kinner M, Motte J, Pitarokoili K, Gold R, Komorowski L, Ayzenberg I. Effects of IVIg treatment on autoantibody testing in neurological patients: marked reduction in sensitivity but reliable specificity. J Neurol 2019; 267:715-720. [PMID: 31728710 DOI: 10.1007/s00415-019-09614-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/10/2019] [Accepted: 10/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Therapy of autoimmune diseases of the central and peripheral nervous system with intravenous IgG immunoglobulin (IVIg) is well established. Since IVIg is produced from pooled human plasma, autoantibodies can be found in IVIg products and, accordingly, in patient sera after transfusion. The de novo evidence or disappearance of anti-neural autoantibodies after IVIg treatment has so far not been systematically examined. METHODS We screened 50 neurological patients before and after IVIg treatment for classical onconeural and the most common neurological surface autoantibodies as well as for ganglioside autoantibodies and 23 different antinuclear autoantibodies using immunoblot or cell-based indirect immunofluorescence assays. Furthermore, we screened 31 neurological patients with previously known seropositivity for disappearance of the corresponding antibody after treatment. RESULTS After IVIg treatment, 90% of all sera were de novo positive for antinuclear antibodies, especially for Ro-52. In contrast, 94% of all sera did not show any de novo-positive anti-neural antibodies. In the remaining three cases, titers were very low. Importantly, 12.9% of all tested sera of patients with known antibody positivity turned false negative after IVIg treatment and titers were falsely low in 37% of the remaining sera. CONCLUSIONS Here, we present for the first time results of a broad screening for clinically relevant autoantibodies before and after IVIg treatment in neurological patients. We identified a high specificity but reduced sensitivity for anti-neural antibody testing after IVIg transfusion. In contrast, antinuclear antibody testing is not reliable after IVIg treatment. These results are of high practical importance for diagnostic of neuroimmunological diseases.
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Affiliation(s)
- Thomas Grüter
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Anthonina Ott
- Institute for Experimental Immunology, Lübeck, Germany
| | | | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Kinner
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany
| | | | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr-University Bochum, Gudrunstr. 56, 44791, Bochum, Germany.
- Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.
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Smith TD, Cunningham-Rundles C. Detection of anti-glutamic acid decarboxylase antibodies in immunoglobulin products. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:260-261. [PMID: 28669890 DOI: 10.1016/j.jaip.2017.04.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/04/2017] [Accepted: 04/26/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Tukisa D Smith
- Division of Allergy and Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York, NY
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Ghia T, Kanhangad M, Alessandri AJ, Price G, Gera P, Nagarajan L. Opsoclonus-Myoclonus Syndrome, Neuroblastoma, and Insulin-Dependent Diabetes Mellitus in a Child: A Unique Patient. Pediatr Neurol 2016; 55:68-70. [PMID: 26778146 DOI: 10.1016/j.pediatrneurol.2015.09.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/26/2015] [Accepted: 09/26/2015] [Indexed: 01/13/2023]
Abstract
AIM We present a new and unique association of opsoclonus-myoclonus-ataxia syndrome with neuroblastoma and type 1 diabetes mellitus. PATIENT DESCRIPTION This 17-month-old child presented with opsoclonus-myoclonus-ataxia syndrome. Investigations revealed a thoracic neuroblastoma. Eleven days later, she re-presented with diabetic ketoacidosis. The neuroblastoma was resected, and she was given immunotherapy. At 12 months' follow-up, her neurological signs and symptoms have significantly improved, but she continues to be insulin dependent. DISCUSSION This child expands the clinical spectrum of autoimmune disorders associated with opsoclonus-myoclonus-ataxia syndrome.
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Affiliation(s)
- Twinkle Ghia
- Department of Neurology, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Manoj Kanhangad
- Department of Neurology, Princess Margaret Hospital, Perth, Western Australia, Australia
| | | | - Glynis Price
- Department of Endocrinology, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Parshotam Gera
- Department of Paediatric Surgery, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Lakshmi Nagarajan
- Department of Neurology, Princess Margaret Hospital, Perth, Western Australia, Australia; School of Paediatrics and Child Health, University of Western Australia, Princess Margaret Hospital, Perth, Western Australia, Australia.
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Reintjes W, Romijn MD, Hollander D, ter Bruggen JP, van Marum RJ. Reversible Dementia: Two Nursing Home Patients With Voltage-Gated Potassium Channel Antibody-Associated Limbic Encephalitis. J Am Med Dir Assoc 2015; 16:790-4. [DOI: 10.1016/j.jamda.2015.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/04/2015] [Indexed: 11/24/2022]
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Tveitnes D, Hjetland R, Øymar K. Tolking av serologiske testar. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2013; 133:826. [DOI: 10.4045/tidsskr.13.0409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Bhandari HS. Presentation of opsoclonus myoclonus ataxia syndrome with glutamic acid decarboxylase antibodies. BMJ Case Rep 2012; 2012:bcr2012006339. [PMID: 22878989 PMCID: PMC4543362 DOI: 10.1136/bcr-2012-006339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In this rare case, the patient presented with opsoclonus, myoclonus and ataxia. Serological and imaging studies revealed high glutamic acid decarboxylase antibody (GAD-Ab) levels. High-dose corticosteroids were of no benefit and subsequent intravenous immunoglobulin (IVIg) administration proved resolution of the condition. Levetiracetam proved useful in symptomatically controlling the myoclonus. Follow-up GAD-Ab levels were within normal limits.
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Khan S, Davies L, Cowley D, Wild G, Sewell WAC. Anti-acetylcholine receptor antibody reactivity of IgG in commercial immunoglobulin preparations. Clin Neurol Neurosurg 2011; 112:835-6. [PMID: 20619959 DOI: 10.1016/j.clineuro.2010.06.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2009] [Revised: 06/11/2010] [Accepted: 06/14/2010] [Indexed: 10/19/2022]
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