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Goudot M, Frismand S, Hopes L, Verger A, Joubert B, Honnorat J, Tyvaert L. Recurrent seizures of autoimmune origin: emerging phenotypes. J Neurol 2021; 268:3000-3010. [PMID: 33638022 DOI: 10.1007/s00415-021-10457-1] [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: 09/12/2020] [Revised: 01/15/2021] [Accepted: 02/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Recurrent seizures of autoimmune origin (AEp) are one of the most frequent causes of recurrent seizures or suspected epilepsy of unknown cause. The aim of this study was to identify specific phenotypes corresponding to AEp. METHODS We retrospectively reviewed features of patients with recurrent seizures of unknown cause and investigated for suspected AEp (January 2015-May 2018). Patients were separated in: (1) AEpAb+: AEp with positive autoantibodies; (2) AEpAb-: suspected AEp (inflammatory central nervous system (CNS) profile) without autoantibodies; (3) NAEp: epilepsy without CNS inflammation. RESULTS Eighty-nine epileptic patients underwent a CSF antibody detection. From the remaining 57 epileptic patients (32 excluded for a differential diagnosis), 61.4% were considered as AEp. 21% were AEpAb+ (4 NMDAR, 2 GABAbR, 3 GAD-Ab, 2 LGi1, 1 CASPR2), 40.4% AEpAb-, and 38.6% NAE. AE (AEpAb+ and AEpAb-) was significantly associated with antibody prevalence in epilepsy (APE) score ≥ 4 (80%), encephalitic phase (71.4%), psychiatric involvement (64.7%), cognitive impairment (50%), and status epilepticus (41.2%). Within the group of 29 patients without encephalitic phase and with chronic epilepsy (NEPp), 34.5% were defined as AEp. 10.4% were AEpAb+ (2 GAD, 1 CASPR2) and 24.1% were AEpAb-. NEP AEp was associated with non-cerebral autoimmune disorders, short epileptic disease duration, and cognitive impairment. CONCLUSIONS Autoimmune cause (AEp) should be assessed in patient suffering from recurrent seizures of unknown cause. Acute encephalitis is clearly the main AEp phenotype. AEp was also defined in more than one-third of chronic epilepsy patients (NEP) of unknown cause. Then, AEp may be combined with other autoimmune comorbidities, a shorter evolution of recurrent seizures, and cognitive impairment.
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Affiliation(s)
- Mathilde Goudot
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Solène Frismand
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Lucie Hopes
- Department of Neurology, University Hospital of Nancy, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine, IADI, INSERM U1254, University Hospital of Nancy, Nancy, France
| | - Bastien Joubert
- Department of Neurology, French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, INSERM U1217/CNRS, UMR5310, Lyon, France
| | - Jérôme Honnorat
- Department of Neurology, French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, INSERM U1217/CNRS, UMR5310, Lyon, France
| | - Louise Tyvaert
- Department of Neurology, University Hospital of Nancy, Nancy, France. .,Faculty of Medicine, CRAN CNRS UMR 7039, University of Lorraine, Nancy, France. .,Epilepsy Unit, Department of Neurology, Nancy University Medical Centre, Central Hospital, 54000, Nancy, France.
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Psychiatric symptoms in anti glutamic acid decarboxylase associated limbic encephalitis in adults: a systematic review. Neurosci Biobehav Rev 2020; 119:128-137. [PMID: 33022299 DOI: 10.1016/j.neubiorev.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/13/2020] [Accepted: 08/22/2020] [Indexed: 01/17/2023]
Abstract
Autoimmune Limbic Encephalitis (LE) is a relatively new category of immune-mediated diseases with a wide range of neuropsychiatric symptoms. LE associated with Glutamic Acid Decarboxylase (GAD) antibodies is difficult to diagnose due to its possible atypical presentation with neuropsychiatric and behavioral features. We performed a systematic review of literature and retrieved 21 cases of anti GAD-associated LE with neuropsychiatric signs. Median age at onset was 27 years with a female predominance (81.0 %) and median diagnostic delay of 6 months. Clinical presentation included typical LE symptoms such as anterograde amnesia (95.2 %) and temporal lobe or tonico-clonic seizures (95.2 %). Psychiatric symptoms were described in 61.9 % of patients, presenting as anxiety, depressive symptoms, apathy and behavioral changes. Extra-limbic symptoms were present in 14.3 % of patients. No neoplasia associated was found. Some patients had poor epileptic, cognitive and psychiatric outcomes requiring prolonged immunosuppressive treatment. The description of the neuropsychiatric spectrum of anti-GAD LE and its specificities aims to improve our understanding of this entity, and may lead to earlier diagnosis as well as better outcome.
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Neuroinflammation in CNS diseases: Molecular mechanisms and the therapeutic potential of plant derived bioactive molecules. PHARMANUTRITION 2020. [DOI: 10.1016/j.phanu.2020.100176] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Cox C, Larner AJ. Recurrent hypoglycaemia and cognitive impairment: a 14-year follow up. Br J Hosp Med (Lond) 2016; 77:540-1. [PMID: 27640659 DOI: 10.12968/hmed.2016.77.9.540] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Catrin Cox
- Final Year Medical Student in the Walton Centre for Neurology and Neurosurgery, Liverpool
| | - Andrew J Larner
- Consultant Neurologist in the Walton Centre for Neurology and Neurosurgery, Liverpool L9 7LJ
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Grilo E, Pinto J, Caetano JS, Pereira H, Cardoso P, Cardoso R, Dinis I, Pereira C, Fineza I, Mirante A. Type 1 diabetes and GAD65 limbic encephalitis: a case report of a 10-year-old girl. J Pediatr Endocrinol Metab 2016; 29:985-90. [PMID: 27115322 DOI: 10.1515/jpem-2016-0016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 03/07/2016] [Indexed: 12/14/2022]
Abstract
Limbic encephalitis is a rare neurological disorder that may be difficult to recognize. Clinical features include memory impairment, temporal lobe seizures and affective disturbance. We report the case of a 10-year-old girl with type 1 diabetes mellitus that presented with seizures, depressed mood and memory changes. The diagnosis of glutamic acid decarboxylase 65 (GAD65) mediated limbic encephalitis relied on cerebral magnetic resonance imaging lesions and high serological and cerebrospinal fluid GAD65-antibodies titers. High-dose steroidal therapy was started with clinical improvement. Relapse led to a second high-dose steroid treatment followed by rituximab with remission. A correlation between serum GAD65-antibodies levels and symptoms was found, demonstrating GAD65-antibodies titers may be useful for clinical follow-up and immunotherapy guidance. This report raises awareness of this serious neurological condition that may be associated with type 1 diabetes, underlining the importance of an early diagnosis and prompt treatment for a better prognosis.
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Martínez Zapico A, Martínez Rodríguez L, Morís de la Tassa G, Caminal Montero L. Encefalitis límbica: una entidad hasta ahora poco conocida. Med Clin (Barc) 2016; 146:465-6. [DOI: 10.1016/j.medcli.2015.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 11/14/2015] [Accepted: 11/19/2015] [Indexed: 10/22/2022]
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Limbic Encephalitis Associated With GAD65 Antibodies: Brief Review of the Relevant literature. Can J Neurol Sci 2016; 43:486-93. [DOI: 10.1017/cjn.2016.13] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
AbstractRecently, many cases of autoimmune limbic encephalitis with positive GAD65 (glutamic acid decarboxylase) antibodies have been described in the scientific literature. However, it remains an understudied topic of great relevance to practicing neurologists. Thus, we report here a review of published cases, in English, of autoimmune limbic encephalitis with this type of antibodies, focusing on presenting symptoms and signs, associated conditions, and findings upon investigation. We also report treatment responses. We aim to offer a better description of the clinical spectrum of autoimmune limbic encephalitis associated with GAD65 antibodies as well as to expose its paraclinical features and outcome.
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Barahona Afonso AF, João CMP. The Production Processes and Biological Effects of Intravenous Immunoglobulin. Biomolecules 2016; 6:15. [PMID: 27005671 PMCID: PMC4808809 DOI: 10.3390/biom6010015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/17/2022] Open
Abstract
Immunoglobulin is a highly diverse autologous molecule able to influence immunity in different physiological and diseased situations. Its effect may be visible both in terms of development and function of B and T lymphocytes. Polyclonal immunoglobulin may be used as therapy in many diseases in different circumstances such as primary and secondary hypogammaglobulinemia, recurrent infections, polyneuropathies, cancer, after allogeneic transplantation in the presence of infections and/or GVHD. However, recent studies have broadened the possible uses of polyclonal immunoglobulin showing that it can stimulate certain sub-populations of T cells with effects on T cell proliferation, survival and function in situations of lymphopenia. These results present a novel and considerable impact of intravenous immunoglobulin (IVIg) treatment in situations of severe lymphopenia, a situation that can occur in cancer patients after chemo and radiotherapy treatments. In this review paper the established and experimental role of polyclonal immunoglobulin will be presented and discussed as well as the manufacturing processes involved in their production.
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Affiliation(s)
- Ana Filipa Barahona Afonso
- Department of Chemistry, Universidade de Évora, Colégio Luís António Verney, Rua Romão Ramalho 59, 7000-671 Évora, Portugal.
| | - Cristina Maria Pires João
- Hematology Department, Champalimaud Center for the Unknown, Av. Brasília, 1400-038 Lisboa, Portugal.
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Kim SY, Choi SA, Ryu HW, Kim H, Lim BC, Hwang H, Chae JH, Choi J, Kim KJ, Hwang YS, Lee ST, Chu K, Lee SK. Screening Autoimmune Anti-neuronal Antibodies in Pediatric Patients with Suspected Autoimmune Encephalitis. J Epilepsy Res 2014; 4:55-61. [PMID: 25625089 PMCID: PMC4295054 DOI: 10.14581/jer.14012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 09/01/2014] [Indexed: 12/15/2022] Open
Abstract
Background and Purpose: The aim of this study was to identify and describe the pediatric autoimmune encephalitis cases positive for anti-neuronal antibody tests. Methods: Screening of six anti-neuronal antibodies in 23 children with suspected autoimmune encephalitis was performed by cell-based indirect immunofluorescence test with patients’ serum or cerebrospinal fluid. Results: Among the 23 cases enrolled here, eight patients (35%) were positive for the anti-N-methyl-d-aspartate (NMDA) receptor antibody and one patient (4%) was positive for the anti-contactin-associated protein-like 2 (CASPR2) antibody. In the anti-NMDA receptor antibody-positive group, seizure and movement disorders were the most prominent features and were present in all patients. A tumor was present in only one patient. Three patients with infant- and toddler-onset disease did not exhibit a classic multistage illness. In addition to seizure and dyskinesia, aphasia or mutism without severe consciousness impairment was present in all three patients. These atypical clinical presentations may suggest different pathomechanism of anti-NMDA receptor encephalitis among these age groups. The patient who was positive for the anti-CASPR2 antibody was an 8-year-old girl who presented with fever, encephalopathy, and seizure. Neuromyotonia or other dyskinesia was not present. Conclusions: Eight anti-NMDA receptor antibody positive patients and one CASPR2 positive patient were identified from the screening of six anti-neuronal antibodies in pediatric patients suspected with autoimmune encephalitis. Developmental regression specifically for language skills was suggested as one of the atypical clinical features in infants and toddler onset anti-NMDA receptor antibody positive patients.
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Affiliation(s)
- Soo Yeon Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul
| | - Sun Ah Choi
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul
| | - Hye Won Ryu
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul; ; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul; ; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul
| | - Jieun Choi
- Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul; ; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul
| | - Yong Seung Hwang
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul; ; Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul
| | - Soon-Tae Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Kon Chu
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Sang Kun Lee
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
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Autoimmune-mediated cognitive impairment: a case report. PSYCHOSOMATICS 2014; 55:698-702. [PMID: 24751115 DOI: 10.1016/j.psym.2013.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 12/26/2013] [Accepted: 12/27/2013] [Indexed: 11/20/2022]
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Hermans MP, Mahadeb YP, Katchunga P, Cikomola Cirhuza J, Ahn SA, Rousseau MF. Novel sexual dimorphisms of sleep apnea syndrome in diabetes. Diabetes Metab Syndr 2014; 8:36-44. [PMID: 24661757 DOI: 10.1016/j.dsx.2013.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND OSAS, a frequently neglected, yet frequent comorbidity in T2DM, is associated with obesity, metabolic syndrome and central fat. OSAS is better documented in males, and this study explored novel gender dimorphisms in T2DM. METHODS Cross-sectional study: 815 T2DM (541 males; 274 females) classified into OSAS[-] and OSAS[+] were assessed for cardiometabolic risk factors, glucose homeostasis, micro/macroangiopathies, CV risk, autoimmune thyroid disease (AITD); and GAD65 antibodies. RESULTS There was a gender dimorphism in glucose control (worse in females), apolipoprotein B100 (higher in females), with apoB100/apoA1 and log(TG)/HDL-C sexually dimorphic. There was also a marked gender dimorphism in GAD65 positivity, higher (+793%) in OSAS[+] females vs. males. There were clear sexual dimorphisms in macro-/microangioathies, regarding stroke, retinopathy and polyneuropathy. OSAS was not sexually dimorphic regarding age; education; and diabetes duration. There was a significant dimorphism in ethnicity. There were no gender-specific dimorphisms related to OSAS in anthropometrics, nor in hypertension, insulin sensitivity, or hyperbolic product loss rate. CONCLUSION We report a series of novel OSAS-related sexual dimorphisms, concerning GAD65 auto-antibodies; polyneuropathy; atherogenic dyslipidemia [all increased in females]; diabetic retinopathy; North-Caucasian ethnicity; metabolic control; and TIA/stroke prevalence [all lower in females]. These findings raise challenging questions regarding the reciprocal pathophysiology between obstructive sleep disorders and cardiometabolic risk in T2DM.
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Affiliation(s)
- Michel P Hermans
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium.
| | - Yovan P Mahadeb
- Division of Endocrinology and Nutrition, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Katchunga
- Faculty of Medicine, Catholic University of Bukavu, Democratic Republic of the Congo
| | | | - Sylvie A Ahn
- Division of Cardiology, Université catholique de Louvain, Brussels, Belgium
| | - Michel F Rousseau
- Division of Cardiology, Université catholique de Louvain, Brussels, Belgium
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