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Dwyer GE, Johnsen E, Hugdahl K. NMDAR dysfunction and the regulation of dopaminergic transmission in schizophrenia. Schizophr Res 2024; 271:19-27. [PMID: 39002526 DOI: 10.1016/j.schres.2024.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/27/2024] [Accepted: 07/07/2024] [Indexed: 07/15/2024]
Abstract
A substantial body of evidence implicates dysfunction in N-methyl-d-aspartate receptors (NMDARs) in the pathophysiology of schizophrenia. This article illustrates how NMDAR dysfunction may give rise to many of the neurobiological phenomena frequently associated with schizophrenia with a particular focus on how NMDAR dysfunction affects the thalamic reticular nucleus (nRT) and pedunculopontine tegmental nucleus (PPTg). Furthermore, this article presents a model for schizophrenia illustrating how dysfunction in the nRT may interrupt prefrontal regulation of midbrain dopaminergic neurons, and how dysfunction in the PPTg may drive increased, irregular burst firing.
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Affiliation(s)
- Gerard Eric Dwyer
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Erik Johnsen
- NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway; Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
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Jarmoc G, Smith C, Finnerty E, Noel NL, Marks A. Anti-NMDA encephalitis secondary to an ovarian teratoma presenting as altered mental status in a 32-year-old woman: A case report. Case Rep Womens Health 2024; 42:e00612. [PMID: 38737718 PMCID: PMC11087903 DOI: 10.1016/j.crwh.2024.e00612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/09/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
NMDA-R encephalitis is an autoimmune encephalitis that is known to be associated with ovarian teratomas. Eighty to 100 % of patients initially present with neuropsychiatric symptoms. Early recognition and intervention are critical to management and prognosis. This case demonstrates non-specific presenting symptoms of NMDA-R encephalitis. A 32-year-old woman presented to the emergency room with headache, nausea, vomiting, and photophobia. She was discharged with probable aseptic meningitis. Eight days later, she represented with delusional thought content, perseverative speech, and bizarre behavior. Cerebrospinal fluid studies showed elevated protein and mild pleocytosis. A computed tomography scan with contrast showed a 35-mm complex cystic lesion in the right adnexa, which was resected. Confirmatory pathology showed a mature cystic teratoma. Paraneoplastic panel later resulted positive for NMDA-R encephalitis. The patient was treated with methylprednisolone, IVIG, plasmapheresis, and rituximab. The clinical course was complicated by a hypersensitivity reaction to rituximab, non-convulsive status epilepticus requiring intubation, dysphagia requiring a PEG placement, a rectal ulcer causing acute blood loss anemia requiring multiple blood transfusions, bilateral hearing loss, and a left lung pneumothorax. The patient's mood, cognition, and motor function were favorably improving 19 months after diagnosis. This case illustrates presenting signs of NMDA-R encephalitis in a young woman as headache and altered mental status followed by psychosis and epilepsy. Treatment should involve a multidisciplinary team and be individualized and escalated in patients with worsening clinical status refractory to first-line therapy. Further research is warranted to understand the optimal treatment strategy for this disease.
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Affiliation(s)
- Grace Jarmoc
- Chobanian and Avedisian School of Medicine, Boston University, 72 E. Concord Street, Boston, MA 02118, USA
| | - Candace Smith
- Chobanian and Avedisian School of Medicine, Boston University, 72 E. Concord Street, Boston, MA 02118, USA
| | - Emma Finnerty
- Chobanian and Avedisian School of Medicine, Boston University, 72 E. Concord Street, Boston, MA 02118, USA
| | - Nyia L. Noel
- Chobanian and Avedisian School of Medicine, Boston University, 72 E. Concord Street, Boston, MA 02118, USA
- Boston Medical Center, Department of Obstetrics and Gynecology, 725 Albany St, Boston, MA 02118, USA
| | - Ariel Marks
- Chobanian and Avedisian School of Medicine, Boston University, 72 E. Concord Street, Boston, MA 02118, USA
- Boston Medical Center, Department of Neurology, 725 Albany St, Boston, MA 02118, USA
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Miao A, Wang K. Contribution of cerebrospinal fluid antibody titers and sex to acute cerebral blood flow in patients with anti-NMDAR autoimmune encephalitis. Front Immunol 2024; 15:1299898. [PMID: 38495877 PMCID: PMC10940436 DOI: 10.3389/fimmu.2024.1299898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Objective The objective of this study was to elucidate the contribution of cerebrospinal fluid (CSF) antibody titers (AT) and sex to acute cerebral blood flow (CBF) in patients diagnosed with anti-N-methyl-d-aspartate receptor autoimmune encephalitis (NMDAR AE). Methods Forty-five patients diagnosed with NMDAR AE were recruited from December 2016 to January 2023. The acute CBF in patients with NMDAR AE at the early stage of the disease was analyzed using arterial spin labeling. The groups were compared based on CSF AT and sex. The connectivity of the CBF in the region of interest was also compared between groups. Results The patients with different CSF AT exhibited varied brain regions with CBF abnormalities compared to the healthy subjects (p = 0.001, cluster-level FWE corrected). High antibody titers (HAT) in CSF contributed to more brain regions with CBF alterations in female patients than in female patients with low antibody titers (LAT) in CSF (p = 0.001, cluster-level FWE corrected). Female patients with HAT in CSF displayed more decreased CBF in the left post cingulum gyrus, left precuneus, left calcarine, and left middle cingulum gyrus than the male patients with the same AT in CSF (p = 0.001, cluster-level FWE corrected). All patients with NMDAR AE showed increased CBF in the left putamen (Putamen_L) and left amygdala (Amygdala_L) and decreased CBF in the right precuneus (Precuneus_R), which suggests that these are diagnostic CBF markers for NMDAR AE. Conclusion CSF AT and sex contributed to CBF abnormalities in the patients diagnosed with NMDAR AE. Altered CBF might potentially serve as the diagnostic marker for NMDAR AE.
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Affiliation(s)
- Ailiang Miao
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Department of Neurology, The Affiliated Brain Hospital of Nanjing Medical University, Jiangsu, Nanjing, China
| | - Kai Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- School of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China
- Institute of Artificial Intelligence, Hefei Comprehensive National Science Center, Hefei, China
- Anhui Province Key Laboratory of Cognition and Neuropsychiatric Disorders, Hefei, China
- Collaborative Innovation Center of Neuropsychiatric Disorders and Mental Health, Hefei, China
- Anhui Provincial Institute of Translational Medicine, Anhui Medical University, Hefei, China
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Shen S, Wei R, Gao Y, Yang X, Zhang G, Yan B, Xiao Z, Li J. Cortical atrophy in early-stage patients with anti-NMDA receptor encephalitis: a machine-learning MRI study with various feature extraction. Cereb Cortex 2024; 34:bhad499. [PMID: 38185983 DOI: 10.1093/cercor/bhad499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024] Open
Abstract
Conventional brain magnetic resonance imaging (MRI) of anti-N-methyl-D-aspartate-receptor encephalitis (NMDARE) is non-specific, thus showing little differential diagnostic value, especially for MRI-negative patients. To characterize patterns of structural alterations and facilitate the diagnosis of MRI-negative NMDARE patients, we build two support vector machine models (NMDARE versus healthy controls [HC] model and NMDARE versus viral encephalitis [VE] model) based on radiomics features extracted from brain MRI. A total of 109 MRI-negative NMDARE patients in the acute phase, 108 HCs and 84 acute MRI-negative VE cases were included for training. Another 29 NMDARE patients, 28 HCs and 26 VE cases were included for validation. Eighty features discriminated NMDARE patients from HCs, with area under the receiver operating characteristic curve (AUC) of 0.963 in validation set. NMDARE patients presented with significantly lower thickness, area, and volume and higher mean curvature than HCs. Potential atrophy predominately presented in the frontal lobe (cumulative weight = 4.3725, contribution rate of 29.86%), and temporal lobe (cumulative weight = 2.573, contribution rate of 17.57%). The NMDARE versus VE model achieved certain diagnostic power, with AUC of 0.879 in validation set. Our research shows potential atrophy across the entire cerebral cortex in acute NMDARE patients, and MRI machine learning model has a potential to facilitate the diagnosis MRI-negative NMDARE.
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Affiliation(s)
- Sisi Shen
- Department of Neurology, West China Hospital of Sichuan University, 37 GuoXue Alley, Chengdu 610041, China
| | - Ran Wei
- School of Information and Communication Engineering, University of Electronic Science and Technology of China No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731| Chengdu, Sichuan, P.R. China
| | - Yu Gao
- School of Information and Communication Engineering, University of Electronic Science and Technology of China No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731| Chengdu, Sichuan, P.R. China
| | - Xinyuan Yang
- School of Information and Communication Engineering, University of Electronic Science and Technology of China No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731| Chengdu, Sichuan, P.R. China
| | - Guoning Zhang
- School of Information and Communication Engineering, University of Electronic Science and Technology of China No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731| Chengdu, Sichuan, P.R. China
| | - Bo Yan
- School of Information and Communication Engineering, University of Electronic Science and Technology of China No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731| Chengdu, Sichuan, P.R. China
| | - Zhuoling Xiao
- School of Information and Communication Engineering, University of Electronic Science and Technology of China No.2006, Xiyuan Ave, West Hi-Tech Zone, 611731| Chengdu, Sichuan, P.R. China
| | - Jinmei Li
- Department of Neurology, West China Hospital of Sichuan University, 37 GuoXue Alley, Chengdu 610041, China
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Li X, Saiyin H, Chen X, Yu Q, Ma L, Liang W. Ketamine impairs growth cone and synaptogenesis in human GABAergic projection neurons via GSK-3β and HDAC6 signaling. Mol Psychiatry 2022:10.1038/s41380-022-01864-5. [PMID: 36414713 DOI: 10.1038/s41380-022-01864-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
Abstract
The growth cone guides the axon or dendrite of striatal GABAergic projection neurons that protrude into the midbrain and cortex and form complex neuronal circuits and synaptic networks in a developing brain, aberrant projections and synaptic connections in the striatum related to multiple brain disorders. Previously, we showed that ketamine, an anesthetic, reduced dendritic growth, dendritic branches, and spine density in human striatal GABAergic neurons. However, whether ketamine affects the growth cone, the synaptic connection of growing striatal GABAergic neurons has not been tested. Using human GABAergic projection neurons derived from human inducible pluripotent stem cells (hiPSCs) and embryonic stem cells (ES) in vitro, we tested ketamine effects on the growth cones and synapses in developing GABAergic neurons by assessing the morphometry and the glycogen synthase kinase-3 (GSK-3) and histone deacetylase 6 (HDAC6) pathway. Ketamine exposure impairs growth cone formation, synaptogenesis, dendritic development, and maturation via ketamine-mediated activation of GSK-3 pathways and inhibiting HDAC6, an essential stabilizing protein for dendritic morphogenesis and synapse maturation. Our findings identified a novel ketamine neurotoxic pathway that depends on GSK-3β and HDAC6 signaling, suggesting that microtubule acetylation is a potential target for reducing ketamine's toxic effect on GABAergic projection neuronal development.
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Affiliation(s)
- Xuan Li
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China
- Department of Anesthesiology, The Fifth Affiliated Hospital, Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Hexige Saiyin
- State Key Laboratory of Genetic Engineering, School of Life Sciences, Fudan University, Shanghai, China
| | - Xinyu Chen
- Department of Anatomy and Histology & Embryology, School of Basic Medical Sciences, Fudan University, Shanghai, China
| | - Qiong Yu
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Lixiang Ma
- Department of Anatomy and Histology & Embryology, School of Basic Medical Sciences, Fudan University, Shanghai, China.
| | - Weimin Liang
- Department of Anesthesiology, Huashan Hospital, Fudan University, Shanghai, China.
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Seillier C, Lesept F, Toutirais O, Potzeha F, Blanc M, Vivien D. Targeting NMDA Receptors at the Neurovascular Unit: Past and Future Treatments for Central Nervous System Diseases. Int J Mol Sci 2022; 23:ijms231810336. [PMID: 36142247 PMCID: PMC9499580 DOI: 10.3390/ijms231810336] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/30/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
The excitatory neurotransmission of the central nervous system (CNS) mainly involves glutamate and its receptors, especially N-methyl-D-Aspartate receptors (NMDARs). These receptors have been extensively described on neurons and, more recently, also on other cell types. Nowadays, the study of their differential expression and function is taking a growing place in preclinical and clinical research. The diversity of NMDAR subtypes and their signaling pathways give rise to pleiotropic functions such as brain development, neuronal plasticity, maturation along with excitotoxicity, blood-brain barrier integrity, and inflammation. NMDARs have thus emerged as key targets for the treatment of neurological disorders. By their large extracellular regions and complex intracellular structures, NMDARs are modulated by a variety of endogenous and pharmacological compounds. Here, we will present an overview of NMDAR functions on neurons and other important cell types involved in the pathophysiology of neurodegenerative, neurovascular, mental, autoimmune, and neurodevelopmental diseases. We will then discuss past and future development of NMDAR targeting drugs, including innovative and promising new approaches.
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Affiliation(s)
- Célia Seillier
- Normandie University, UNICAEN, INSERM, GIP Cyceron, Institute Blood and Brain @Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), 14000 Caen, France
| | - Flavie Lesept
- Lys Therapeutics, Cyceron, Boulevard Henri Becquerel, 14000 Caen, France
| | - Olivier Toutirais
- Normandie University, UNICAEN, INSERM, GIP Cyceron, Institute Blood and Brain @Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), 14000 Caen, France
- Department of Immunology and Histocompatibility (HLA), Caen University Hospital, CHU, 14000 Caen, France
| | - Fanny Potzeha
- Lys Therapeutics, Cyceron, Boulevard Henri Becquerel, 14000 Caen, France
| | - Manuel Blanc
- Lys Therapeutics, Cyceron, Boulevard Henri Becquerel, 14000 Caen, France
| | - Denis Vivien
- Normandie University, UNICAEN, INSERM, GIP Cyceron, Institute Blood and Brain @Caen-Normandie (BB@C), UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), 14000 Caen, France
- Department of Clinical Research, Caen University Hospital, CHU, 14000 Caen, France
- Correspondence:
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Zhang S, Mao C, Li X, Miao W, Teng J. Advances in Potential Cerebrospinal Fluid Biomarkers for Autoimmune Encephalitis: A Review. Front Neurol 2022; 13:746653. [PMID: 35937071 PMCID: PMC9355282 DOI: 10.3389/fneur.2022.746653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 06/20/2022] [Indexed: 12/24/2022] Open
Abstract
Autoimmune encephalitis (AE) is a severe inflammatory disease of the brain. Patients with AE demonstrate amnesia, seizures, and psychosis. Recent studies have identified numerous associated autoantibodies (e.g., against NMDA receptors (NMDARs), LGI1, etc.) involved in the pathogenesis of AE, and the levels of diagnosis and treatment are thus improved dramatically. However, there are drawbacks of clinical diagnosis and treatment based solely on antibody levels, and thus the application of additional biomarkers is urgently needed. Considering the important role of immune mechanisms in AE development, we summarize the relevant research progress in identifying cerebrospinal fluid (CSF) biomarkers with a focus on cytokines/chemokines, demyelination, and nerve damage.
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Clinical Relevance of Cerebrospinal Fluid Antibody Titers in Anti-N-Methyl-d-Aspartate Receptor Encephalitis. Brain Sci 2021; 12:brainsci12010004. [PMID: 35053749 PMCID: PMC8773744 DOI: 10.3390/brainsci12010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/24/2021] [Accepted: 12/09/2021] [Indexed: 12/20/2022] Open
Abstract
Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is the most common autoimmune encephalitis. To date, there has been no study on the relationship between antibody (Ab) titers and clinical phenotype. This study aims to clarify the relationship between cerebrospinal fluid Ab titers and clinical manifestations of anti-NMDAR encephalitis at onset. Seventy-six consecutive patients with a definite diagnosis were enrolled. The relationship between Ab titers and different onset symptoms including psychiatric symptoms, seizures, and memory deficits were analyzed. We further investigated the correlation between Ab titers and clinical severity as assessed by the modified Rankin scale (mRS) and the clinical assessment scale for autoimmune encephalitis (CASE), respectively. The Ab titers had a median value of 1:10 (range 1:1–1:100). There was no significant difference in titers among various clinical factors including gender and combination of tumor and other diseases (each p > 0.05). Patients presenting with psychiatric symptoms at onset had higher titers than those with seizures (p = 0.008) and memory deficits (p = 0.003). The mRS scores revealed a significant but weak correlation with Ab titers (r = 0.243, p = 0.034), while CASE scores did not correlate with the titers (p = 0.125). Our findings indicated that the Ab titers were associated with the type of onset symptoms, with a higher level of patients with psychiatric symptoms. Regarding the clinical severity, the titers showed a weak correlation with the mRS, but no correlation with the CASE.
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Bordonne M, Chawki MB, Doyen M, Kas A, Guedj E, Tyvaert L, Verger A. Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis. Eur J Nucl Med Mol Imaging 2021; 48:3847-3858. [PMID: 33677643 DOI: 10.1007/s00259-021-05299-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To consolidate current understanding of detection sensitivity of brain 18F-FDG PET scans in the diagnosis of autoimmune encephalitis and to define specific metabolic imaging patterns for the most frequently occurring autoantibodies. METHODS A systematic and exhaustive search of data available in the literature was performed by querying the PubMed/MEDLINE and Cochrane databases for the search terms: ((PET) OR (positron emission tomography)) AND ((FDG) OR (fluorodeoxyglucose)) AND ((encephalitis) OR (brain inflammation)). Studies had to satisfy the following criteria: (i) include at least ten pediatric or adult patients suspected or diagnosed with autoimmune encephalitis according to the current recommendations, (ii) specifically present 18F-FDG PET and/or morphologic imaging findings. The diagnostic 18F-FDG PET detection sensitivity in autoimmune encephalitis was determined for all cases reported in this systematic review, according to a meta-analysis following the PRISMA method, and selected publication quality was assessed with the QUADAS-2 tool. RESULTS The search strategy identified 626 articles including references from publications. The detection sensitivity of 18F-FDG PET was 87% (80-92%) based on 21 publications and 444 patients included in the meta-analysis. We also report specific brain 18F-FDG PET imaging patterns for the main encephalitis autoantibody subtypes. CONCLUSION AND RELEVANCE Brain 18F-FDG PET has a high detection sensitivity and should be included in future diagnostic autoimmune encephalitis recommendations. Specific metabolic 18F-FDG PET patterns corresponding to the main autoimmune encephalitis autoantibody subtypes further enhance the value of this diagnostic.
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Affiliation(s)
- Manon Bordonne
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-les-Nancy, F-54000, Nancy, France
| | - Mohammad B Chawki
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-les-Nancy, F-54000, Nancy, France
| | - Matthieu Doyen
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-les-Nancy, F-54000, Nancy, France
- Université de Lorraine, IADI, INSERM U1254, F-54000, Nancy, France
| | - Aurelie Kas
- Nuclear Medicine Department, Pitié-Salpêtrière Hospital, APHP Sorbonne-Université, Laboratoire d'Imagerie Biomédicale, Sorbonne Université, F-75000, Paris, France
| | - Eric Guedj
- Nuclear Medicine Department, Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, F-13000, Marseille, France
| | - Louise Tyvaert
- Department of Neurology, Université de Lorraine, CRAN UMR 7039, CHRU, F-54000, Nancy, France
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, Université de Lorraine, CHRU Nancy, Rue du Morvan, 54500 Vandoeuvre-les-Nancy, F-54000, Nancy, France.
- Université de Lorraine, IADI, INSERM U1254, F-54000, Nancy, France.
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Luo Y, Möhn N, Skripuletz T, Senel M, Tumani H, Peßler F, Sühs KW, Stangel M. Differentiation of viral and autoimmune central nervous system inflammation by kynurenine pathway. Ann Clin Transl Neurol 2021; 8:2228-2234. [PMID: 34623755 PMCID: PMC8670317 DOI: 10.1002/acn3.51383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/16/2021] [Accepted: 04/28/2021] [Indexed: 12/28/2022] Open
Abstract
Objective To determine whether the metabolites of Kynurenine pathway (KP) could serve as biomarkers for distinguishing between viral CNS infections and autoimmune neuroinflammatory diseases, especially anti‐N‐methyl‐D‐aspartate receptor encephalitis (NMDARE) and herpes virus encephalitis (HSE). Methods This study enrolled CSF samples from 76 patients with viral CNS infections, autoimmune neuroinflammatory, and non‐inflammatory neurological diseases. We measured cerebrospinal fluid (CSF) concentrations of tryptophan (Trp) and kynurenine (Kyn) by ELISA. Results Kyn concentrations and Kyn/Trp ratios were highly increased (p < 0.001, viral vs. autoimmune) in viral CNS infections, whereas patients with autoimmune neuroinflammatory and non‐inflammatory diseases exhibited low concentrations. Furthermore, Kyn concentrations and Kyn/Trp ratio turned out to be excellent biomarkers to distinguish between herpes simplex encephalitis (HSE) and NMDARE (AUC 0.920 and AUC 0.906), whereas Trp concentrations were similar in all three groups. Interpretation The results suggest that elevated CSF Kyn concentrations and Kyn/Trp ratio may serve as biomarkers for distinguishing viral CNS infections from autoimmune neuroinflammatory diseases. In particular, the distinction between HSE and NMDARE is of great clinical relevance. Further studies are warranted to investigate the potential of CSF Kyn levels and Kyn/Trp ratio as routine parameters in patients with CNS diseases.
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Affiliation(s)
- Yi Luo
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Nora Möhn
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Thomas Skripuletz
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Frank Peßler
- Research Group Biomarkers for Infectious Diseases, Helmholtz Centre for Infection Research, Braunschweig, Germany.,TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Kurt-Wolfram Sühs
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
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Emerging role of free triiodothyronine in patients with anti-N-methyl-D-aspartate receptor encephalitis. Sci Rep 2021; 11:6045. [PMID: 33723352 PMCID: PMC7960963 DOI: 10.1038/s41598-021-85596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the role of free triiodothyronine (FT3) in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. 137 consecutive inpatients (2016–2019) were registered prospectively and followed up for 12 months. 96 eligible patients were included in the study. The modified Rankin scale (mRS) score was collected, and the score of 3–6 was defined as a poor outcome. The patients were equally classified into 3 subgroups based on their FT3 levels obtained within 24 h of admission, and the subgroup differences were analyzed by parametric or nonparametric tests as appropriate. Logistic regression analysis was performed. We found that there was no difference in the mRS scores upon admission among 3 subgroups, however, patients in the low-FT3 subgroup tended to have higher disease severity during hospitalization and worse outcome in follow-up visits, represented by higher chances of intense care unit (ICU) admission (P < 0.001), longer hospital stay (P < 0.001), greater maximum mRS scores during hospitalization (P = 0.011), lower rates of getting clinical improvement within 4 weeks of starting treatment (P = 0.006), and higher percentages of poor 1-year outcome (P = 0.002). The level of FT3 was an independent factor correlated with ICU admission (P = 0.002) and might be a potential predictor for 1-year outcome. Our preliminary results suggest that the FT3 may be a risk factor involved in the evolution and progression of anti-NMDAR encephalitis, whereas the underline mechanisms remain to be explored. Attention should be paid to these patients with relatively low FT3 upon admission, which might possibly aid clinical prediction and guide clinical decision-making.
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Ramirez Bermúdez J, Bustamante-Gomez P, Espínola-Nadurille M, Kerik NE, Dias Meneses IE, Restrepo-Martinez M, Mendez MF. Cotard syndrome in anti-NMDAR encephalitis: two patients and insights from molecular imaging. Neurocase 2021; 27:64-71. [PMID: 33390066 DOI: 10.1080/13554794.2020.1866018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Cotard syndrome is a clinical condition defined by the presence of nihilistic delusions. We report two patients with Cotard syndrome in whom anti-NMDAR encephalitis (ANMDARE) was confirmed. Both cases showed features of affective psychosis, developed catatonic syndrome, and worsened after the use of antipsychotics. 18F-FDG PET brain studies showed a bilateral hemispheric pattern of hypometabolism in posterior regions, mainly in the cingulate cortex and in the medial aspects of parietal and occipital lobes. A more severe hypometabolism was observed in the right hemisphere of both patients. Both cases remitted with the use of specific immunotherapy for ANMDARE.
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Affiliation(s)
| | | | | | - N E Kerik
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - I E Dias Meneses
- Molecular Imaging PET/CT Unit, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | - M F Mendez
- National Institute of Neurology and Neurosurgery, Mexico City; and the Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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13
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Abstract
Dinutuximab is a monoclonal antibody administered to patients with high-risk neuroblastoma, usually after an autologous stem cell transplant. Dinutuximab is associated with immune mediated and neurologic toxicities, but fatal adverse events are rare. A case is presented of high-risk neuroblastoma with development of encephalopathy shortly after the first course of dinutuximab. The patient had extensive evaluation for etiology of the symptoms and received aggressive interventions, but ultimately expired. Postmortem diagnosis of anti-N-methyl D-aspartate receptor encephalitis, an autoimmune phenomenon often triggered by infection or malignancy, was made. The potential association of autoimmune encephalitis with dinutuximab and with previous autologous transplant is discussed.
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14
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Paraneoplastic and autoimmune encephalitis: Alterations of mood and emotion. HANDBOOK OF CLINICAL NEUROLOGY 2021; 183:221-234. [PMID: 34389119 DOI: 10.1016/b978-0-12-822290-4.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Autoimmune encephalitis often produces signs and symptoms that appear to be at the interface between neurology and psychiatry. Since psychiatric symptoms are often prominent, patients are often first seen in a psychiatric setting. Therefore it is important that psychiatrists, as well as neurologists, be able to recognize autoimmune encephalitis, a task that is often difficult. Early diagnosis of autoimmune encephalitis is crucial as this will usually result in a better outcome for the patient. This chapter provides an introduction to various autoimmune encephalitides and describes their pathophysiology and the possible associated neuropsychiatric, neuropsychological (cognitive), and neurological (sensory-motor) signs and symptoms. This chapter also reviews the possible treatments of these associated signs and symptoms.
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15
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Jorratt P, Hoschl C, Ovsepian SV. Endogenous antagonists of N-methyl-d-aspartate receptor in schizophrenia. Alzheimers Dement 2020; 17:888-905. [PMID: 33336545 DOI: 10.1002/alz.12244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/24/2020] [Indexed: 12/28/2022]
Abstract
Schizophrenia is a chronic neuropsychiatric brain disorder that has devastating personal impact and rising healthcare costs. Dysregulation of glutamatergic neurotransmission has been implicated in the pathobiology of the disease, attributed largely to the hypofunction of the N-methyl-d-aspartate (NMDA) receptor. Currently, there is a major gap in mechanistic analysis as to how endogenous modulators of the NMDA receptors contribute to the onset and progression of the disease. We present a systematic review of the neurobiology and the role of endogenous NMDA receptor antagonists in animal models of schizophrenia, and in patients. We discuss their neurochemical origin, release from neurons and glia with action mechanisms, and functional effects, which might contribute toward the impairment of neuronal processes underlying this complex pathological state. We consider clinical evidence suggesting dysregulations of endogenous NMDA receptor in schizophrenia, and highlight the pressing need in future studies and emerging directions, to restore the NMDA receptor functions for therapeutic benefits.
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Affiliation(s)
- Pascal Jorratt
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Cyril Hoschl
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
| | - Saak V Ovsepian
- Department of Experimental Neurobiology, National Institute of Mental Health, Klecany, Czech Republic.,Department of Psychiatry and Medical Psychology, Third Faculty of Medicine, Charles University, Prague 10, Czech Republic
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16
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Guo J, Han B, Wang J, Zhang L, Chen N, Sun W, Gao Y. The differential expression and potential roles of circular RNAs in children with anti-NMDA receptor encephalitis. J Neuroimmunol 2020; 348:577381. [PMID: 32911360 DOI: 10.1016/j.jneuroim.2020.577381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 10/23/2022]
Abstract
To explore the role of circular RNAs (circRNAs) in pediatric anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, we assessed the profiles of circRNAs and mRNAs in blood leukocytes from anti-NMDA receptor encephalitis patients and healthy controls using microarray analysis. 1196 circRNAs and 719 mRNAs (change ≥2, p < .05) were dysregulated in anti-NMDA receptor encephalitis patients, relative to healthy controls, based on microarray data. Further bioinformatic analysis demonstrated that the host genes of dysregulated circRNAs are primarily associated with receptor internalization. In conclusion, circRNAs may be implicated in the pathogenesis of pediatric anti-NMDA receptor encephalitis.
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Affiliation(s)
- Jiamin Guo
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Bo Han
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China.
| | - Jing Wang
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Li Zhang
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
| | - Na Chen
- Department of Pediatrics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China; Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Wenxiu Sun
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
| | - Yuxing Gao
- Department of Pediatrics, Shandong Provincial Hospital Affiliated to Shandong first Medical University, Jinan, Shandong, 250021, China
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17
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Hallucinations: diagnosis, neurobiology and clinical management. Int Clin Psychopharmacol 2020; 35:293-299. [PMID: 32324611 DOI: 10.1097/yic.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hallucinations are important diagnostic symptoms in schizophrenia, but also occur in other medical and neuropsychiatric conditions. Not all patients with hallucinations are psychotic. There has been a surge of interest in the topic of hallucinations, as new research data have begun to reveal their neurobiology. Hallucinogenic molecules may also serve as new scaffolds for the development of new psychotropic drugs. We searched and reviewed recent literature, focusing on the refinement of clinical management, which was inspired by new data regarding the neurobiology of hallucination subtypes. We concluded that the successful management of hallucinations depends on accurate differential diagnosis to identify subtypes, which would then determine the most appropriate treatment.
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18
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Dhaliwal J, Ganguly R, Mindel J, Krishna V. VNS Stopping Anti-NMDA Receptor Encephalitis-Triggered Nonconvulsive Status Epilepticus. World Neurosurg 2020; 146:364-366.e2. [PMID: 33091646 DOI: 10.1016/j.wneu.2020.10.076] [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: 07/27/2020] [Accepted: 10/14/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anti-NMDA receptor encephalitis (ANRE) is a rare autoimmune neurologic disorder characterized by encephalitis and a constellational of symptoms, including seizures, psychiatric disturbances, autonomic instability, and respiratory insufficiency. It is caused by the anti-NMDA receptor antibody. The most common etiologies for ANRE include malignancy and infection. Ovarian teratoma is the most commonly associated malignancy. CASE DESCRIPTION We describe the first reported case to our knowledge of ovarian teratoma causing ANRE resulting in nonconvulsive status epilepticus (NCSE), which was terminated with vagus nerve stimulation (VNS). CONCLUSIONS This case report provides a temporal correlation suggesting that VNS significantly altered the natural history of this patient's NCSE-ANRE. As more data are collected, and the VNS treatment modality more liberally used to treat NCSE, especially in the situation of ANRE, stronger layers of evidence will emerge to fill the gaps of understanding beyond this case report.
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Affiliation(s)
- Joravar Dhaliwal
- Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
| | - Ranjit Ganguly
- Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jesse Mindel
- Department of Neurology, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Vibhor Krishna
- Department of Neurosurgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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19
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Neuroimmunological antibody-mediated encephalitis and implications for diagnosis and therapy in neuropsychiatry. Acta Neuropsychiatr 2020; 32:177-185. [PMID: 31791436 DOI: 10.1017/neu.2019.50] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The past decade has seen a surge of reports and investigations into cases of autoimmune-mediated encephalitis. The increasing recognition of these disorders is especially of relevance to the fields of neurology and psychiatry. Autoimmune encephalitis involves antibodies against synaptic receptors, neuronal cell surface proteins and intracellular targets. These disorders feature prominent symptoms of cognitive impairment and behavioural changes, often associated with the presence of seizures. Early in the clinical course, autoimmune encephalitis may manifest as psychiatric symptoms of psychosis and involve psychiatry as an initial point of contact. Although commonly associated with malignancy, these disorders can present in the absence of an inciting neoplasm. The identification of autoimmune encephalitis is of clinical importance as a large proportion of individuals experience a response to immunotherapy. This review focuses on the current state of knowledge on n-methyl-d-aspartate (NMDA) receptor-associated encephalitis and limbic encephalitis, the latter predominantly involving antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor, the γ-aminobutyric acid (GABA)B receptor and leucine-rich glioma-inactivated 1 (LGI1) protein. In addition, we briefly describe anti-dopamine D2 receptor encephalitis. A summary of the literature will focus on common clinical presentations and course, diagnostic approaches and response to treatment. Since a substantial proportion of patients with autoimmune encephalitis exhibit symptoms of psychosis, the relevance of this disorder to theories of psychosis and schizophrenia will also be discussed.
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20
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Abstract
PURPOSE OF REVIEW Autoimmune encephalitis is increasingly recognized and must be distinguished from infectious forms of encephalitis. Moreover, physicians should be aware of infectious triggers of autoimmune encephalitis and of infectious complications associated with treatment. RECENT FINDINGS Recent epidemiological studies suggest that the incidence of autoimmune encephalitis may rival that of infectious encephalitis. Although distinguishing autoimmune from infectious forms of encephalitis on clinical grounds can be challenging, recently proposed diagnostic criteria can provide some assistance. There has been an explosion in our knowledge of autoimmune encephalitis associated with antibodies to neuronal cell surface antigens, and two of the most common forms, anti-NMDA receptor encephalitis and anti-LGI1 encephalitis, are typically associated with distinctive clinical features. Although tumors have long been known to trigger autoimmune encephalitis, it has been recently recognized that herpes simplex encephalitis may trigger the generation of antineuronal autoantibodies resulting in an autoimmune neurologic relapse. Both first and second-line therapies for autoimmune encephalitis are associated with infectious complications, whereas emerging treatments, including anakinra and tocilizumab, may also result in increased susceptibility to certain infections. SUMMARY The diagnosis and management of autoimmune encephalitis is complex, and awareness of diagnostic criteria and modalities, typical clinical syndromes, infectious triggers of disease, and infectious complications of therapies is critical in optimizing care for affected patients.
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21
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da Silva APB, Silva RBM, Goi LDS, Molina RD, Machado DC, Sato DK. Experimental Models of Neuroimmunological Disorders: A Review. Front Neurol 2020; 11:389. [PMID: 32477252 PMCID: PMC7235321 DOI: 10.3389/fneur.2020.00389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
Immune-mediated inflammatory diseases of the central nervous system (CNS) are a group of neurological disorders in which inflammation and/or demyelination are induced by cellular and humoral immune responses specific to CNS antigens. They include diseases such as multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), acute disseminated encephalomyelitis (ADEM) and anti-NMDA receptor encephalitis (NMDAR encephalitis). Over the years, many in vivo and in vitro models were used to study clinical, pathological, physiological and immunological features of these neuroimmunological disorders. Nevertheless, there are important aspects of human diseases that are not fully reproduced in the experimental models due to their technical limitations. In this review, we describe the preclinical models of neuroimmune disorders, and how they contributed to the understanding of these disorders and explore potential treatments. We also describe the purpose and limitation of each one, as well as the recent advances in this field.
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Affiliation(s)
- Ana Paula Bornes da Silva
- Neuroinflammation and Neuroimmunology Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Rodrigo Braccini Madeira Silva
- Research Center in Toxicology and Pharmacology, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Leise Daniele Sckenal Goi
- Neuroinflammation and Neuroimmunology Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Rachel Dias Molina
- Neuroinflammation and Neuroimmunology Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Denise Cantarelli Machado
- School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,Molecular and Cellular Biology Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Douglas Kazutoshi Sato
- Neuroinflammation and Neuroimmunology Laboratory, Brain Institute, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Pediatrics and Child Health, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil.,School of Medicine, Graduate Program in Medicine and Health Sciences, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
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22
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Levchenko A, Nurgaliev T, Kanapin A, Samsonova A, Gainetdinov RR. Current challenges and possible future developments in personalized psychiatry with an emphasis on psychotic disorders. Heliyon 2020; 6:e03990. [PMID: 32462093 PMCID: PMC7240336 DOI: 10.1016/j.heliyon.2020.e03990] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/31/2019] [Accepted: 05/12/2020] [Indexed: 12/13/2022] Open
Abstract
A personalized medicine approach seems to be particularly applicable to psychiatry. Indeed, considering mental illness as deregulation, unique to each patient, of molecular pathways, governing the development and functioning of the brain, seems to be the most justified way to understand and treat disorders of this medical category. In order to extract correct information about the implicated molecular pathways, data can be drawn from sampling phenotypic and genetic biomarkers and then analyzed by a machine learning algorithm. This review describes current difficulties in the field of personalized psychiatry and gives several examples of possibly actionable biomarkers of psychotic and other psychiatric disorders, including several examples of genetic studies relevant to personalized psychiatry. Most of these biomarkers are not yet ready to be introduced in clinical practice. In a next step, a perspective on the path personalized psychiatry may take in the future is given, paying particular attention to machine learning algorithms that can be used with the goal of handling multidimensional datasets.
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Affiliation(s)
- Anastasia Levchenko
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, 199034, Russia
| | - Timur Nurgaliev
- Institute of Translational Biomedicine, Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, 199034, Russia
| | - Alexander Kanapin
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, 199034, Russia
| | - Anastasia Samsonova
- Theodosius Dobzhansky Center for Genome Bioinformatics, Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, 199034, Russia
| | - Raul R. Gainetdinov
- Institute of Translational Biomedicine, Saint Petersburg State University, 7/9 Universitetskaya nab., Saint Petersburg, 199034, Russia
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23
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Forrester A, Latorre S, O'Dea PK, Robinson C, Goldwaser EL, Trenton A, Tobia A, Aziz R, Dhawan S, Brennan A, Kurukumbi M, Dong Y, Benavides DR, Offurum AI. Anti-NMDAR Encephalitis: A Multidisciplinary Approach to Identification of the Disorder and Management of Psychiatric Symptoms. PSYCHOSOMATICS 2020; 61:456-466. [PMID: 32507506 DOI: 10.1016/j.psym.2020.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/21/2020] [Accepted: 04/21/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND The novelty of anti-NMDA receptor encephalitis, for which somatic treatments have only recently been developed, has led to a lack of information on assessment and treatment of its variable behavioral manifestations. METHOD In this article, we discuss 4 challenging cases of anti-NMDAR encephalitis, focusing on the importance of a multidisciplinary approach to identification and management of the disorder and the necessity of close collaboration in the acute hospital setting for management of the behavioral symptoms. CONCLUSION The cases we discuss highlight some of the medication and nonpharmacologic treatment strategies that may facilitate management of psychiatric symptoms, both while the medical workup is ongoing and after the diagnosis has been confirmed.
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Affiliation(s)
- Anique Forrester
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD.
| | - Samantha Latorre
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Pamela K O'Dea
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Charles Robinson
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Eric Luria Goldwaser
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - Adam Trenton
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Anthony Tobia
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Rehan Aziz
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Survandita Dhawan
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Andrew Brennan
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Mohan Kurukumbi
- Department of Neurology, Virginia Commonwealth University/INOVA Fairfax Hospital, Fairfax, VA
| | - Yu Dong
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD
| | - David R Benavides
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD
| | - Ada Ibe Offurum
- Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
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24
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Valdoleiros SR, Calejo M, Marinho A, Martins da Silva A, Vasconcelos O, Gonçalves MJ, Sarmento E Castro R. First report of concomitant cryptococcal meningitis and anti-NMDAR encephalitis. Brain Behav Immun Health 2020; 2:100036. [PMID: 34589827 PMCID: PMC8474238 DOI: 10.1016/j.bbih.2020.100036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 12/28/2019] [Accepted: 01/03/2020] [Indexed: 11/25/2022] Open
Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder, seen most often in young adults and children, triggered by tumors or infections. We report a case of cryptococcal meningitis in a patient with sarcoidosis, presenting prominent neuropsychiatric symptoms, electroencephalographic features of autoimmune encephalitis and positive anti-NMDAR antibodies in the cerebrospinal fluid, raising the hypothesis of an infectious immune-mediated mechanism triggering the production of anti-NMDAR antibodies. Since anti-NMDAR encephalitis is potentially fatal and has significant morbidity, further descriptions of its etiological associations are essential to early identification and prompt treatment. Cryptococcal meningitis is a rare complication of sarcoidosis and CD4 lymphopenia. Anti-NMDAR encephalitis is an autoimmune disorder triggered by tumors or infection. A case of concomitant cryptococcosis and anti-NMDAR encephalitis is presented.
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Affiliation(s)
- Sofia R Valdoleiros
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Margarida Calejo
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - António Marinho
- Department of Internal Medicine, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4099-001, Porto, Portugal
| | - Ana Martins da Silva
- Department of Neurology, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas Abel Salazar, University of Porto, 4099-001, Porto, Portugal
| | - Olga Vasconcelos
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Maria João Gonçalves
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Rui Sarmento E Castro
- Department of Infectious Diseases, Centro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, 4099-001, Porto, Portugal
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25
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Anti-NMDAR Encephalitis: Higher Suspicious Needed for Earlier Diagnosis (Case Report, Literature Review and Diagnostic Criteria). Case Rep Neurol Med 2019; 2019:7476254. [PMID: 31956454 PMCID: PMC6949662 DOI: 10.1155/2019/7476254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 12/05/2019] [Indexed: 02/08/2023] Open
Abstract
Background Auto-immune mediated anti-NMDA receptor encephalitis is a very common delayed diagnosed encephalitis which predominately affecting young population. Objectives This encephalitis is relatively unknown amongst emergency physicians and a majority of patients are admitted to psychiatric wards before their diagnosis is confirmed and appropriate treatments are commenced. We reported a case of a 22-year-old female presented to our emergency department with acute psychiatric symptoms. She was initially diagnosed with first presentation of acute psychosis and was hospitalised under mental health act. further assessment in the emergency department identified possible an organic cause for her acute psychosis and she was later admitted under medical team after her mental health assessment order was revoke. Several days later, her CSF result was positive with anti-NMDA receptor anti-bodies. Appropriate treatments were instituted leading to her full recovery. Conclusion This case was the first confirmed anti-NMDA receptor encephalitis in our emergency department. It highlights the importance of thorough assessment of psychiatric presentations to emergency departments and consideration of auto-immune medicated encephalitis as one of the differential diagnosis in young patients presenting with first acute psychotic episode.
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26
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Huang Q, Xie Y, Hu Z, Tang X. Anti-N-methyl-D-aspartate receptor encephalitis: A review of pathogenic mechanisms, treatment, prognosis. Brain Res 2019; 1727:146549. [PMID: 31726044 DOI: 10.1016/j.brainres.2019.146549] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 02/06/2023]
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatable autoimmune disorder characterized by prominent neuropsychiatric symptoms that predominantly affects children and young adults. In this review, we discuss the pathogenic mechanisms and immunologic triggers of anti-NMDAR encephalitis, and provide an overview of treatment and prognosis of this disorder, with specific focus on the management of common symptoms, complications, and patients during pregnancy. Most patients respond well to first-line treatment and surgical resection of tumors. When first-line immunotherapy fails, second-line immunotherapy can often improve outcomes. In addition, treatment with immunomodulators and tumor resection are effective treatment strategies for pregnant patients. Benzodiazepines are the preferred treatment for patients with catatonia, and electroconvulsive therapy (ECT) may be considered when pharmacological treatment is ineffective. Age, antibody titer, cerebellar atrophy, levels of biomarkers such as C-X-C motif chemokine 13 (CXCL13), cell-free mitochondrial (mt)DNA in cerebral serum fluid (CSF), and timing from symptom onset to treatment are the main prognostic factors. Patients without tumors or those who receive insufficient immunotherapy during the first episode are more likely to relapse.
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Affiliation(s)
- Qianyi Huang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yue Xie
- Department of Neurology, The Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Xiangqi Tang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.
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27
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Clinical analysis of psychiatric symptoms of Japanese encephalitis during the convalescent Period: A single center study in Chongqing, China. Brain Dev 2019; 41:614-617. [PMID: 30902357 DOI: 10.1016/j.braindev.2019.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND This study aimed to analyze clinical and imaging features of children with severe Japanese encephalitis (JE), and to analyze causes and solutions for psychiatric symptoms of JE during the convalescent period. METHODS We analyzed clinical information for 78 children with severe JE at the Department of Neurology, Department of Infection, and Department of Rehabilitation in our hospital during 2014-2016. Seventy-eight cases of severe JE were divided into patients with psychiatric symptoms and no psychiatric symptoms groups. We focused on analysis of the patients with psychiatric symptoms group. RESULTS The incidence of psychiatric symptoms during the convalescent period was 46.15% (36/78). Antipsychotic drugs can effectively control psychiatric symptoms and shorten duration of symptoms. Seventy-one patients underwent reexamination with a head MRI. Of these, 8 cases (8/36 = 22.22%) in patients with psychiatric symptoms group showed new lesions in the basal ganglia, insula, and hippocampus. During the 12-month follow-up, two cases showed reappearance of psychiatric symptoms that had been relieved previously. CONCLUSION This study found that severe JE cases revealed a considerable proportion with psychiatric symptoms during the convalescent period.
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Isobe N. Link between HLA alleles and anti-NMDAR encephalitis. J Neurol Neurosurg Psychiatry 2019; 90:626. [PMID: 30971420 DOI: 10.1136/jnnp-2018-319925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Noriko Isobe
- Department of Neurological Therapeutics, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka 812-8582, Japan
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29
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Holmdahl R, Nimmerjahn F, Ludwig RJ. Editorial: Autoantibodies. Front Immunol 2019; 10:484. [PMID: 31001243 PMCID: PMC6454132 DOI: 10.3389/fimmu.2019.00484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/22/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Rikard Holmdahl
- Section of Medical Inflammation Research, Department of Medical Biochemistry and Biophysics, Karolinska Institute, Stockholm, Sweden
| | - Falk Nimmerjahn
- Department of Biology, Institute of Genetics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Lübeck, Germany
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Cohen J, Sotoca J, Gandhi S, Yeshokumar AK, Gordon-Lipkin E, Geocadin RG, Frick KD, Probasco JC, Venkatesan A. Autoimmune encephalitis: A costly condition. Neurology 2019; 92:e964-e972. [PMID: 30674590 DOI: 10.1212/wnl.0000000000006990] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/22/2018] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To assess the inpatient hospitalization burden and costs of patients with autoimmune encephalitis (AE) at a tertiary care institution. METHODS Adult inpatients with AE were identified retrospectively from July 1, 2005, to June 30, 2015. Demographic and clinical data were collected and analyzed. Billing data were compared to those of patients with herpes simplex encephalitis (HSE). Charges were adjusted for inflation. RESULTS Of 244 admissions for encephalitis reviewed, 63 patients met criteria for probable or definite AE. Thirty-one (49%) patients were antibody positive, and 27 (43%) were admitted to the intensive care unit (ICU). Median hospital charges per patient with AE were more than $70,000; median length of stay (LOS) was 15 days; and in-hospital mortality was 6%. Patients admitted to the ICU had substantially higher median hospital charges (ICU $173,000 per admission vs non-ICU $50,000 per admission, p < 0.001). LOS was strongly associated with charges and was driven by delay in diagnosis of AE, prolonged treatment courses, and lack of response to therapy. Compared with HSE, median hospital charges per patient with AE were nearly 4 times higher, median AE LOS was 3 times higher, and total charges over the study period were nearly twice as high. CONCLUSIONS Patients with AE used more inpatient health care resources per patient during a 10-year period than patients with HSE at our institution. ICU-admitted patients with AE were responsible for a substantially higher financial burden than non-ICU-admitted patients with AE. Our data underscore the need for the development of novel diagnostic and therapeutic modalities to improve patient outcomes and to decrease hospital burden in AE.
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Affiliation(s)
- Jesse Cohen
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Javier Sotoca
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Shikha Gandhi
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Anusha K Yeshokumar
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Eliza Gordon-Lipkin
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Romergyko G Geocadin
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Kevin D Frick
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - John C Probasco
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD
| | - Arun Venkatesan
- From the Johns Hopkins Encephalitis Center (J.C., S.G., E.G.-L., R.G.G., J.C.P., A.V.), Department of Neurology, and Departments of Neurosurgery and Anaesthesia/Critical Care (R.G.G.), Johns Hopkins University School of Medicine, Baltimore, MD; Neurology Department (J.S.), IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Neurology and Pediatrics (A.K.Y.), Icahn School of Medicine at Mt. Sinai, New York, NY; Department of Neurology and Developmental Medicine (E.G.-L.), Kennedy Krieger Institute; and Johns Hopkins Carey Business School (K.D.F.), Baltimore MD.
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Staley EM, Jamy R, Phan AQ, Figge DA, Pham HP. N-Methyl-d-aspartate Receptor Antibody Encephalitis: A Concise Review of the Disorder, Diagnosis, and Management. ACS Chem Neurosci 2019; 10:132-142. [PMID: 30134661 DOI: 10.1021/acschemneuro.8b00304] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Anti-NMDA ( N-methyl-d-aspartate) receptor (anti-NMDAR) encephalitis is one of the most common paraneoplastic encephalitides. It occurs in both sexes, across all age ranges, and may occur in the presence or absence of an associated tumor. Its pathogenesis and clinical presentation relate to the presence of IgG1 or IgG3 antibodies targeting the NR1 subunit of the NMDA receptor, leading to a disinhibition of neuronal excitatory pathways. Initial clinical manifestations may be nonspecific, resembling a viral-like illness; however, with disease progression, symptoms can become quite severe, including prominent psychiatric features, cognitive problems, motor dysfunction, and autonomic instability. Anti-NMDAR encephalitis may even result in death in severe untreated cases. Diagnosis can be challenging, given that initial laboratory and radiographic results are typically nonspecific. The majority of patients respond to first or second-line treatments, although therapeutic options remain limited, usually consisting of tumor removal (if there is confirmation of an underlying malignancy) in conjunction with prompt initiation of immunosuppressive medications along with intravenous immunoglobulins and/or plasma exchange. Although the clinical presentation of anti-NMDAR encephalitis overlaps with several other more common neurological and psychiatric disorders, early diagnosis and treatment is essential for a positive prognosis. Here, we concisely review the pathogenesis, diagnosis, and clinical management of this disease.
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Affiliation(s)
- Elizabeth M. Staley
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis, St. Louis, Missouri 63110, United States
| | - Rabia Jamy
- Department of Neurology, University of Alabama at Birmingham, Birmingham, Alabama 35249, United States
| | - Allan Q. Phan
- Doctor of Medicine Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53726, United States
| | - David A. Figge
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama 35249, United States
| | - Huy P. Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California 90033, United States
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Molnár E. Cell-Based Enzyme-Linked Immunosorbent Assay (Cell-ELISA) Analysis of Native and Recombinant Glutamate Receptors. Methods Mol Biol 2019; 1941:47-54. [PMID: 30707426 DOI: 10.1007/978-1-4939-9077-1_4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Glutamate receptors (GluRs) located primarily on the membranes of neurons and glial cells are responsible for excitatory synaptic transmission in the central nervous system. The transport of GluRs to the cell surface is a highly regulated dynamic process that determines neuronal excitability and synaptic responses. The molecular and cellular mechanisms of GluR trafficking are often studied in cell cultures. These studies require sensitive techniques that allow the measurement of total and surface-expressed GluRs in cell populations. The cell-based enzyme-linked immunosorbent assay (cell-ELISA) combines steps of direct immunochemical labelling of cell cultures and ELISA. It can be used for quantitative comparisons of surface-expressed and total protein contents of various cell cultures. While several cell-ELISA protocols are available for different cell types, in this chapter we describe the procedure that we have applied for the investigation of quantitative changes in the cell surface expression of recombinant ionotropic glutamate receptors (iGluRs) in adherent human embryonic kidney 293 (HEK293) cells and endogenous iGluR proteins in primary neuronal cultures.
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Affiliation(s)
- Elek Molnár
- School of Physiology, Pharmacology and Neuroscience, University of Bristol, Bristol, UK.
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Hashimoto K. Biomarkers for Alzheimer's disease: from pathogenesis to drug development. Eur Arch Psychiatry Clin Neurosci 2018; 268:441-442. [PMID: 29948251 DOI: 10.1007/s00406-018-0912-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Kenji Hashimoto
- Division of Clinical Neuroscience, Chiba University Center for Forensic Mental Health, 1-8-1 Inohana, Chiba, 260-8670, Japan.
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The effect of delayed anti-NMDAR encephalitis recognition on disease outcome. J Neurovirol 2018; 24:638-641. [PMID: 29785583 DOI: 10.1007/s13365-018-0648-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/30/2018] [Indexed: 12/14/2022]
Abstract
Anti-NMDA receptor encephalitis is an acute form of brain inflammation that is potentially lethal but has a high probability for recovery with treatment. Although the clinical picture of anti-NMDAR encephalitis is usually recognizable due to its relatively well-known symptoms, the disorder can sometimes present itself in an unpredictable and atypical way. In this case report, we wish to present the influence of different delay times prior to the establishment of diagnosis. Thus, our first patient was diagnosed with anti-NMDAR encephalitis 4 years after the initial symptoms, the second one after 8 years, and the third one after 13 months. The outcomes of the three presented patients indicate the importance of being aware of many clinical presentations of this disorder, as its early diagnosis greatly affects the outcome and may reduce permanent damage, especially in cognitive functions.
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