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Finsterer J. Before Diagnosing SARS-CoV-2 Vaccination-Associated Immune Encephalitis Alternative Aetiologies Must Be Ruled Out. Arch Clin Neuropsychol 2024:acae044. [PMID: 38819297 DOI: 10.1093/arclin/acae044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/08/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
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Kvam KA, Stahl JP, Chow FC, Soldatos A, Tattevin P, Sejvar J, Mailles A. Outcome and Sequelae of Autoimmune Encephalitis. J Clin Neurol 2024; 20:3-22. [PMID: 38179628 PMCID: PMC10782092 DOI: 10.3988/jcn.2023.0242] [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: 07/04/2023] [Revised: 10/31/2023] [Accepted: 11/06/2023] [Indexed: 01/06/2024] Open
Abstract
Autoimmune etiologies are a common cause for encephalitis. The clinical syndromes consistent with autoimmune encephalitis are both distinct and increasingly recognized, but less is known about persisting sequelae or outcomes. We searched PubMed for reports on outcomes after autoimmune encephalitis. Studies assessing validated, quantitative outcomes were included. We performed a narrative review of the published literature of outcomes after autoimmune encephalitis. We found 146 studies that produced outcomes data. The mortality rates were 6%-19% and the relapse risks were 10%-62%. Most patients achieved a good outcome based on a score on the modified Rankin Scale (mRS) of ≤2. Forty-nine studies evaluated outcomes beyond mRS; these studies investigated cognitive outcome, psychiatric sequelae, neurological deficits, global function, and quality-of-life/patient-reported outcomes using various tools at varying time points after the index hospital discharge. These more-detailed assessments revealed that most patients had persistent impairments, with frequent deficits in cognitive function, especially memory and attention. Depression and anxiety were also common. Many of these sequelae continued to improve over months or even years after the acute illness. While we found that lasting impairments were common among survivors of autoimmune encephalitis, additional research is needed to better understand the nature and impact of these sequelae. Standardized evaluation protocols are needed to improve the ability to compare outcomes across studies, guide rehabilitation strategies, and inform outcomes of interest in treatment trials as the field advances.
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Affiliation(s)
- Kathryn A Kvam
- Department of Neurology & Neurological Sciences, Center for Academic Medicine, Stanford University, Stanford, CA, USA.
| | | | - Felicia C Chow
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
- Department of Medicine, Division of Infectious Diseases, University of California, San Francisco, CA, USA
| | - Ariane Soldatos
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Pontchaillou University Hospital, Rennes, France
| | - James Sejvar
- Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alexandra Mailles
- Department of Infectious Diseases, Santé publique France, Saint-Maurice, France
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Liu Y, Gong Y, Wu XL, Hao XM, Liu JP, Li YY, Yang KZ, Gao XY, Zhang J, Zhang L, Zhang XD, Wang J, Liu QG. Fire acupuncture for anti-LGI1 antibody autoimmune encephalitis: a case report. Front Neurosci 2023; 17:1203915. [PMID: 37539383 PMCID: PMC10395828 DOI: 10.3389/fnins.2023.1203915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/19/2023] [Indexed: 08/05/2023] Open
Abstract
Autoimmune encephalitis, a class of encephalitis, is clinically characterized by multifocal or diffuse brain injury, including aberrant mental behavior, convulsions, and near-event memory impairment. In this article, we describe a female patient with autoimmune encephalitis who tested positive for leucine-rich glioma inactivated 1 (LGI1) antibodies and had hippocampal inflammatory edema in the lesion area. During the first 3 months of her illness, the patient primarily experienced memory loss, the onset of rigid twitching in her extremities that lasted for 1 min while in remission, and incontinence. After gamma globulin administration, methylprednisolone shock, and other symptomatic therapies during hospitalization, the patient's psychiatric symptoms and seizures improved considerably; however, she did not fully recover her memory. After receiving fire acupuncture for 6 months, the patient's understanding, orientation, and calculation skills improved considerably. Her memory and mental state were also improved at the follow-up visit. In this case, the use of fire acupuncture for the treatment of autoimmune encephalitis resulted in favorable outcomes with important benefits for conditions affecting the central nervous system; however, more convincing data are required to support the effectiveness of this treatment method.
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Affiliation(s)
- Yu Liu
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yu Gong
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-li Wu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-min Hao
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Ji-peng Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Yin-yin Li
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Ke-zhen Yang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xin-yu Gao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Jing Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Lin Zhang
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
| | - Xu-dong Zhang
- Department of Chinese Medicine, Beijing Jishuitan Hospital, Beijing, China
| | - Jun Wang
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qing-guo Liu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
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Wang J, Ge J, Jin L, Deng B, Tang W, Yu H, Zhang X, Liu X, Xue L, Zuo C, Chen X. Characterization of neuroinflammation pattern in anti-LGI1 encephalitis based on TSPO PET and symptom clustering analysis. Eur J Nucl Med Mol Imaging 2023; 50:2394-2408. [PMID: 36929211 DOI: 10.1007/s00259-023-06190-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 03/05/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE TSPO PET with radioligand [18F]DPA-714 is an emerging molecular imaging technique that reflects cerebral inflammation and microglial activation, and it has been recently used in central nervous system diseases. In this study, we aimed to investigate the neuroinflammation pattern of anti-leucine-rich glioma-inactivated 1 (LGI1) protein autoimmune encephalitis (AIE) and to evaluate its possible correlation with clinical phenotypes. METHODS Twenty patients with anti-LGI1 encephalitis from the autoimmune encephalitis cohort in Huashan Hospital and ten with other AIE and non-inflammatory diseases that underwent TSPO PET imaging were included in the current study. Increased regional [18F]DPA-714 retention in anti-LGI1 encephalitis was detected on a voxel basis using statistic parametric mapping analysis. Multiple correspondence analysis and hierarchical clustering were conducted for discriminate subgroups in anti-LGI1 encephalitis. Standardized uptake value ratios normalized to the cerebellum (SUVRc) were calculated for semiquantitative analysis of TSPO PET features between different LGI1-AIE subgroups. RESULTS Increased regional retention of [18F]DPA-714 was identified in the bilateral hippocampus, caudate nucleus, and frontal cortex in LGI1-AIE patients. Two subgroups of LGI1-AIE patients were distinguished based on the top seven common symptoms. Patients in cluster 1 had a high frequency of facio-brachial dystonic seizures than those in cluster 2 (p = 0.004), whereas patients in cluster 2 had a higher frequency of general tonic-clonic (GTC) seizures than those in cluster 1 (p < 0.001). Supplementary motor area and superior frontal gyrus showed higher [18F]DPA-714 retention in cluster 2 patients compared with those in cluster 1 (p = 0.024; p = 0.04, respectively). CONCLUSIONS Anti-LGI1 encephalitis had a distinctive molecular imaging pattern presented by TSPO PET scan. LGI1-AIE patients with higher retention of [18F]DPA-714 in the frontal cortex were more prone to present with GTC seizures. Further studies are required for verifying its value in clinical application.
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Affiliation(s)
- Jingguo Wang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Jingjie Ge
- Department of Nuclear Medicine/PET Center, Huashan Hospital, Fudan University, 518 East Wuzhong Road, Shanghai, 200235, China
| | - Lei Jin
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Bo Deng
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Shanghai, 200040, China
| | - Hai Yu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiang Zhang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Xiaoni Liu
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China
| | - Le Xue
- Department of Nuclear Medicine, the Second Hospital of Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China
| | - Chuantao Zuo
- Department of Nuclear Medicine/PET Center, Huashan Hospital, Fudan University, 518 East Wuzhong Road, Shanghai, 200235, China.
| | - Xiangjun Chen
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
- National Center for Neurological Disorders, 12 Wulumuqi Zhong Road, Shanghai, 200040, China.
- Human Phenome Institute, Fudan University, Shanghai, China.
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Wang Y, Zhang D, Tong L, Yang L, Yin P, Li J, Lei G, Yang X, Li B. Anti-LGI1 encephalitis with initiating symptom of seizures in children. Front Neurosci 2023; 17:1151430. [PMID: 37179544 PMCID: PMC10169679 DOI: 10.3389/fnins.2023.1151430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/30/2023] [Indexed: 05/15/2023] Open
Abstract
Background Anti-leucine-rich glioma-inactivated 1 (LGI1) encephalitis is infrequently reported but more and more recognizable in children. Here we give detailed description of the clinical features and long-term outcome of three cases of childhood onset anti-LGI1 encephalitis. Methods Three anti-LGI1 encephalitis patients were hospitalized in the Department of Pediatrics at Qilu Hospital of Shandong University. Data about the clinical manifestations, treatments and long-term follow-up outcomes were described in detail. Results Case 1 showed an adolescent girl with initiating symptom of acute-onset frequent focal seizures. Her serum LGI1-antibody test was positive, and she had a good response to antiseizure medication (ASM) and IVIG. Case 2 showed a preschool-age boy with long-period refractory focal seizures and recent behavioral change. Both serum and cerebrospinal fluid (CSF) tests of LGI1-antibody were positive, and the MRI showed progressive atrophy in the left hemisphere. The symptoms got improved after receiving second-line immunotherapy initially but there are still the sequelae of drug-resistant epilepsy and mild to moderate intellectual disability. Case 3 showed an adolescent boy with initiating symptom of acute-onset frequent focal seizures. Both serum and CSF tests of LGI1-antibody were positive, and he had a good response to immunotherapy. By analyzing all literature-reported 19 pediatric cases, we found pediatric anti-LGI1 encephalitis is more common in female and adolescent. Seizures and behavioral changes were the most common symptoms. CSF pleocytosis and LGI1-antibodies results were mostly negative. Most patients showed good response to immunotherapy. Conclusion Childhood onset anti-LGI1 encephalitis is a heterogeneous clinical syndrome, ranging from typical limbic encephalitis to isolating focal seizures. It is important to test autoimmune antibodies when encountering similar cases and repeat antibody testing if necessary. Timely recognition leads to earlier diagnosis and more rapid initiation of effective immunotherapy and potentially better outcomes.
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Affiliation(s)
| | | | | | | | | | | | | | - Xiaofan Yang
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
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Joshi J, Patel R, Figley CR, Figley TD, Salter J, Bernstein CN, Marrie RA. Neuropsychological and Structural Neuroimaging Outcomes in LGI1-Limbic Encephalitis: A Case Study. Arch Clin Neuropsychol 2022; 38:139-153. [PMID: 36064192 PMCID: PMC9868528 DOI: 10.1093/arclin/acac072] [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] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Anti-leucine-rich glioma-inactivated 1 limbic encephalitis (LGI1-LE) is a rare autoimmune condition that affects the structural integrity and functioning of the brain's limbic system. Little is known about its impact on long-term neuropsychological functioning and the structural integrity of the medial temporal lobe. Here we examined the long-term neuropsychological and neuroanatomical outcomes of a 68-year-old male who acquired LGI1-LE. METHODS Our case patient underwent standardized neuropsychological testing at two time points. Volumetric analyses of T1-weighted images were undertaken at four separate time points and qualitatively compared with a group of age-matched healthy controls. RESULTS At the time of initial assessment, our case study exhibited focal impairments in verbal and visual episodic memory and these impairments continued to persist after undergoing a course of immunotherapy. Furthermore, in reference to an age-matched healthy control group, over the course of 11 months, volumetric brain imaging analyses revealed that areas of the medial temporal lobe including specific hippocampal subfields (e.g., CA1 and dentate gyrus) underwent a subacute period of volumetric enlargement followed by a chronic period of volumetric reduction in the same regions. CONCLUSIONS In patients with persisting neurocognitive deficits, LGI1-LE may produce chronic volume loss in specific areas of the medial temporal lobe; however, this appears to follow a subacute period of volume enlargement possibly driven by neuro-inflammatory processes.
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Affiliation(s)
- Jarod Joshi
- Corresponding author at: Department of Psychology, University of Windsor, Windsor, ON, Canada. E-mail address: (J. Joshi)
| | - Ronak Patel
- Department of Clinical Health Psychology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Chase R Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Teresa D Figley
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer Salter
- Department of Internal Medicine (Physical Medicine and Rehabilitation), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Charles N Bernstein
- Department of Internal Medicine (Gastroenterology), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine (Neurology), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Huang X, Fan C, Gao L, Li L, Ye J, Shen H. Clinical Features, Immunotherapy, and Outcomes of Anti-Leucine-Rich Glioma-Inactivated-1 Encephalitis. J Neuropsychiatry Clin Neurosci 2022; 34:141-148. [PMID: 34794327 DOI: 10.1176/appi.neuropsych.20120303] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The investigators aimed to explore the clinical characteristics, immunotherapy, and outcomes of patients with antileucine-rich glioma-inactivated-1 (anti-LGI1) encephalitis. METHODS Data on participants' clinical characteristics, laboratory findings, radiological and electroencephalogram (EEG) features, treatment, and outcomes from January 2012 to December 2016 were collected. Statistical analysis was conducted to assess the factors associated with patient functional outcome. Forty-three patients were enrolled in the study, with a predominance of males (65.1%). The median age at onset was 57 years (interquartile range [IQR]: 44.0-65.0). The median time from onset to diagnosis was 60 days (IQR: 37.0-127.0). RESULTS The main clinical manifestations included epilepsy (100%), faciobrachial dystonic seizures (FBDS; 44.2%), cognitive dysfunction (95.3%), neuropsychiatric disturbances (76.7%), sleep disorders (58.1%), and disturbance of consciousness (48.8%). Twenty-two patients (51.2%) had hyponatremia, 31 (72.1%) had abnormal EEG results, and 30 (69.8%) had abnormal brain MRI scans, mainly involving the hippocampus (76.7%) or temporal lobe (40%). Twenty of 34 patients (58.8%) in a follow-up MRI examination exhibited hippocampal atrophy. Twenty-five patients (58.2%) were administered corticosteroids and intravenous immunoglobulin, whereas 17 patients were treated only with corticosteroids. Forty-one patients (95.3%) had favorable outcomes after a median of 21.5 months (IQR: 7-43) of follow-up. Serum sodium level was a factor associated with a disabled status (odds ratio=0.81, 95% CI=0.66, 0.98, p=0.03). Anti-LGI1 encephalitis patients were characterized by seizures, FBDS, cognitive deficits, neuropsychiatric disturbances, and hyponatremia. CONCLUSIONS Most patients with anti-LGI1 encephalitis are nonparaneoplastic, have low recurrence rates, and have favorable prognostic outcomes. Rapid evaluation, prompt immunotherapy, and long-term follow-up are essential in the care of anti-LGI1 encephalitis patients.
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Affiliation(s)
- Xiaoqin Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Chunqiu Fan
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Lehong Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Liping Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
| | - Huixin Shen
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing
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Rodriguez A, Klein CJ, Sechi E, Alden E, Basso MR, Pudumjee S, Pittock SJ, McKeon A, Britton JW, Lopez-Chiriboga AS, Zekeridou A, Zalewski NL, Boeve BF, Day GS, Gadoth A, Burkholder D, Toledano M, Dubey D, Flanagan EP. LGI1 antibody encephalitis: acute treatment comparisons and outcome. J Neurol Neurosurg Psychiatry 2022; 93:309-315. [PMID: 34824144 PMCID: PMC8862031 DOI: 10.1136/jnnp-2021-327302] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/28/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare acute treatment responses and long-term outcome in leucine-rich glioma-inactivated 1 (LGI1) antibody encephalitis. METHODS Retrospective case series of 118 patients with LGI1 antibody encephalitis evaluated at Mayo Clinic across all US sites from 1 May 2008 to 31 March 2019. Patient clinical data were identified and analysed through the neuroimmunology laboratory and electronic medical record. LGI1 antibody detection was by cell-based indirect immunofluorescence assay of serum, cerebrospinal fluid or both. Clinical outcomes were faciobrachial dystonic seizure (FBDS) resolution, modified Rankin Scale (mRS) score, Kokmen Short Test of Mental Status (STMS) score (0-38 point scale) and neuropsychometric testing results. RESULTS Compared with intravenous immunoglobulin (IVIg) (n=21), patients treated with single-agent acute corticosteroids (intravenous, oral or both) (n=49) were more likely to experience resolution of FBDS (61% vs 7%, p=0.002) and improvements in mRS score (ΔmRS score 2 vs 0, p=0.008) and median Kokmen STMS scores (ΔKokmen STMS score 5 points vs 0 points, p=0.01). In 54 patients with long-term follow-up (≥2 years), the median mRS score was 1 (range 0-6) and the median Kokmen STMS score was 36 (range 24-38) after all combinations of immunotherapy. Neuropsychometric testing in 32 patients with long-term follow-up (≥2 years) demonstrated short-term memory impairments in 37%. CONCLUSIONS Corticosteroids appeared more effective acutely than IVIg in improving LGI1 antibody encephalitis in this retrospective comparison of immunotherapies. While improvement with immunotherapy is typical and long-term outcome is favourable, short-term memory deficits are noted in approximately a third of the patients.
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Affiliation(s)
| | - C J Klein
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eva Alden
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael R Basso
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shehroo Pudumjee
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Anastasia Zekeridou
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - B F Boeve
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Gregory S Day
- Department of Neurology, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - Avi Gadoth
- Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Michel Toledano
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Rissanen E, Carter K, Cicero S, Ficke J, Kijewski M, Park MA, Kijewski J, Stern E, Chitnis T, Silbersweig D, Weiner HL, Kim CK, Lyons J, Klein JP, Bhattacharyya S, Singhal T. Cortical and Subcortical Dysmetabolism Are Dynamic Markers of Clinical Disability and Course in Anti-LGI1 Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/e1136. [PMID: 35091466 PMCID: PMC8802686 DOI: 10.1212/nxi.0000000000001136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 12/14/2021] [Indexed: 12/19/2022]
Abstract
Background and Objectives This [18F]fluorodeoxyglucose (FDG) PET study evaluates the accuracy of semiquantitative measurement of putaminal hypermetabolism in identifying anti–leucine-rich, glioma–inactivated-1 (LGI1) protein autoimmune encephalitis (AE). In addition, the extent of brain dysmetabolism, their association with clinical outcomes, and longitudinal metabolic changes after immunotherapy in LGI1-AE are examined. Methods FDG-PET scans from 49 age-matched and sex-matched subjects (13 in LGI1-AE group, 15 in non–LGI1-AE group, 11 with Alzheimer disease [AD], and 10 negative controls [NCs]) and follow-up scans from 8 patients with LGI1 AE on a median 6 months after immunotherapy were analyzed. Putaminal standardized uptake value ratios (SUVRs) normalized to global brain (P-SUVRg), thalamus (P/Th), and midbrain (P/Mi) were evaluated for diagnostic accuracy. SUVRg was applied for all other analyses. Results P-SUVRg, P/Th, and P/Mi were higher in LGI1-AE group than in non–LGI1-AE group, AD group, and NCs (all p < 0.05). P/Mi and P-SUVRg differentiated LGI1-AE group robustly from other groups (areas under the curve 0.84–0.99). Mediotemporal lobe (MTL) SUVRg was increased in both LGI1-AE and non–LGI1-AE groups when compared with NCs (both p < 0.05). SUVRg was decreased in several frontoparietal regions and increased in pallidum, caudate, pons, olfactory, and inferior occipital gyrus in LGI1-AE group when compared with that in NCs (all p < 0.05). In LGI1-AE group, both MTL and putaminal hypermetabolism were reduced after immunotherapy. Normalization of regional cortical dysmetabolism associated with clinical improvement at the 6- and 20-month follow-up. Discussion Semiquantitative measurement of putaminal hypermetabolism with FDG-PET may be used to distinguish LGI1-AE from other pathologies. Metabolic abnormalities in LGI1-AE extend beyond putamen and MTL into other subcortical and cortical regions. FDG-PET may be used in evaluating disease evolution in LGI1-AE. Classification of Evidence This study provides Class II evidence that semiquantitative measures of putaminal metabolism on PET can differentiate patients with LGI1-AE from patients without LGI1-AE, patients with AD, or NCs.
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Affiliation(s)
- Eero Rissanen
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Kelsey Carter
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Steven Cicero
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - John Ficke
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Marie Kijewski
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mi-Ae Park
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Joseph Kijewski
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Emily Stern
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Tanuja Chitnis
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - David Silbersweig
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Howard L Weiner
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Chun K Kim
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jennifer Lyons
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Joshua P Klein
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Shamik Bhattacharyya
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Tarun Singhal
- From the PET Imaging Program in Neurologic Diseases (E.R., K.C., S.C., J.F., T.S.) and Brigham Multiple Sclerosis Center (E.R., T.C., H.L.W., S.B., T.S.), Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital and Harvard Medical School; Division of Nuclear Medicine and Molecular Imaging (M.K.), Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Medical Physics Section (M.-A.P.), Radiology Department, University of Texas Southwestern Medical Center, Dallas, TX; Department of Neurology (J.K.), Brigham and Women's Hospital, Boston, MA; Ceretype Neuromedicine (E.S.), Cambridge, MA; Functional Neuroimaging Laboratory (D.S.), Department of Psychiatry, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; Nuclear Medicine (C.K.K.), Department of Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea; Biogen Inc. (J.L.), Cambridge, MA; and Department of Neurology (J.P.K.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
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10
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Lardeux P, Fourier A, Peter E, Dorey A, Muñiz-Castrillo S, Vogrig A, Picard G, Rogemond V, Verdurand M, Formaglio M, Joubert B, Froment Tilikete C, Honnorat J, Quadrio I, Desestret V. Core cerebrospinal fluid biomarker profile in anti-LGI1 encephalitis. J Neurol 2021; 269:377-388. [PMID: 34104991 DOI: 10.1007/s00415-021-10642-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/29/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare CSF biomarkers' levels in patients suffering from anti-Leucine-rich Glioma-Inactivated 1 (LGI1) encephalitis to neurodegenerative [Alzheimer's disease (AD), Creutzfeldt-Jakob's disease (CJD)] and primary psychiatric (PSY) disorders. METHODS Patients with LGI1 encephalitis were retrospectively selected from the French Reference Centre database between 2010 and 2019 and enrolled if CSF was available for biomarkers analysis including total tau (T-tau), phosphorylated tau (P-tau), amyloid-beta Aβ1-42, and neurofilaments light chains (Nf L). Samples sent for biomarker determination as part of routine practice, and formally diagnosed as AD, CJD, and PSY, were used as comparators. RESULTS Twenty-four patients with LGI1 encephalitis were compared to 39 AD, 20 CJD and 20 PSY. No significant difference was observed in T-tau, P-tau, and Aβ1-42 levels between LGI1 encephalitis and PSY patients. T-Tau and P-Tau levels were significantly lower in LGI1 encephalitis (231 and 43 ng/L) than in AD (621 and 90 ng/L, p < 0.001) and CJD patients (4327 and 55 ng/L, p < 0.001 and p < 0.01). Nf L concentrations of LGI1 encephalitis (2039 ng/L) were similar to AD (2,765 ng/L) and significantly higher compared to PSY (1223 ng/L, p < 0.005), but significantly lower than those of CJD (13,457 ng/L, p < 0.001). Higher levels of Nf L were observed in LGI1 encephalitis presenting with epilepsy (3855 ng/L) compared to LGI1 without epilepsy (1490 ng/L, p = 0.02). No correlation between CSF biomarkers' levels and clinical outcome could be drawn. CONCLUSION LGI encephalitis patients showed higher Nf L levels than PSY, comparable to AD, and even higher when presenting epilepsy suggesting axonal or synaptic damage linked to epileptic seizures.
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Affiliation(s)
- Pierre Lardeux
- Service de Neurocognition Et Neuro-Ophtalmologie, Hôpital Neurologique Pierre Wertheimer, Bron Cedex, France.,Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France
| | - Anthony Fourier
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Laboratoire de Neurochimie, Service de Biochimie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.,BIORAN Team, Centre de Recherche en Neurosciences de Lyon, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Elise Peter
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
| | - Aline Dorey
- Laboratoire de Neurochimie, Service de Biochimie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Sergio Muñiz-Castrillo
- Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.,SynatAc Team, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Lyon, France
| | - Alberto Vogrig
- Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.,SynatAc Team, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Lyon, France
| | - Géraldine Picard
- Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
| | - Véronique Rogemond
- Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.,SynatAc Team, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Lyon, France
| | - Mathieu Verdurand
- Laboratoire de Neurochimie, Service de Biochimie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
| | - Maité Formaglio
- Service de Neurocognition Et Neuro-Ophtalmologie, Hôpital Neurologique Pierre Wertheimer, Bron Cedex, France.,Hospices Civils de Lyon, Lyon, France
| | - Bastien Joubert
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.,SynatAc Team, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Lyon, France
| | - Caroline Froment Tilikete
- Service de Neurocognition Et Neuro-Ophtalmologie, Hôpital Neurologique Pierre Wertheimer, Bron Cedex, France.,Hospices Civils de Lyon, Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,IMPACT Team, Centre de Recherche en Neurosciences de Lyon, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Jérôme Honnorat
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France.,SynatAc Team, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Lyon, France
| | - Isabelle Quadrio
- Laboratoire de Neurochimie, Service de Biochimie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France.,BIORAN Team, Centre de Recherche en Neurosciences de Lyon, CNRS UMR 5292, INSERM U1028, Lyon, France
| | - Virginie Desestret
- Service de Neurocognition Et Neuro-Ophtalmologie, Hôpital Neurologique Pierre Wertheimer, Bron Cedex, France. .,Hospices Civils de Lyon, Lyon, France. .,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France. .,Centre de Référence National pour les Syndromes Neurologiques Paranéoplasique, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France. .,SynatAc Team, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Lyon, France.
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11
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Hayden Z, Bóné B, Orsi G, Szots M, Nagy F, Csépány T, Mezei Z, Rajda C, Simon D, Najbauer J, Illes Z, Berki T. Clinical Characteristics and Outcome of Neuronal Surface Antibody-Mediated Autoimmune Encephalitis Patients in a National Cohort. Front Neurol 2021; 12:611597. [PMID: 33767656 PMCID: PMC7985080 DOI: 10.3389/fneur.2021.611597] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 02/16/2021] [Indexed: 01/15/2023] Open
Abstract
Background: In our previous single-center study of autoimmune encephalitis (AE) related autoantibody test results we found positivity in 60 patients out of 1,034 with suspected AE from 2012 through 2018 as part of a Hungarian nationwide program. In our current multicenter retrospective study, we analyzed the clinical characteristics and outcome of AE patients with positive neuronal cell surface autoantibody test results. Methods: A standard online questionnaire was used to collect demographic and clinical characteristics, laboratory and imaging data, therapy and prognosis of 30 definitive AE patients in four major clinical centers of the region. Results: In our study, 19 patients were positive for anti-NMDAR (63%), 6 patients (20%) for anti-LGI1, 3 patients for anti-GABABR (10%) and 3 patients for anti-Caspr2 (10%) autoantibodies. Most common prodromal symptoms were fever or flu-like symptoms (10/30, 33%). Main clinical features included psychiatric symptoms (83%), epileptic seizures (73%) and memory loss (50%). 19 patients (63%) presented with signs of central nervous system (CNS) inflammation, which occurred more frequently in elder individuals (p = 0.024), although no significant differences were observed in sex, tumor association, time to diagnosis, prognosis and immunotherapy compared to AE patients without CNS inflammatory markers. Anti-NMDAR encephalitis patients were in more severe condition at the disease onset (p = 0.028), although no significant correlation between mRS score, age, sex and immunotherapy was found. 27% of patients (n = 8) with associated tumors had worse outcome (p = 0.045) than patients without tumor. In most cases, immunotherapy led to clinical improvement of AE patients (80%) who achieved a good outcome (mRS ≤ 2; median follow-up 33 months). Conclusion: Our study confirms previous publications describing characteristics of AE patients, however, differences were observed in anti-NMDAR encephalitis that showed no association with ovarian teratoma and occurred more frequently among young males. One-third of AE patients lacked signs of inflammation in both CSF and brain MRI, which emphasizes the importance of clinical symptoms and autoantibody testing in diagnostic workflow for early introduction of immunotherapy, which can lead to favorable outcome in AE patients.
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Affiliation(s)
- Zsófia Hayden
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Beáta Bóné
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Gergely Orsi
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,Department of Neurosurgery, Clinical Centre, University of Pécs Medical School, Pécs, Hungary
| | - Monika Szots
- Department of Neurology, Somogy County Kaposi Mór University Teaching Hospital, Kaposvár, Hungary
| | - Ferenc Nagy
- Department of Neurology, Somogy County Kaposi Mór University Teaching Hospital, Kaposvár, Hungary
| | - Tünde Csépány
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Zsolt Mezei
- Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Cecília Rajda
- Department of Neurology, University of Szeged, Szeged, Hungary
| | - Diána Simon
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - József Najbauer
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark.,Institute of Clinical Research, BRIDGE, University of Southern Denmark, Odense, Denmark
| | - Timea Berki
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
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12
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Sungura R, Onyambu C, Mpolya E, Sauli E, Vianney JM. The extended scope of neuroimaging and prospects in brain atrophy mitigation: A systematic review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.100875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Uribe-San-Martín R, Ciampi E, Santibañez R, Irani SR, Márquez A, Cruz JP, Soler B, Miranda MC, Henríquez M, Cárcamo C. LGI1-antibody associated epilepsy successfully treated in the outpatient setting. J Neuroimmunol 2020; 345:577268. [PMID: 32480242 PMCID: PMC7339132 DOI: 10.1016/j.jneuroim.2020.577268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 01/17/2023]
Abstract
We report six patients with anti-LGI1 associated epilepsy. Two patients presented with new-onset generalized tonic-clonic seizures, four developed faciobrachial dystonic seizures and two piloerection. All patients had significant cognitive complaints at the time of diagnosis. All patients described seizure reduction during the first week of carbamazepine, and seizure freedom was obtained at a median of 13 days (range 7-22), sustained after the initiation of immunosuppression. Median time from symptom onset to carbamazepine initiation was 164 days (range 38-206 days). We discuss the particular seizure response to sodium channel blocking antiepileptic drugs, alone or associated with immunosuppression in this antibody mediated seizures.
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Affiliation(s)
- R Uribe-San-Martín
- Neurology Service, Hospital Dr. Sótero del Río, Santiago, Chile; Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - E Ciampi
- Neurology Service, Hospital Dr. Sótero del Río, Santiago, Chile; Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - R Santibañez
- Neurology Service, Hospital Dr. Sótero del Río, Santiago, Chile; Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - S R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical. Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, UK; Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - A Márquez
- Neurology Service, Hospital Dr. Sótero del Río, Santiago, Chile; Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - J P Cruz
- Neuroradiology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - B Soler
- Neurology Service, Hospital Dr. Sótero del Río, Santiago, Chile; Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M C Miranda
- Neurology Service, Hospital Dr. Sótero del Río, Santiago, Chile; Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M Henríquez
- Clinical Laboratories Department, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - C Cárcamo
- Neurology Department, Pontificia Universidad Católica de Chile, Santiago, Chile
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14
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Qiao J, Zhao X, Wang S, Li A, Wang Z, Cao C, Wang Q. Functional and Structural Brain Alterations in Encephalitis With LGI1 Antibodies. Front Neurosci 2020; 14:304. [PMID: 32317923 PMCID: PMC7146067 DOI: 10.3389/fnins.2020.00304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/16/2020] [Indexed: 01/17/2023] Open
Abstract
Objective: The purpose of this study was to examine the neural substrates and mechanisms that generate memory deficits, seizures and neuropsychiatric abnormalities in encephalitis with LGI1 antibodies using a data-driven, multimodal magnetic resonance imaging (MRI) approach. Methods: Functional MRI data were acquired from 14 anti-LGI1 encephalitis patients and 14 age and gender matched normal controls. Independent component analysis with hierarchical partner matching (HPM-ICA) was used to assess the whole-brain intrinsic functional connectivity. Granger causality (GC) was applied to investigate the effective connectivity among the brain regions that identified by HPM-ICA. Diffusion tensor imaging (DTI) was utilized to investigate white matter microstructural changes of the patients. Results: Participants with LGI1 antibodies encephalitis presented reduced functional connectivity in the brain areas associated with memory, cognition and motion circuits, while increased functional connectivity in putamen and caudate in comparison to the normal controls. Moreover, the effective connectivity in patients was decreased from the frontal cortex to supplementary motor area. Finally, patients had significant reductions in fractional anisotropy (FA) for the corpus callosum, internal capsule, corona radiata and superior longitudinal fasciculus, accompanied by increases in mean diffusivity (MD) for these regions as compared to controls. Conclusion: Our findings suggest that the neural disorder and behavioral deficits of anti-LGI1 encephalitis may be associated with extensive changes in brain connectivity and microstructure. These pathological alterations affect the basal ganglia and limbic system besides the temporal and frontal lobe.
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Affiliation(s)
- Jianping Qiao
- Shandong Province Key Laboratory of Medical Physics and Image Processing Technology, Institute of Data Science and Technology, School of Physics and Electronics, Shandong Normal University, Jinan, China
| | - Xiuhe Zhao
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Shengjun Wang
- Department of Neurology, Qilu Hospital of Shandong University, Jinan, China
| | - Anning Li
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
| | - Zhishun Wang
- Department of Psychiatry, Columbia University, New York, NY, United States
| | - Chongfeng Cao
- Department of Emergency, Jinan Central Hospital Affiliated to Shandong University, Jinan, China
| | - Qing Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, China
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15
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Hayden Z, Böröcz K, Csizmadia Z, Balogh P, Kellermayer Z, Bodó K, Najbauer J, Berki T. Single-center study of autoimmune encephalitis-related autoantibody testing in Hungary. Brain Behav 2019; 9:e01454. [PMID: 31650706 PMCID: PMC6908871 DOI: 10.1002/brb3.1454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/06/2019] [Accepted: 10/05/2019] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE Autoantibody detection is crucial for the early diagnosis of autoimmune encephalitis (AIE) since prompt therapy can determine the disease outcome. Here, we report a single-center 6-year retrospective study of autoantibody testing in AIE in the Hungarian population. METHODS Serum and/or cerebrospinal fluid (CSF) autoantibody tests were performed using cell-based indirect immunofluorescence assay for AIE diagnosis. Samples were provided by neurology clinics as part of a nationwide program. Test results were analyzed for samples received during the period from 2012 to 2018. RESULTS We tested 1,247 samples from 1,034 patients with suspected AIE. Autoantibodies were present in 60 patients (5.8% of total). The distribution of patients with different autoantibodies by age and sex was as follows: NMDAR (70%), mostly in young females, LGI1 (15%) in middle-aged males, GABAB R (12%) in elderly males, and Caspr2 (7%) in males. Long-term follow-up was conducted in 30 patients with repeated test requests, of which 17 remained positive, and 13 switched to negative. CONCLUSION We report the most comprehensive clinical laboratory study of autoantibody testing in AIE in the Hungarian population. Our results show that the frequency of different autoantibody types in AIE corresponds to the data described in the literature.
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Affiliation(s)
- Zsófia Hayden
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Katalin Böröcz
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Zsuzsanna Csizmadia
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Péter Balogh
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Zoltán Kellermayer
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Kornélia Bodó
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - József Najbauer
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
| | - Tímea Berki
- Department of Immunology and Biotechnology, Clinical Center, University of Pécs Medical School, Pécs, Hungary
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16
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Magnetic resonanse imaging as a prognostic tool in encephalitis in children. КЛИНИЧЕСКАЯ ПРАКТИКА 2019. [DOI: 10.17816/clinpract10355-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We provide the data on the modern use of MRI of different modalities as a prognostic tool in the encephalitis diagnostics in pediatrics. According to the recent scientific knowledge, this implementation is possible, but its efficacy depends on the modality of MRI: structural, functional or MRI with contrast. Structural MRI efficacy in children with encephalitis is dubious and clearly depends on the etiology and phase of the inflammatory process. In the recent years, the implementation of the functional MRI methods (DTI MRS) and MRI with contrast significantly changed the imaging practice; there are some reports that these modalities of MRI are more effective as a prognostic tool in encephalitis than the structural one. Thus, a future research in this field is needed.
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17
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Wesselingh R, Butzkueven H, Buzzard K, Tarlinton D, O'Brien TJ, Monif M. Innate Immunity in the Central Nervous System: A Missing Piece of the Autoimmune Encephalitis Puzzle? Front Immunol 2019; 10:2066. [PMID: 31552027 PMCID: PMC6746826 DOI: 10.3389/fimmu.2019.02066] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/15/2019] [Indexed: 12/14/2022] Open
Abstract
The autoimmune encephalitides are a group of autoimmune conditions targeting the central nervous system and causing severe clinical symptoms including drug-resistant seizures, cognitive dysfunction and psychiatric disturbance. Although these disorders appear to be antibody mediated, the role of innate immune responses needs further clarification. Infiltrating monocytes and microglial proliferation at the site of pathology could contribute to the pathogenesis of the disease with resultant blood brain barrier dysfunction, and subsequent activation of adaptive immune response. Both innate and adaptive immune cells can produce pro-inflammatory molecules which can perpetuate ongoing neuroinflammation and drive ongoing seizure activity. Ultimately neurodegenerative changes can ensue with resultant long-term neurological sequelae that can impact on ongoing patient morbidity and quality of life, providing a potential target for future translational research.
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Affiliation(s)
- Robb Wesselingh
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Helmut Butzkueven
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Katherine Buzzard
- Department of Neurology, Melbourne Health, Melbourne, VIC, Australia.,Department of Neurology, Eastern Health, Melbourne, VIC, Australia
| | - David Tarlinton
- Department of Immunology, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia.,Department of Neurology, Melbourne Health, Melbourne, VIC, Australia
| | - Mastura Monif
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Central Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Neurology, Alfred Health, Melbourne, VIC, Australia.,Department of Neurology, Melbourne Health, Melbourne, VIC, Australia
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18
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Yelam A, Nagarajan E, Bollu PC. Rapidly progressive global cerebral atrophy in the setting of anti-LGI1 encephalitis. BMJ Case Rep 2019; 12:12/5/e228428. [PMID: 31129638 DOI: 10.1136/bcr-2018-228428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
A 47-year-old man presented with complaints of breakthrough seizures, psychiatric and behavioural changes and catatonic features. MRI of the brain showed mild cerebral and right hippocampal atrophy, while the electroencephalogram showed intermittent right temporal slowing. With a presumed diagnosis of autoimmune encephalitis, he was treated with intravenous immunoglobulin (IVIG) and methylprednisolone, which significantly improved the symptoms. Serological testing later was positive for antileucine-rich glioma inactivated 1 antibody. Two months after the initial presentation, patient had a relapse of the symptoms without any further episodes of seizures. Repeat MRI of the brain showed a significant rapidly progressive diffuse cortical atrophy and hippocampal atrophy, more prominent on the right side along with hydrocephalus ex vacuo when compared with the initial MRI. He is currently on monthly IVIG therapy. At 4 months follow-up from the second imagining study, the patient had persistent MRI findings.
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Affiliation(s)
- Anudeep Yelam
- Department of Neurology, University of Missouri Health Care, Columbia, Missouri, USA
| | - Elanagan Nagarajan
- Department of Neurology, Howard Hughes Medical Institute - University of Missouri Columbia School of Medicine, Columbia, Missouri, USA
| | - Pradeep C Bollu
- Department of Neurology, University of Missouri Health Care, Columbia, Missouri, USA
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19
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Tröscher AR, Klang A, French M, Quemada-Garrido L, Kneissl SM, Bien CG, Pákozdy Á, Bauer J. Selective Limbic Blood-Brain Barrier Breakdown in a Feline Model of Limbic Encephalitis with LGI1 Antibodies. Front Immunol 2017; 8:1364. [PMID: 29093718 PMCID: PMC5651237 DOI: 10.3389/fimmu.2017.01364] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/05/2017] [Indexed: 12/30/2022] Open
Abstract
Human leucine-rich glioma-inactivated protein 1 encephalitis (LGI1) is an autoimmune limbic encephalitis in which serum and cerebrospinal fluid contain antibodies targeting LGI1, a protein of the voltage gated potassium channel (VGKC) complex. Recently, we showed that a feline model of limbic encephalitis with LGI1 antibodies, called feline complex partial seizures with orofacial involvement (FEPSO), is highly comparable to human LGI1 encephalitis. In human LGI1 encephalitis, neuropathological investigations are difficult because very little material is available. Taking advantage of this natural animal model to study pathological mechanisms will, therefore, contribute to a better understanding of its human counterpart. Here, we present a brain-wide histopathological analysis of FEPSO. We discovered that blood–brain barrier (BBB) leakage was present not only in all regions of the hippocampus but also in other limbic structures such as the subiculum, amygdale, and piriform lobe. However, in other regions, such as the cerebellum, no leakage was observed. In addition, this brain-region-specific immunoglobulin leakage was associated with the breakdown of endothelial tight junctions. Brain areas affected by BBB dysfunction also revealed immunoglobulin and complement deposition as well as neuronal cell death. These neuropathological findings were supported by magnetic resonance imaging showing signal and volume increase in the amygdala and the piriform lobe. Importantly, we could show that BBB disturbance in LGI1 encephalitis does not depend on T cell infiltrates, which were present brain-wide. This finding points toward another, so far unknown, mechanism of opening the BBB. The limbic predilection sites of immunoglobulin antibody leakage into the brain may explain why most patients with LGI1 antibodies have a limbic phenotype even though LGI1, the target protein, is ubiquitously distributed across the central nervous system.
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Affiliation(s)
- Anna R Tröscher
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Andrea Klang
- Department for Pathobiology, Institute of Pathology and Forensic Veterinary Medicine, University of Veterinary Medicine, Vienna, Austria
| | - Maria French
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Lucía Quemada-Garrido
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Sibylle Maria Kneissl
- Diagnostic Imaging, Department for Companion Animals and Horses, University of Veterinary Medicine, Vienna, Austria
| | | | - Ákos Pákozdy
- Clinical Unit of Internal Medicine Small Animals, University of Veterinary Medicine, Vienna, Austria
| | - Jan Bauer
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
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