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Melzer N, Weber K, Räuber S, Rosenow F. [(Auto)immunity in focal epilepsy: mechanisms of (auto‑)immune-inflammatory epileptogenic neurodegeneration]. DER NERVENARZT 2024:10.1007/s00115-024-01695-5. [PMID: 38953922 DOI: 10.1007/s00115-024-01695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE While the neuronal mechanisms of epileptic hyperexcitability (HE) have been studied in detail, recent findings suggest that extraneuronal, mainly immune-mediated inflammatory and vascular mechanisms play an important role in the development and progression of HE in epilepsy and the cognitive and behavioral comorbidities. MATERIAL AND METHODS Narrative review. RESULTS As in autoimmune (limbic) encephalitis (ALE/AIE) or Rasmussen's encephalitis (RE), the primary adaptive and innate immune responses and associated changes in the blood-brain barrier (BBB) and neurovascular unit (NVU) can cause acute cortical hyperexcitability (HE) and the development of hippocampal sclerosis (HS) and other structural cortical lesions with chronic HE. Cortical HE, which is associated with malformation of cortical development (MCD) and low-grade epilepsy-associated tumors (LEAT), for example, can be accompanied by secondary adaptive and innate immune responses and alterations in the BBB and NVU, potentially modulating the ictogenicity and epileptogenicity. These associations illustrate the influence of adaptive and innate immune mechanisms and associated changes in the BBB and NVU on cortical excitability and vice versa, suggesting a dynamic and complex interplay of these factors in the development and progression of epilepsy in general. DISCUSSION The described concept of a neuro-immune-vascular interaction in focal epilepsy opens up new possibilities for the pathogenetic understanding and thus also for the selective therapeutic intervention.
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Affiliation(s)
- Nico Melzer
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Katharina Weber
- Neurologisches Institut (Edinger Institut), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Frankfurt Cancer Institute (FCI), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Partnerstätte Frankfurt, Frankfurt am Main und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland
- Universitäres Centrum für Tumorerkrankungen Frankfurt (UCT), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Saskia Räuber
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, Zentrum für Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
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Smith KM, Budhram A, Geis C, McKeon A, Steriade C, Stredny CM, Titulaer MJ, Britton JW. Autoimmune-associated seizure disorders. Epileptic Disord 2024. [PMID: 38818801 DOI: 10.1002/epd2.20231] [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: 01/24/2024] [Revised: 03/28/2024] [Accepted: 04/13/2024] [Indexed: 06/01/2024]
Abstract
With the discovery of an expanding number of neural autoantibodies, autoimmune etiologies of seizures have been increasingly recognized. Clinical phenotypes have been identified in association with specific underlying antibodies, allowing an earlier diagnosis. These phenotypes include faciobrachial dystonic seizures with LGI1 encephalitis, neuropsychiatric presentations associated with movement disorders and seizures in NMDA-receptor encephalitis, and chronic temporal lobe epilepsy in GAD65 neurologic autoimmunity. Prompt recognition of these disorders is important, as some of them are highly responsive to immunotherapy. The response to immunotherapy is highest in patients with encephalitis secondary to antibodies targeting cell surface synaptic antigens. However, the response is less effective in conditions involving antibodies binding intracellular antigens or in Rasmussen syndrome, which are predominantly mediated by cytotoxic T-cell processes that are associated with irreversible cellular destruction. Autoimmune encephalitides also may have a paraneoplastic etiology, further emphasizing the importance of recognizing these disorders. Finally, autoimmune processes and responses to novel immunotherapies have been reported in new-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES), warranting their inclusion in any current review of autoimmune-associated seizure disorders.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Christian Geis
- Department of Neurology and Section Translational Neuroimmunology, Jena University Hospital, Jena, Germany
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claude Steriade
- Department of Neurology, New York University Langone Health, New York, New York, USA
| | - Coral M Stredny
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
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3
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Talucci I, Arlt FA, Kreissner KO, Nasouti M, Wiessler AL, Miske R, Mindorf S, Dettmann I, Moniri M, Bayer M, Broegger Christensen P, Ayzenberg I, Kraft A, Endres M, Komorowski L, Villmann C, Doppler K, Prüss H, Maric HM. Molecular dissection of an immunodominant epitope in K v1.2-exclusive autoimmunity. Front Immunol 2024; 15:1329013. [PMID: 38665908 PMCID: PMC11043588 DOI: 10.3389/fimmu.2024.1329013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/22/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction Subgroups of autoantibodies directed against voltage-gated potassium channel (Kv) complex components have been associated with immunotherapy-responsive clinical syndromes. The high prevalence and the role of autoantibodies directly binding Kv remain, however, controversial. Our objective was to determine Kv autoantibody binding requirements and to clarify their contribution to the observed immune response. Methods Binding epitopes were studied in sera (n = 36) and cerebrospinal fluid (CSF) (n = 12) from a patient cohort positive for Kv1.2 but negative for 32 common neurological autoantigens and controls (sera n = 18 and CSF n = 5) by phospho and deep mutational scans. Autoantibody specificity and contribution to the observed immune response were resolved on recombinant cells, cerebellum slices, and nerve fibers. Results 83% of the patients (30/36) within the studied cohort shared one out of the two major binding epitopes with Kv1.2-3 reactivity. Eleven percent (4/36) of the serum samples showed no binding. Fingerprinting resolved close to identical sequence requirements for both shared epitopes. Kv autoantibody response is directed against juxtaparanodal regions in peripheral nerves and the axon initial segment in central nervous system neurons and exclusively mediated by the shared epitopes. Discussion Systematic mapping revealed two shared autoimmune responses, with one dominant Kv1.2-3 autoantibody epitope being unexpectedly prevalent. The conservation of the molecular binding requirements among these patients indicates a uniform autoantibody repertoire with monospecific reactivity. The enhanced sensitivity of the epitope-based (10/12) compared with that of the cell-based detection (7/12) highlights its use for detection. The determined immunodominant epitope is also the primary immune response visible in tissue, suggesting a diagnostic significance and a specific value for routine screening.
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Affiliation(s)
- Ivan Talucci
- Rudolf Virchow Center for Integrative and Translational Bioimaging; University of Würzburg, Würzburg, Germany
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Friederike A. Arlt
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Kai O. Kreissner
- Rudolf Virchow Center for Integrative and Translational Bioimaging; University of Würzburg, Würzburg, Germany
| | - Mahoor Nasouti
- Rudolf Virchow Center for Integrative and Translational Bioimaging; University of Würzburg, Würzburg, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Anna-Lena Wiessler
- Institute for Clinical Neurobiology, University of Wuerzburg, Würzburg, Germany
| | - Ramona Miske
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Swantje Mindorf
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Inga Dettmann
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Mehrnaz Moniri
- Rudolf Virchow Center for Integrative and Translational Bioimaging; University of Würzburg, Würzburg, Germany
| | - Markus Bayer
- Rudolf Virchow Center for Integrative and Translational Bioimaging; University of Würzburg, Würzburg, Germany
| | | | - Ilya Ayzenberg
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Andrea Kraft
- Department of Neurology, Hospital Martha-Maria, Halle, Germany
| | - Matthias Endres
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité-Universitätsmedizin, Berlin, Germany
- Center for Stroke Research, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- German Center for Mental Health (DZPG), Berlin, Germany
| | - Lars Komorowski
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Carmen Villmann
- Institute for Clinical Neurobiology, University of Wuerzburg, Würzburg, Germany
| | - Kathrin Doppler
- Department of Neurology, University Hospital Würzburg, Würzburg, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany
| | - Hans M. Maric
- Rudolf Virchow Center for Integrative and Translational Bioimaging; University of Würzburg, Würzburg, Germany
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Sanli E, Sirin NG, Kucukali CI, Baykan B, Ulusoy CA, Bebek N, Yilmaz V, Tuzun E. Peripheral blood regulatory B and T cells are decreased in patients with focal epilepsy. J Neuroimmunol 2024; 387:578287. [PMID: 38241950 DOI: 10.1016/j.jneuroim.2024.578287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/12/2023] [Accepted: 01/06/2024] [Indexed: 01/21/2024]
Abstract
Patients with focal epilepsy of unknown cause (FEoUC) may display T cell infiltration in post-surgery brain specimens and increased serum levels of pro-inflammatory cytokines produced by B and T cells, indicating potential involvement of adaptive immunity. Our study aimed to investigate the peripheral blood distribution of B and T cell subgroups to find clues supporting the distinct organization of adaptive immunity in FEoUC. Twenty-two patients with FEoUC and 25 age and sex matched healthy individuals were included. Peripheral blood mononuclear cells were immunophenotyped by flow cytometry. Expression levels of anti-inflammatory cytokines and FOXP3 were measured by real-time PCR. Carboxyfluorescein succinimidyl ester (CFSE) proliferation assay was conducted using CD4+ T cells. Patients with FEoUC showed significantly decreased regulatory B (Breg), B1a, plasmablast and regulatory T (Treg) cell percentages, and increased switched memory B and Th17 cell ratios. Moreover, CD4+CD25+CD49d- Tregs of FEoUC patients displayed significantly reduced TGFB1 and FOXP3, but increased IL10 gene expression levels. CD4+ helper T cells of patients with FEoUC gave more exaggerated proliferation responses to phytohemagglutinin, anti-CD3 and anti-CD28 stimulation. Patients with FEoUC display increased effector lymphocyte, decreased regulatory lymphocyte ratios, and impaired Treg function and enhanced lymphocyte proliferation capacity. Overall, this pro-inflammatory phenotype lends support to the involvement of adaptive immunity in FEoUC.
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Affiliation(s)
- Elif Sanli
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey; Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cem Ismail Kucukali
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Betul Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurology, EMAR Medical Center, Istanbul, Turkey
| | - Canan Aysel Ulusoy
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Nerses Bebek
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Vuslat Yilmaz
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey.
| | - Erdem Tuzun
- Department of Neuroscience, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
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Blümcke I. Neuropathology and epilepsy surgery - 2024 update. FREE NEUROPATHOLOGY 2024; 5:5-8. [PMID: 38532826 PMCID: PMC10964794 DOI: 10.17879/freeneuropathology-2024-5347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/11/2024] [Indexed: 03/28/2024]
Abstract
Neuropathology-based studies in neurosurgically resected brain tissue obtained from carefully examined patients with focal epilepsies remain a treasure box for excellent insights into human neuroscience, including avenues to better understand the neurobiology of human brain organization and neuronal hyperexcitability at the cellular level including glio-neuronal interaction. It also allows to translate results from animal models in order to develop personalized treatment strategies in the near future. A nice example of this is the discovery of a new disease entity in 2017, termed mild malformation of cortical development with oligodendroglial hyperplasia in epilepsy or MOGHE, in the frontal lobe of young children with intractable seizures. In 2021, a brain somatic missense mutation of the galactose transporter SLC35A2 leading to altered glycosylation of lipoproteins in the Golgi apparatus was detected in 50 % of MOGHE samples. In 2023, the first clinical trial evaluated galactose supplementation in patients with histopathologically confirmed MOGHE carrying brain somatic SLC35A2 mutations that were not seizure free after surgery. The promising results of this pilot trial are an example of personalized medicine in the arena of epileptology. Besides this, neuropathological studies of epilepsy samples have revealed many other fascinating results for the main disease categories in focal epilepsies, such as the first deep-learning based classifier for Focal Cortical Dysplasia, or the genomic landscape of cortical malformations showing new candidate genes such as PTPN11, which is associated with ganglioglioma and adverse clinical outcome. This update will also ask why common pathogenic variants accumulate in certain brain regions, e.g., MTOR in the frontal lobe, and BRAF in the temporal lobe. Finally, I will highlight the ongoing discussion addressing commonalities between temporal lobe epilepsy and Alzheimer's disease, the impact of adult neurogenesis and gliogenesis for the initiation and progression of temporal lobe seizures in the human brain as well as the immunopathogenesis of glutamic acid decarboxylase antibody associated temporal lobe epilepsy as a meaningful disease entity. This review will update the reader on some of these fascinating publications from 2022 and 2023 which were selected carefully, yet subjectively, by the author.
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Affiliation(s)
- Ingmar Blümcke
- Department of Neuropathology, University Hospital Erlangen, Germany
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Masciocchi S, Businaro P, Scaranzin S, Morandi C, Franciotta D, Gastaldi M. General features, pathogenesis, and laboratory diagnostics of autoimmune encephalitis. Crit Rev Clin Lab Sci 2024; 61:45-69. [PMID: 37777038 DOI: 10.1080/10408363.2023.2247482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Autoimmune encephalitis (AE) is a group of inflammatory conditions that can associate with the presence of antibodies directed to neuronal intracellular, or cell surface antigens. These disorders are increasingly recognized as an important differential diagnosis of infectious encephalitis and of other common neuropsychiatric conditions. Autoantibody diagnostics plays a pivotal role for accurate diagnosis of AE, which is of utmost importance for the prompt recognition and early treatment. Several AE subgroups can be identified, either according to the prominent clinical phenotype, presence of a concomitant tumor, or type of neuronal autoantibody, and recent diagnostic criteria have provided important insights into AE classification. Antibodies to neuronal intracellular antigens typically associate with paraneoplastic neurological syndromes and poor prognosis, whereas antibodies to synaptic/neuronal cell surface antigens characterize many AE subtypes that associate with tumors less frequently, and that are often immunotherapy-responsive. In addition to the general features of AE, we review current knowledge on the pathogenic mechanisms underlying these disorders, focusing mainly on the potential role of neuronal antibodies in the most frequent conditions, and highlight current theories and controversies. Then, we dissect the crucial aspects of the laboratory diagnostics of neuronal antibodies, which represents an actual challenge for both pathologists and neurologists. Indeed, this diagnostics entails technical difficulties, along with particularly interesting novel features and pitfalls. The novelties especially apply to the wide range of assays used, including specific tissue-based and cell-based assays. These assays can be developed in-house, usually in specialized laboratories, or are commercially available. They are widely used in clinical immunology and in clinical chemistry laboratories, with relevant differences in analytic performance. Indeed, several data indicate that in-house assays could perform better than commercial kits, notwithstanding that the former are based on non-standardized protocols. Moreover, they need expertise and laboratory facilities usually unavailable in clinical chemistry laboratories. Together with the data of the literature, we critically evaluate the analytical performance of the in-house vs commercial kit-based approach. Finally, we propose an algorithm aimed at integrating the present strategies of the laboratory diagnostics in AE for the best clinical management of patients with these disorders.
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Affiliation(s)
- Stefano Masciocchi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Pietro Businaro
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Morandi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
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7
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Eisenhut K, Faber J, Engels D, Gerhards R, Lewerenz J, Doppler K, Sommer C, Markewitz R, Falk KK, Rössling R, Pruess H, Finke C, Wickel J, Geis C, Ratuszny D, Pfeffer LK, Bittner S, Piepgras J, Kraft A, Klausewitz J, Nuscher B, Kümpfel T, Thaler FS. Early Neuroaxonal Damage in Neurologic Disorders Associated With GAD65 Antibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200176. [PMID: 37914416 PMCID: PMC10624332 DOI: 10.1212/nxi.0000000000200176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
OBJECTIVES Neurodegeneration is considered a relevant pathophysiologic feature in neurologic disorders associated with antibodies against glutamic acid decarboxylase 65 (GAD65). In this study, we investigate surrogates of neuroaxonal damage in relation to disease duration and clinical presentation. METHODS In a multicentric cohort of 50 patients, we measured serum neurofilament light chain (sNfL) in relation to disease duration and disease phenotypes, applied automated MRI volumetry, and analyzed clinical characteristics. RESULTS In patients with neurologic disorders associated with GAD65 antibodies, we detected elevated sNfL levels early in the disease course. By contrast, this elevation of sNfL levels was less pronounced in patients with long-standing disease. Increased sNfL levels were observed in patients presenting with cerebellar ataxia and limbic encephalitis, but not in those with stiff person syndrome. Using MRI volumetry, we identified atrophy predominantly of the cerebellar cortex, cerebellar superior posterior lobe, and cerebral cortex with similar atrophy patterns throughout all clinical phenotypes. DISCUSSION Together, our data provide evidence for early neuroaxonal damage and support the need for timely therapeutic interventions in GAD65 antibody-associated neurologic disorders.
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Affiliation(s)
- Katharina Eisenhut
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jennifer Faber
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Daniel Engels
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Ramona Gerhards
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jan Lewerenz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Kathrin Doppler
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Claudia Sommer
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Robert Markewitz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Kim K Falk
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Rosa Rössling
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Harald Pruess
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Carsten Finke
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jonathan Wickel
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Christian Geis
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Dominica Ratuszny
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Lena K Pfeffer
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Stefan Bittner
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Johannes Piepgras
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Andrea Kraft
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Jaqueline Klausewitz
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Brigitte Nuscher
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Tania Kümpfel
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys
| | - Franziska S Thaler
- From the Institute of Clinical Neuroimmunology (K.E.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Sy; German Center for Neurodegenerative Diseases (DZNE) (J.F.); Department of Neurology, University Hospital Bonn, Germany; Institute of Clinical Neuroimmunology (D.E., R.G., T.K.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Department of Neurology (J.L.), Ulm University; Department of Neurology (K.D., C.S.), University Hospital Würzburg; Institute of Clinical Chemistry (R.M.), University Hospital Schleswig-Holstein, Lübeck; Institute of Clinical Chemistry (K.K.F.), University Hospital Schleswig-Holstein, Kiel; Department of Neurology and Experimental Neurology (R.R., H.P.), Charité - Universitätsmedizin Berlin; German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Neurology and Experimental Neurology (C.F.), Charité - Universitätsmedizin Berlin; Section of Translational Neuroimmunology (J.W., C.G.), Department of Neurology, Jena University Hospital; Department of Neurology (D.R.), Hannover Medical School; Institute of Neuroimmunology and Multiple Sclerosis (L.K.P.), Center for Molecular Neurobiology Hamburg, University Medical Center Hamburg-Eppendorf; Department of Neurology (S.B., J.P.), University Medical Center of the Johannes Gutenberg University Mainz; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.K.), University Hospital Bochum; German Center for Neurodegenerative Diseases (DZNE) (B.N.), Munich; Metabolic Biochemistry, Faculty of Medicine, Biomedical Center (BMC), Ludwig-Maximilians-Universität München; and Institute of Clinical Neuroimmunology (F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany; Munich Cluster for Sys.
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8
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Heneberg P. Diabetes in stiff-person syndrome. Trends Endocrinol Metab 2023; 34:640-651. [PMID: 37586963 DOI: 10.1016/j.tem.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 08/18/2023]
Abstract
Anti-glutamic acid decarboxylase (GAD) autoantibodies are a hallmark of stiff-person syndrome (SPS) and insulin-dependent diabetes mellitus (IDDM). However, patients with concurrent IDDM and SPS often manifest insulin resistance, and SPS-associated IDDM probably has heterogeneous causes. Some patients manifest IDDM associated only with high titers of anti-GAD65 caused by SPS. By contrast, other patients develop IDDM only after being treated with high-dose corticosteroids or they progress to insulin dependency following their treatment with high-dose corticosteroids. The profile of autoantibodies differs markedly between type 1 diabetes mellitus (T1DM), late-onset diabetes mellitus, and SPS-associated IDDM. Therefore, as with new-onset diabetes after transplantation (NODAT), SPS-associated IDDM should be classified as a specific diabetes entity, the pathophysiology of which requires increased attention.
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Affiliation(s)
- Petr Heneberg
- Charles University, Third Faculty of Medicine, Prague, Czech Republic.
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9
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Rada A, Bien CG. What is autoimmune encephalitis-associated epilepsy? Proposal of a practical definition. Epilepsia 2023; 64:2249-2255. [PMID: 37353891 DOI: 10.1111/epi.17699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 06/25/2023]
Abstract
Seizures resulting from cerebral autoimmunity are either acutely symptomatic in the context of autoimmune encephalitis (AIE) with neural surface antibodies, or they are indicative of an enduring predisposition to seizures, that is, epilepsy. Here, we propose a practical definition for autoimmune encephalitis-associated epilepsy (AEAE): Seizures associated with antibodies against glutamic acid decarboxylase, paraneoplastic syndromes, or Rasmussen encephalitis are classified as AEAE. AEAE secondary to AIE with antibodies against the N-methyl-D-aspartate receptor, leucine-rich glioma inactivated protein 1, contactin-associated protein-2, or γ-aminobutyric acid-B receptor can be diagnosed if the following criteria are met: seizures persist for at least 2 years after immunotherapy initiation; no signs of encephalitis on magnetic resonance imaging and no fluorodeoxyglucose positron emission tomography hypermetabolism; normal cerebrospinal fluid cell count; and a substantial decrease in antibody titers. This classification corresponds to different disease mechanisms. While AIE results from the pathogenic effects of neural antibodies, AEAE is probably the consequence of encephalitis-related tissue damage and thereby mainly structurally mediated. The distinction between AIE and AEAE also has practical consequences: In AIE, immunotherapy is usually highly beneficial, whereas anti-seizure medication has little effect. In AEAE, immunotherapy is less promising and the usual anti-seizure interventions are preferable. In addition, the diagnosis of AEAE has social consequences in terms of driving and professional limitations.
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Affiliation(s)
- Anna Rada
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
| | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Medical School, Bielefeld University, Bielefeld, Germany
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10
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Smith KM, Britton JW, Thakolwiboon S, Chia NH, Gupta P, Flanagan EP, Zekeridou A, Lopez Chiriboga AS, Valencia Sanchez C, McKeon A, Pittock SJ, Dubey D. Seizure characteristics and outcomes in patients with neurological conditions related to high-risk paraneoplastic antibodies. Epilepsia 2023; 64:2385-2398. [PMID: 37366270 DOI: 10.1111/epi.17695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Seizures are a common manifestation of paraneoplastic neurologic syndromes. The objective of this study was to describe the seizure characteristics and outcomes in patients with high-risk paraneoplastic autoantibodies (>70% cancer association) and to determine factors associated with ongoing seizures. METHODS Patients from 2000 to 2020 with seizures and high-risk paraneoplastic autoantibodies were retrospectively identified. Factors associated with ongoing seizures at last follow-up were evaluated. RESULTS Sixty patients were identified (34 males, median age at presentation = 52 years). ANNA1-IgG (Hu; n = 24, 39%), Ma2-IgG (n = 14, 23%), and CRMP5-IgG (CV2; n = 11, 18%) were the most common underlying antibodies. Seizures were the initial presenting symptom in 26 (43%), and malignancy was present in 38 (63%). Seizures persisted for >1 month in 83%, and 60% had ongoing seizures, with almost all patients (55/60, 92%) still being on antiseizure medications at last follow-up a median of 25 months after seizure onset. Ongoing seizures at last follow-up were associated with Ma2-IgG or ANNA1-IgG compared to other antibodies (p = .04), highest seizure frequency being at least daily (p = .0002), seizures on electroencephalogram (EEG; p = .03), and imaging evidence of limbic encephalitis (LE; p = .03). Death occurred in 48% throughout the course of follow-up, with a higher mortality in patients with LE than in those without LE (p = .04). Of 31 surviving patients at last follow-up, 55% continued to have intermittent seizures. SIGNIFICANCE Seizures in the setting of high-risk paraneoplastic antibodies are frequently resistant to treatment. Ongoing seizures are associated with ANNA1-IgG and Ma2-IgG, high seizure frequency, and EEG and imaging abnormalities. Although a subset of patients may respond to immunotherapy and achieve seizure freedom, poor outcomes are frequently encountered. Death was more common among patients with LE.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Nicholas H Chia
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pranjal Gupta
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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11
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Boldrini VO, Brito MR, Quintiliano RPS, Scárdua Silva L, Yasuda CL, Cendes F, Farias AS, Damasceno A. Case report: Granzyme-B expression by T- and B- cells during severe AQP4-positive Neuromyelitis Optica spectrum disorder with fatal venous thromboembolism outcome. Front Neurol 2023; 14:1208977. [PMID: 37662034 PMCID: PMC10470460 DOI: 10.3389/fneur.2023.1208977] [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: 04/20/2023] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background The expression of serine protease granzyme-B (GzmB) by circulating CD8+ T lymphocytes has been recently suggested as a biomarker for poor immunotherapy response and severe disability in patients with Neuromyelitis Optica spectrum disorders (NMOSD). In parallel, venous thromboembolism (VTE) has been reported mainly in NMOSD patients exhibiting transverse myelitis. Case presentation Here, we describe an Aquaporin-4 positive (AQP4-positive) NMOSD patient who showed short myelitis (SM) and experienced a fatal pulmonary thromboembolism/lower extremity deep vein thrombosis during anti-CD20 treatment. Flow cytometry analyses from the peripheral blood revealed an enhanced cytotoxic behavior through circulating CD8+GzmB+ T, CD4+GzmB+ T lymphocytes, and residual CD19+GzmB+ B cells. Conclusions Fatal VTE may be a rare outcome, particularly in patients exhibiting SM, and may share poorly understood immunological mechanisms with AQP4-positive NMOSD severity.
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Affiliation(s)
- Vinícius Oliveira Boldrini
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, São Paulo, Brazil
| | - Mariana Rabelo Brito
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, São Paulo, Brazil
| | - Raphael Patrício Silva Quintiliano
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil
| | - Lucas Scárdua Silva
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, São Paulo, Brazil
| | - Clarissa Lin Yasuda
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, São Paulo, Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, São Paulo, Brazil
| | - Alessandro Santos Farias
- Neuroimmunology Unit, Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil
- Autoimmune Research Laboratory, Department of Genetics, Evolution, Microbiology and Immunology, Institute of Biology, University of Campinas, Campinas, São Paulo, Brazil
| | - Alfredo Damasceno
- Neuroimaging Laboratory, Department of Neurology, University of Campinas, Campinas, São Paulo, Brazil
- Brazilian Institute of Neuroscience and Neurotechnology (BRAINN), University of Campinas, Campinas, São Paulo, Brazil
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12
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Terrabuio E, Zenaro E, Constantin G. The role of the CD8+ T cell compartment in ageing and neurodegenerative disorders. Front Immunol 2023; 14:1233870. [PMID: 37575227 PMCID: PMC10416633 DOI: 10.3389/fimmu.2023.1233870] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
CD8+ lymphocytes are adaptive immunity cells with the particular function to directly kill the target cell following antigen recognition in the context of MHC class I. In addition, CD8+ T cells may release pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and a plethora of other cytokines and chemoattractants modulating immune and inflammatory responses. A role for CD8+ T cells has been suggested in aging and several diseases of the central nervous system (CNS), including Alzheimer's disease, Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis, limbic encephalitis-induced temporal lobe epilepsy and Susac syndrome. Here we discuss the phenotypic and functional alterations of CD8+ T cell compartment during these conditions, highlighting similarities and differences between CNS disorders. Particularly, we describe the pathological changes in CD8+ T cell memory phenotypes emphasizing the role of senescence and exhaustion in promoting neuroinflammation and neurodegeneration. We also discuss the relevance of trafficking molecules such as selectins, mucins and integrins controlling the extravasation of CD8+ T cells into the CNS and promoting disease development. Finally, we discuss how CD8+ T cells may induce CNS tissue damage leading to neurodegeneration and suggest that targeting detrimental CD8+ T cells functions may have therapeutic effect in CNS disorders.
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Affiliation(s)
- Eleonora Terrabuio
- Department of Medicine, Section of General Pathology, University of Verona, Verona, Italy
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13
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Gallus M, Roll W, Dik A, Barca C, Zinnhardt B, Hicking G, Mueller C, Naik VN, Anstötz M, Krämer J, Rolfes L, Wachsmuth L, Pitsch J, van Loo KM, Räuber S, Okada H, Wimberley C, Strippel C, Golombeck KS, Johnen A, Kovac S, Groß CC, Backhaus P, Seifert R, Lewerenz J, Surges R, Elger CE, Wiendl H, Ruck T, Becker AJ, Faber C, Jacobs AH, Bauer J, Meuth SG, Schäfers M, Melzer N. Translational imaging of TSPO reveals pronounced innate inflammation in human and murine CD8 T cell-mediated limbic encephalitis. SCIENCE ADVANCES 2023; 9:eabq7595. [PMID: 37294768 PMCID: PMC10256169 DOI: 10.1126/sciadv.abq7595] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 05/08/2023] [Indexed: 06/11/2023]
Abstract
Autoimmune limbic encephalitis (ALE) presents with new-onset mesial temporal lobe seizures, progressive memory disturbance, and other behavioral and cognitive changes. CD8 T cells are considered to play a key role in those cases where autoantibodies (ABs) target intracellular antigens or no ABs were found. Assessment of such patients presents a clinical challenge, and novel noninvasive imaging biomarkers are urgently needed. Here, we demonstrate that visualization of the translocator protein (TSPO) with [18F]DPA-714-PET-MRI reveals pronounced microglia activation and reactive gliosis in the hippocampus and amygdala of patients suspected with CD8 T cell ALE, which correlates with FLAIR-MRI and EEG alterations. Back-translation into a preclinical mouse model of neuronal antigen-specific CD8 T cell-mediated ALE allowed us to corroborate our preliminary clinical findings. These translational data underline the potential of [18F]DPA-714-PET-MRI as a clinical molecular imaging method for the direct assessment of innate immunity in CD8 T cell-mediated ALE.
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Affiliation(s)
- Marco Gallus
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurosurgery, University of Münster, Münster, Germany
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | - Wolfgang Roll
- Department of Nuclear Medicine, University of Münster, Münster, Germany
| | - Andre Dik
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Cristina Barca
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Bastian Zinnhardt
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
- Biomarkers and Translational Technologies (BTT), Pharma Research and Early Development (pRED), F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Gordon Hicking
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Christoph Mueller
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Venu Narayanan Naik
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Max Anstötz
- Institute of Anatomy II, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Julia Krämer
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Leoni Rolfes
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Lydia Wachsmuth
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Julika Pitsch
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Karen M. J. van Loo
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
- Department of Epileptology and Neurology, RWTH Aachen University, Aachen, Germany
| | - Saskia Räuber
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Hideho Okada
- Department of Neurosurgery, University of California, San Francisco, San Francisco, CA, USA
| | | | - Christine Strippel
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Kristin S. Golombeck
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Andreas Johnen
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Catharina C. Groß
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Philipp Backhaus
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Rainer Surges
- Department of Epileptology, University of Bonn, Bonn, Germany
| | | | - Heinz Wiendl
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Tobias Ruck
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Albert J. Becker
- Section for Translational Epilepsy Research, Department of Neuropathology, University of Bonn, Bonn, Germany
| | - Cornelius Faber
- Department of Clinical Radiology, University of Münster, Münster, Germany
| | - Andreas H. Jacobs
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Jan Bauer
- Department of Neuroimmunology, Centre for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Sven G. Meuth
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Michael Schäfers
- Department of Nuclear Medicine, University of Münster, Münster, Germany
- European Institute for Molecular Imaging, University of Münster, Münster, Germany
| | - Nico Melzer
- Department of Neurology Institute of Translational Neurology, University of Münster, Münster, Germany
- Department of Neurology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
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14
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Biljecki M, Eisenhut K, Beltrán E, Winklmeier S, Mader S, Thaller A, Eichhorn P, Steininger P, Flierl-Hecht A, Lewerenz J, Kümpfel T, Kerschensteiner M, Meinl E, Thaler FS. Antibodies Against Glutamic Acid Decarboxylase 65 Are Locally Produced in the CSF and Arise During Affinity Maturation. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200090. [PMID: 36823135 PMCID: PMC9969496 DOI: 10.1212/nxi.0000000000200090] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 12/12/2022] [Indexed: 02/25/2023]
Abstract
BACKGROUND AND OBJECTIVES Antibodies (Abs) against the cytoplasmic protein glutamic acid decarboxylase 65 (GAD65) are detected in patients with neurologic syndromes together referred to as GAD65-Ab spectrum disorders. The response of some of these patients to plasma exchange or immunoglobulins indicates that GAD65-Abs could contribute to disease pathogenesis at least at some stages of disease. However, the involvement of GAD65-reactive B cells in the CNS is incompletely understood. METHODS We studied 7 patients with high levels of GAD65-Abs and generated monoclonal Abs (mAbs) derived from single cells in the CSF. Sequence characteristics, reactivity to GAD65, and the role of somatic hypermutations of the mAbs were analyzed. RESULTS Twelve CSF-derived mAbs were generated originating from 3 patients with short disease duration, and 7/12 of these mAbs (58%) were GAD65 reactive in at least 1 detection assay. Four of 12 (33%) were definitely positive in all 3 detection assays. The intrathecal anti-GAD65 response was polyclonal. GAD65-Abs were mostly of the IgG1 subtype and had undergone affinity maturation. Reversion of 2 GAD65-reactive mAbs to their corresponding germline-encoded unmutated common ancestors abolished GAD65 reactivity. DISCUSSION GAD65-specific B cells are present in the CNS and represent a sizable fraction of CSF B cells early in the disease course. The anti-GAD65 response in the CSF is polyclonal and shows evidence of antigen-driven affinity maturation required for GAD65 recognition. Our data support the hypothesis that the accumulation of GAD65-specific B cells and plasma cells in the CSF is an important feature of early disease stages.
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Affiliation(s)
- Michelle Biljecki
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Katharina Eisenhut
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Eduardo Beltrán
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Stephan Winklmeier
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Simone Mader
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Anna Thaller
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Peter Eichhorn
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Philipp Steininger
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Andrea Flierl-Hecht
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Jan Lewerenz
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Tania Kümpfel
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Martin Kerschensteiner
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Edgar Meinl
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany
| | - Franziska S Thaler
- From the Institute of Clinical Neuroimmunology (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), University Hospital, Ludwig-Maximilians-Universität Munich; Biomedical Center (BMC) (M.B., K.E., E.B., S.W., S.M., A.T., A.F.-H., T.K., M.K., E.M., F.S.T.), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried; Graduate School of Systemic Neurosciences Ludwig-Maximilians-Universität Munich (M.B., K.E.); Munich Cluster for Systems Neurology (SyNergy) (E.B., M.K., F.S.T.); Innate Immunity Unit (A.T.), Institut Pasteur, Inserm U1223, Paris, France; Université de Paris (A.T.), Sorbonne Paris Cité, France; Institute of Laboratory Medicine (P.E.), University Hospital, LMU Munich; Institute of Clinical and Molecular Virology (P.S.), University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg; and Department of Neurology (J.L.), University Hospital Ulm, Germany.
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15
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Budhram A, Burneo JG. Acute symptomatic seizures, epilepsy, and autoimmune encephalitis: Clarifying terminology in neural antibody-associated disease. Epilepsia 2023; 64:306-310. [PMID: 36471647 PMCID: PMC10107142 DOI: 10.1111/epi.17478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
- Neuroepidemiology Unit, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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