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Qin S, Wang Y. Anti-IgLON5 disease with severe central sleep apnea-hypopnea syndrome: A case report. Heliyon 2024; 10:e36451. [PMID: 39296154 PMCID: PMC11408130 DOI: 10.1016/j.heliyon.2024.e36451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/30/2024] [Accepted: 08/15/2024] [Indexed: 09/21/2024] Open
Abstract
Anti-IgLON family protein 5 (IgLON5) antibody-related encephalitis is a rare but increasingly recognized central nervous system autoimmune disease. It displays heterogeneity in clinical presentation. As the clinical case repository expands, our understanding of the disease's clinical phenotypes and therapeutic approaches continues to evolve. This report details a 73-year-old male's case, initially misdiagnosed with narcolepsy due to excessive daytime sleepiness and sleep-related involuntary behaviors, but later found to have severe respiratory disturbances, diverging from narcolepsy. During treatment, the patient's condition progressed to respiratory failure, necessitating further investigation. Diagnosis was confirmed through positive serum and cerebrospinal fluid (CSF) tests for anti-IgLON5 antibodies. Treatment with continuous positive airway pressure (CPAP), immunoglobulin pH4, and corticosteroids significantly improved his condition. This case underscores the critical need for awareness of anti-IgLON5 encephalitis within the differential diagnosis of complex sleep disorders, highlighting its potential for severe progression and the challenges associated with its diagnosis.
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Affiliation(s)
- Shiyuan Qin
- Department of Neurology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650031, China
| | - Ying Wang
- Department of Neurology, The Second Affiliated Hospital of Kunming Medical University, Kunming, 650031, China
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2
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Yeo JY, Goh Y, Lim HF, Chan YC, Quek AM. Anti-IgLON5 Disease Presenting with Esophageal Achalasia and Hypercapnic Respiratory Failure. Am J Med 2024:S0002-9343(24)00503-5. [PMID: 39142359 DOI: 10.1016/j.amjmed.2024.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/01/2024] [Accepted: 08/02/2024] [Indexed: 08/16/2024]
Affiliation(s)
- Joshua Yp Yeo
- Department of Medicine, National University Hospital, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Hui Fang Lim
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore; Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
| | - Yee Cheun Chan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Amy Ml Quek
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
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Qi Y, Zheng Y, Cai Z, Zhang X. Anti-IgLON5 disease: A case with intestinal obstruction and peripheral neuropathy. Am J Med Sci 2024:S0002-9629(24)01392-2. [PMID: 39117033 DOI: 10.1016/j.amjms.2024.07.035] [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: 05/08/2024] [Revised: 07/27/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
IgLON5 autoimmunity is a novel antibody-mediated disorder characterized by serum and/or cerebrospinal fluid (CSF) positivity for IgLON5 antibody. Anti-IgLON5 disease mainly manifests as sleep disturbances, movement disorders and brainstem syndromes. In this study, we report the case of a patient with anti-IgLON5 disease who presented with abdominal distension, abdominal pain, intermittent dysuria and constipation, and intermittent lightning pain in the extremities, which are atypical of anti-IgLON5 disease and could easily lead to misdiagnosis. After performing autoantibody screening, we considered anti-IgLON5 disease. The patient was started on a course of immunotherapy with intravenous dexamethasone, intravenous immunoglobulin (IVIG) and oral azathioprine (Imuran). Following treatment, the manifestations nearly resolved. The clinical manifestations of anti-IgLON5 disease are diverse and may present in different combinations, which can easily lead to misdiagnosis. Early recognition and treatment of this autoimmune disease with immunosuppressive agents may lead to better outcomes.
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Affiliation(s)
- Yunwen Qi
- Department of Neurology, Chongqing General Hospital, Chongqing University, Chongqing Key Laboratory of Neurodegenerative Disease, Chongqing, China
| | - Yongling Zheng
- Department of Neurology, Chongqing General Hospital, Chongqing University, Chongqing Key Laboratory of Neurodegenerative Disease, Chongqing, China
| | - Zhiyou Cai
- Department of Neurology, Chongqing General Hospital, Chongqing University, Chongqing Key Laboratory of Neurodegenerative Disease, Chongqing, China
| | - Xiaogang Zhang
- Department of Neurology, Chongqing General Hospital, Chongqing University, Chongqing Key Laboratory of Neurodegenerative Disease, Chongqing, China.
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4
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Sato D, Sato H, Kondo T, Igari R, Iseki C, Kawahara H, Amano S, Ono Y, Kimura A, Shimohata T, Ohta Y. Anti-IgLON5 Disease Showing an Improvement in Dysautonomia, Including Vocal Cord Palsy, via Combined Immunotherapy. Intern Med 2024; 63:2187-2191. [PMID: 38171876 PMCID: PMC11358744 DOI: 10.2169/internalmedicine.2865-23] [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: 09/02/2023] [Accepted: 11/05/2023] [Indexed: 01/05/2024] Open
Abstract
Anti-IgLON5 disease shows various neurological manifestations, of which dysautonomia is one of the major symptoms and is rarely improved by immunotherapy. We herein report a patient with anti-IgLON5 disease who showed several autonomic failures, including vocal cord palsy for four months. The patient presented with cognitive impairments, bulbar symptoms accompanied by myorhythmia in the pharynx and tongue, cerebellar ataxia with tremor, motor neuron symptoms in the limbs, gastrointestinal dysfunction, orthostatic hypotension, non-rapid eye movement sleep disorder on polysomnography, and severe vocal cord palsy. Combined immunotherapy improved his symptoms, including vocal cord palsy, suggesting that combined immunotherapy might improve dysautonomia in anti-IgLON5 disease.
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Affiliation(s)
- Daisuke Sato
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
| | - Hiroyasu Sato
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
| | - Toshiyuki Kondo
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
| | - Ryosuke Igari
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
| | - Chifumi Iseki
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
| | - Hikaru Kawahara
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
| | - Shintaro Amano
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University School of Medicine, Japan
| | - Yoya Ono
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Japan
| | | | - Yasuyuki Ohta
- Division of Neurology and Clinical Neuroscience, Department of Internal Medicine III, Yamagata University School of Medicine, Japan
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5
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Andersen J, Jeffrey B, Varikatt W, Rodriguez M, Lin MW, Brown DA. IgLON5-IgG: Innocent Bystander or Perpetrator? Int J Mol Sci 2024; 25:7956. [PMID: 39063198 PMCID: PMC11276813 DOI: 10.3390/ijms25147956] [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: 05/08/2024] [Revised: 07/18/2024] [Accepted: 07/18/2024] [Indexed: 07/28/2024] Open
Abstract
Anti-IgLON5 (IgLON5-IgG)-associated disease is a newly defined clinical entity. This literature review aims to evaluate its pathogenesis, which remains a pivotal question. Features that favour a primary neurodegenerative mechanism include the non-inflammatory tauopathy neuropathological signature and overrepresentation of microtubule-associated protein tau (MAPT) H1/H1 genotype as seen in other sporadic tauopathies. In contrast, the cell-surface localisation of IgLON5, capability of anti-IgLON5 antibodies to exert direct in vitro pathogenicity and disrupt IgLON5 interactions with its binding partners, human leukocyte antigen (HLA)-DRB1*10:01 and HLA-DQB1*05:01 allele preponderance with high affinity binding of IgLON5 peptides, and responsiveness to immunotherapy favour a primary autoimmune process. The presentation and course of anti-IgLON5-associated disease is heterogenous; hence, we hypothesise that a multitude of immune mechanisms are likely simultaneously operational in this disease cohort.
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Affiliation(s)
- Jane Andersen
- Department of Immunology, NSW Health Pathology-ICPMR, Westmead Hospital, Sydney, NSW 2145, Australia; (B.J.); (M.-W.L.); (D.A.B.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (W.V.); (M.R.)
| | - Bronte Jeffrey
- Department of Immunology, NSW Health Pathology-ICPMR, Westmead Hospital, Sydney, NSW 2145, Australia; (B.J.); (M.-W.L.); (D.A.B.)
- Faculty of Medicine, Western Sydney University, Sydney, NSW 2751, Australia
| | - Winny Varikatt
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (W.V.); (M.R.)
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology-ICPMR, Westmead Hospital, Sydney, NSW 2145, Australia
| | - Michael Rodriguez
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (W.V.); (M.R.)
- Douglass Hanly Moir Pathology, Sydney, NSW 2000, Australia
| | - Ming-Wei Lin
- Department of Immunology, NSW Health Pathology-ICPMR, Westmead Hospital, Sydney, NSW 2145, Australia; (B.J.); (M.-W.L.); (D.A.B.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (W.V.); (M.R.)
| | - David A. Brown
- Department of Immunology, NSW Health Pathology-ICPMR, Westmead Hospital, Sydney, NSW 2145, Australia; (B.J.); (M.-W.L.); (D.A.B.)
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2050, Australia; (W.V.); (M.R.)
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6
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Xue J, Song Z, Zhao H, Yi Z, Li F, Yang C, Liu K, Zhang Y. A rare pediatric patient of anti-IgLON5 encephalitis with epileptic seizures as the first symptom. Int J Dev Neurosci 2024. [PMID: 39003610 DOI: 10.1002/jdn.10364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 06/13/2024] [Accepted: 07/04/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Anti-IgLON5 encephalitis was a rare neurological and heterogeneous disorder, which was mainly found in adults. Epileptic seizures related to anti-IgLON5 disease were rarely reported. METHODS Neural antibodies associated with autoimmune encephalitis in serum and cerebrospinal fluid (CSF) were tested using cell-based assays (CBA) with immunofluorescence double staining. The antibodies in serum were further confirmed by tissue-based assay (TBA) with rat brain and kidney tissue. RESULTS We reported a pediatric case presented with epileptic seizures, cognitive impairments, and sleep disorders. Autoantibody screening showed anti-IgLON5 antibody IgG (1:100+) and anti-NMDAR antibody IgG (1:10+) in the serum. She was diagnosed as anti-IgLON5 encephalitis. Her conditions improved rapidly by treated with intravenous immunoglobulin and high dose intravenous methylprednisolone. CONCLUSION We described the second pediatric case with anti-IgLON5 encephalitis, who was also the first presented with epileptic seizures as the initial presentation. Anti-IgLON5 encephalitis might have mild manifestations. For patients with new onset seizures associated with cognitive impairments and sleep disturbances, anti-IgLON5 antibody should be tested as early, even in children.
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Affiliation(s)
- Jiao Xue
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhenfeng Song
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Hongshan Zhao
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zhi Yi
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Fei Li
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chengqing Yang
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kaixuan Liu
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Zhang
- Department of Pediatric Neurology, The Affiliated Hospital of Qingdao University, Qingdao, China
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7
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Yogeshwar SM, Muñiz-Castrillo S, Sabater L, Peris-Sempere V, Mallajosyula V, Luo G, Yan H, Yu E, Zhang J, Lin L, Fagundes Bueno F, Ji X, Picard G, Rogemond V, Pinto AL, Heidbreder A, Höftberger R, Graus F, Dalmau J, Santamaria J, Iranzo A, Schreiner B, Giannoccaro MP, Liguori R, Shimohata T, Kimura A, Ono Y, Binks S, Mariotto S, Dinoto A, Bonello M, Hartmann CJ, Tambasco N, Nigro P, Prüss H, McKeon A, Davis MM, Irani SR, Honnorat J, Gaig C, Finke C, Mignot E. HLA-DQB1*05 subtypes and not DRB1*10:01 mediates risk in anti-IgLON5 disease. Brain 2024; 147:2579-2592. [PMID: 38425314 PMCID: PMC11224611 DOI: 10.1093/brain/awae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/09/2023] [Accepted: 01/21/2024] [Indexed: 03/02/2024] Open
Abstract
Anti-IgLON5 disease is a rare and likely underdiagnosed subtype of autoimmune encephalitis. The disease displays a heterogeneous phenotype that includes sleep, movement and bulbar-associated dysfunction. The presence of IgLON5-antibodies in CSF/serum, together with a strong association with HLA-DRB1*10:01∼DQB1*05:01, supports an autoimmune basis. In this study, a multicentric human leukocyte antigen (HLA) study of 87 anti-IgLON5 patients revealed a stronger association with HLA-DQ than HLA-DR. Specifically, we identified a predisposing rank-wise association with HLA-DQA1*01:05∼DQB1*05:01, HLA-DQA1*01:01∼DQB1*05:01 and HLA-DQA1*01:04∼DQB1*05:03 in 85% of patients. HLA sequences and binding cores for these three DQ heterodimers were similar, unlike those of linked DRB1 alleles, supporting a causal link to HLA-DQ. This association was further reflected in an increasingly later age of onset across each genotype group, with a delay of up to 11 years, while HLA-DQ-dosage dependent effects were also suggested by reduced risk in the presence of non-predisposing DQ1 alleles. The functional relevance of the observed HLA-DQ molecules was studied with competition binding assays. These proof-of-concept experiments revealed preferential binding of IgLON5 in a post-translationally modified, but not native, state to all three risk-associated HLA-DQ receptors. Further, a deamidated peptide from the Ig2-domain of IgLON5 activated T cells in two patients, compared with one control carrying HLA-DQA1*01:05∼DQB1*05:01. Taken together, these data support a HLA-DQ-mediated T-cell response to IgLON5 as a potentially key step in the initiation of autoimmunity in this disease.
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Affiliation(s)
- Selina M Yogeshwar
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
- Einstein Center for Neurosciences Berlin, Charité—Universitätsmedizin Berlin, 10117 Berlin, Germany
| | - Sergio Muñiz-Castrillo
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Lidia Sabater
- Neuroimmunology Program, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Caixa Research Institute, Universitat de Barcelona, 08036, Barcelona, Spain
| | - Vicente Peris-Sempere
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Vamsee Mallajosyula
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Guo Luo
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Han Yan
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Eric Yu
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Jing Zhang
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Ling Lin
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Flavia Fagundes Bueno
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Xuhuai Ji
- Human Immune Monitoring Center, Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Géraldine Picard
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, 69677, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Véronique Rogemond
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, 69677, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Anne Laurie Pinto
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, 69677, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Anna Heidbreder
- Kepler University Hospital, Department of Neurology, Johannes Kepler University, 4020 Linz, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, 1090 Vienna, Austria
| | - Francesc Graus
- Neurology Service, Hospital Clínic of Barcelona, Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Josep Dalmau
- Neurology Service, Hospital Clínic of Barcelona, Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), 08010 Barcelona, Spain
- Department of Neurology, University of Pennsylvania, Philadelphia, PA 19104, USA
- Spanish National Network for Research on Rare Diseases (CIBERER), 28029 Madrid, Spain
| | - Joan Santamaria
- Neurology Service, Hospital Clínic of Barcelona, Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Hospital Clínic of Barcelona, Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Bettina Schreiner
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland
- Institute of Experimental Immunology, University of Zurich, 8057 Zurich, Switzerland
| | - Maria Pia Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40100 Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, 40139 Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, 40100 Bologna, Italy
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, 501-1194 Gifu, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, 501-1194 Gifu, Japan
| | - Yoya Ono
- Department of Neurology, Gifu University Graduate School of Medicine, 501-1194 Gifu, Japan
| | - Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford OX3 9DU, UK
- Department of Neurology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37124 Verona, Italy
| | - Alessandro Dinoto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37124 Verona, Italy
| | - Michael Bonello
- Department of Neurology, The Walton Centre NHS Foundation Trust, L9 7LJ, Liverpool, UK
| | - Christian J Hartmann
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, 40225 Düsseldorf, Germany
| | - Nicola Tambasco
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, 06156 Perugia, Italy
| | - Pasquale Nigro
- Movement Disorders Center, Neurology Department, Perugia General Hospital and University of Perugia, 06156 Perugia, Italy
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE) Berlin, 10117 Berlin, Germany
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mark M Davis
- Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA 94305, USA
- Department of Microbiology and Immunology, Stanford University School of Medicine, Stanford, CA 94305, USA
- Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Sarosh R Irani
- Department of Neurology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndrome and Autoimmune Encephalitis, Hospices Civils de Lyon, 69677, Lyon, France
- Institut MeLiS INSERM U1314/CNRS UMR 5284, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Biomedical Research Institute (IDIBAPS), 08036 Barcelona, Spain
| | - Carsten Finke
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, 10117, Berlin, Germany
- Berlin Center for Advanced Neuroimaging, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Emmanuel Mignot
- Stanford Center for Sleep Sciences and Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
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8
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Zandiehvakili M, Cui CK, Jeffrey B, Chang FCF, Emerson J, Conyngham S. Atypical brain MRI findings in a patient with treatment responsive anti-IgLON5 disease. Radiol Case Rep 2024; 19:2613-2616. [PMID: 38645962 PMCID: PMC11026686 DOI: 10.1016/j.radcr.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/23/2024] Open
Abstract
Anti-IgLON5 disease is a rare autoimmune neurological condition which was relatively recently described in the literature. This syndrome encompasses a range of clinical manifestations with most cases showing unremarkable findings on brain magnetic resonance imaging (MRI). Here, we report a case of a 61-year-old female patient with unique brain MRI features that, to the best of our knowledge, has not been reported in the literature before. Following treatment including immunotherapy, the patient experienced significant improvement clinically accompanied by radiological improvement on the follow-up imaging.
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Affiliation(s)
| | - Cathy Kexin Cui
- Department of Neurology, Westmead hospital, Sydney, Australia
| | - Bronte Jeffrey
- Department of Immunology, Westmead hospital, Sydney, Australia
- Institute of clinical pathology and medical research, Sydney, Australia
| | | | - Jonathan Emerson
- Department of Immunology, Westmead hospital, Sydney, Australia
- Institute of clinical pathology and medical research, Sydney, Australia
- Westmead institute of medical research, Westmead hospital, Sydney, Australia
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9
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Cincotta MC, Walker RH. Recent advances in non-Huntington's disease choreas. Parkinsonism Relat Disord 2024; 122:106045. [PMID: 38378310 DOI: 10.1016/j.parkreldis.2024.106045] [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: 01/30/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
INTRODUCTION Chorea is primarily due to an imbalance of basal ganglia output pathways, often due to dysfunction or degeneration of the caudate nucleus and putamen, and can be due to many causes. METHODS We reviewed the recent literature to identify newly-recognized causes of chorea, including auto-immune, metabolic, and genetic. We also focused upon developments in mechanisms relating to underlying pathophysiology of certain genetic choreas and advances in therapeutics. RESULTS Novel autoantibodies continue to be identified as causes of chorea. Both COVID-19 infection and vaccination are reported to result rarely in chorea, although in some cases causality is not clearly established. Advances in genetic testing continue to find more causes of chorea, and to expand the phenotype of known genetic disorders. Deep brain stimulation can be successful in certain circumstances. CONCLUSION Our understanding of mechanisms underlying this movement disorder continues to advance, however much remains to be elucidated.
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Affiliation(s)
- Molly C Cincotta
- Department of Neurology, Temple University, Philadelphia, PA, USA
| | - Ruth H Walker
- Department of Neurology, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA; Department of Neurology, Mount Sinai School of Medicine, New York City, NY, USA.
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10
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McWilliam O, Gramkow MH, Blaabjerg M, Clemmensen FK, Hasselbalch SG, Frederiksen KS. Differentiating anti-IgLON5 disease and Lewy body dementia: a systematic review. J Neurol 2024; 271:1707-1716. [PMID: 38195895 DOI: 10.1007/s00415-023-12145-8] [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: 10/24/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND Anti-IgLON5 disease is a rare but potentially reversible cause of cognitive impairment, sleep disturbances, dysautonomia, and movement disorders. It is an autoimmune encephalitis which, due to its insidious onset, could mimic neurodegenerative disorders, and multiple symptoms overlap with those seen in dementia with Lewy bodies (DLB). We hypothesized that the symptomatology and findings in patients with anti-IgLON5 disease overlapped with that of DLB. OBJECTIVES To assess the commonality of features in anti-IgLON5 disease and DLB and identify potential red flags for anti-IgLON5 disease in patients undergoing diagnostic evaluation for DLB. METHODS We searched in MEDLINE, Web of Science, and Embase from inception on December the 8th, 2022 with the search term "IgLON5". We performed a systematic review of case reports and case series of anti-IgLON5 disease, and two reviewers independently extracted data on symptoms and findings. Frequencies of symptoms were compared with consensus criteria for DLB. RESULTS We included 57 studies with 127 individual case reports of anti-IgLON5 disease (mean age 63 years at diagnosis, median symptom duration 2 years). Cognitive dysfunction was reported in 45% of cases, REM-sleep behavioral disorder in 15%, and 14% had parkinsonism. Respiratory insufficiency was reported in 37%, and bulbar symptoms in 67%. CONCLUSIONS We found a significant overlap between anti-IgLON5 disease and DLB. We propose that anti-IgLON5 disease should be considered in young patients with DLB with chorea, gaze palsy, early dysphagia, or prominent respiratory symptoms. Our study contributes to the emerging knowledge on symptoms and biomarkers in anti-IgLON5 disease.
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Affiliation(s)
- Oskar McWilliam
- Danish Dementia Research Centre, Deptartment of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Mathias H Gramkow
- Danish Dementia Research Centre, Deptartment of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Blaabjerg
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Frederikke Kragh Clemmensen
- Danish Dementia Research Centre, Deptartment of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Steen G Hasselbalch
- Danish Dementia Research Centre, Deptartment of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Steen Frederiksen
- Danish Dementia Research Centre, Deptartment of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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11
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Tian Y, Han L, Lenahan C, Wang T, Tian T, Liu R, Liu L, Huang J, Wang L, Hu X. Coexistence of anti-NMDAR and anti-IgLON5 antibodies in an autoimmune encephalitis patient: The first case report. Heliyon 2024; 10:e26659. [PMID: 38449620 PMCID: PMC10915512 DOI: 10.1016/j.heliyon.2024.e26659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/27/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024] Open
Abstract
Background The coexistence of autoimmune encephalitis (AE) with multiple neural auto-antibodies is of great clinical significance because overlying antibodies may cause superposition or variation of clinical syndrome, which increases the difficulty of diagnosis and treatment of the disease. To the best of our knowledge, the coexistence of anti-N-methyl d-aspartate Receptor (NMDAR) and anti-IgLON5 antibodies in AE has not been published previously. Case presentation A 38-year-old female patient presented to our hospital due to headache and abnormal psychiatric behavior. Based on her clinical manifestations (psychiatric and behavioral abnormalities, involuntary limb movements, and sleep disorders) and laboratory assessment results (positive human leukocyte antigen (HLA)-DQB1*05:01 haplotype, anti-NMDAR, and anti-IgLON5 antibodies), she was diagnosed as AE with coexisting anti-NMDAR and anti-IgLON5 antibodies. After treatment with intravenous methylprednisolone and immunoglobulin, as well as plasmapheresis, her symptoms gradually improved with exception for the sleep disorders. Although oral prednisone acetate and mycophenolate mofetil were continued after discharge, her symptoms of sleep disorders did not improve at 6-month follow-up. Conclusion This is the first case of AE co-existing with anti-NMDAR and anti-IgLON5 antibodies. Co-existence of neural auto-antibodies should be considered when patients present with overlapping or atypical symptoms. Special attention should be paid to the treatment of these patients as some anti-IgLON5 encephalitis patients may not benefit from immunotherapy treatment.
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Affiliation(s)
- Yu Tian
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Lu Han
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Cameron Lenahan
- Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Tao Wang
- Department of Imaging Department, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Tian Tian
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Rui Liu
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Lijuan Liu
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Jian Huang
- Zunyi Medical University, Zunyi, 563000, China
| | - Lu Wang
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Xiao Hu
- Department of Neurology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
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12
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Chen Y, Chen J, Pei Z, Qian W. Atypical neurological manifestations in anti-IgLON5 disease: a case report. Front Neurol 2024; 15:1340284. [PMID: 38450066 PMCID: PMC10915776 DOI: 10.3389/fneur.2024.1340284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/31/2024] [Indexed: 03/08/2024] Open
Abstract
Anti-IgLON5 disease is a recently discovered autoimmune encephalopathy with sleep disorder as a hallmark in the majority of reported cases. Additional neurological manifestations include bulbar dysfunction, gait problems, movement disorders, oculomotor abnormalities, and hyperexcitability of the nervous system. At present, an increasing number of publications have dealt with the course and possible treatment options for anti-IgLON5 disease, and its clinical spectrum has expanded wider and more heterogeneous. Here, we report a case of a 66-year-old female with cognitive impairment accompanied by slow reaction, impaired memory, and decreased orientation. A positive cerebral MRI change and serum and cerebrospinal fluid (CSF) antibodies against IgLON5 were found during the diagnostic course. Subsequently the patient received immunotherapy and was generally in good health with no new symptoms during follow-up. Early testing for IgLON5 antibodies should be considered in patients with atypical neurological symptoms such as cognitive impairment, slow reaction, or decreased orientation. In clinical practice, immunotherapy should be considered in all cases of anti-IgLON5 encephalopathies.
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Affiliation(s)
- Yun Chen
- Department of General Practice, The First People’s Hospital of Hangzhou Lin’an District, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jingyao Chen
- Department of General Practice, The First People’s Hospital of Hangzhou Lin’an District, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhaohua Pei
- Department of Emergency Medicine, The First People’s Hospital of Hangzhou Lin’an District, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wei Qian
- Department of General Practice, The First People’s Hospital of Hangzhou Lin’an District, Hangzhou Medical College, Hangzhou, Zhejiang, China
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13
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Luo Y, Xiao J, Li J. The psychiatric symptoms in anti-IgLON5 disease: Case report and literature review. Clin Case Rep 2024; 12:e8310. [PMID: 38223519 PMCID: PMC10784753 DOI: 10.1002/ccr3.8310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/11/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024] Open
Abstract
Immunotherapy may be ineffective in the advanced stages of anti-IgLON5 disease with psychiatric symptoms. The psychiatric symptoms in advanced stages of anti-IgLON5 disease may be associated with neurodegeneration.
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Affiliation(s)
- Yuanyuan Luo
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Key Laboratory of Psychosomatic MedicineChinese Academy of Medical SciencesChengduChina
| | - Jun Xiao
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Key Laboratory of Psychosomatic MedicineChinese Academy of Medical SciencesChengduChina
| | - Jieying Li
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's HospitalUniversity of Electronic Science and Technology of ChinaChengduChina
- Key Laboratory of Psychosomatic MedicineChinese Academy of Medical SciencesChengduChina
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14
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Necpál J, Borsek M, Jeleňová B. PSP-Richardson syndrome mimics: An overview and pragmatic approach. Rev Neurol (Paris) 2024; 180:12-23. [PMID: 37543508 DOI: 10.1016/j.neurol.2023.02.070] [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: 07/12/2022] [Revised: 01/09/2023] [Accepted: 02/03/2023] [Indexed: 08/07/2023]
Abstract
Progressive supranuclear palsy-Richardson syndrome (PSP-RS) is a sporadic atypical parkinsonian syndrome with levodopa-unresponsive axial-predominant parkinsonism, early postural instability, vertical supranuclear gaze palsy, dysarthria, executive dysfunction and behavioural changes. PSP-RS can be mimicked by numbers of other disorders, generally known as PSP mimics, or PSP-like syndromes. Their aetiological spectrum includes neurodegenerative (mostly genetic), vascular, infectious and drug-induced illnesses as well as other causes. Based on the available data, we have tried to create a definition of PSP-RS mimics: a syndrome resembling PSP-RS with at least one of the following red flags: 1) positive family history; 2) onset before 45 years of age; 3) rapid or stepwise progression; 4) acute or subacute onset; 5) atypical symptoms and/or signs; 6) normal or atypical brain MRI; 7) history of HIV or untreated syphilis, aortal surgery or recent therapy with dopamine-blocking agents. We have suggested a short diagnostic algorithm leading to the identification of PSP-RS mimics and the recommended diagnostic work-up. The key point of the diagnostic process is the early identification and treatment of potentially treatable PSP-RS mimics.
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Affiliation(s)
- J Necpál
- 2nd Department of Neurology, Faculty of Medicine, Comenius University, Bratislava, Slovakia; Department of Neurology, Zvolen Hospital, Kuzmányho nábrežie, 28, 960 01 Zvolen, Slovakia.
| | - M Borsek
- Department of Neurology, Zvolen Hospital, Kuzmányho nábrežie, 28, 960 01 Zvolen, Slovakia
| | - B Jeleňová
- Department of Neurology, Zvolen Hospital, Kuzmányho nábrežie, 28, 960 01 Zvolen, Slovakia
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15
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Pandey R, Bakay M, Hakonarson H. SOCS-JAK-STAT inhibitors and SOCS mimetics as treatment options for autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis. Front Immunol 2023; 14:1271102. [PMID: 38022642 PMCID: PMC10643230 DOI: 10.3389/fimmu.2023.1271102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
Autoimmune diseases arise from atypical immune responses that attack self-tissue epitopes, and their development is intricately connected to the disruption of the JAK-STAT signaling pathway, where SOCS proteins play crucial roles. Conditions such as autoimmune uveitis, psoriasis, lupus, and autoimmune encephalitis exhibit immune system dysfunctions associated with JAK-STAT signaling dysregulation. Emerging therapeutic strategies utilize JAK-STAT inhibitors and SOCS mimetics to modulate immune responses and alleviate autoimmune manifestations. Although more research and clinical studies are required to assess their effectiveness, safety profiles, and potential for personalized therapeutic approaches in autoimmune conditions, JAK-STAT inhibitors and SOCS mimetics show promise as potential treatment options. This review explores the action, effectiveness, safety profiles, and future prospects of JAK inhibitors and SOCS mimetics as therapeutic agents for psoriasis, autoimmune uveitis, systemic lupus erythematosus, and autoimmune encephalitis. The findings underscore the importance of investigating these targeted therapies to advance treatment options for individuals suffering from autoimmune diseases.
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Affiliation(s)
- Rahul Pandey
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Marina Bakay
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Hakon Hakonarson
- Center for Applied Genomics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Department of Pediatrics, The University of Pennsylvania School of Medicine, Philadelphia, PA, United States
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16
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Pérez-Carbonell L, Iranzo A. Sleep Disturbances in Autoimmune Neurological Diseases. Curr Neurol Neurosci Rep 2023; 23:617-625. [PMID: 37670202 DOI: 10.1007/s11910-023-01294-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/07/2023]
Abstract
PURPOSE OF REVIEW To summarize the current evidence on the associations between autoimmune neurological diseases (e.g., multiple sclerosis, myasthenia gravis) and sleep disturbances (e.g., insomnia, parasomnias), as well as to review the main characteristics of sleep disorders with an immune-related pathophysiology (e.g., narcolepsy, anti-IgLON5 disease). RECENT FINDINGS An immune-mediated damage of the areas in the central nervous system that control sleep and wake functions (e.g., hypothalamus, brainstem) can lead to sleep disorders and sleep symptoms. Sleep disturbances are the reason to seek for medical attention in certain neuroimmunological conditions (e.g., narcolepsy, anti-IgLON5 disease) where sleep-related alterations are the main clinical feature. The assessment of sleep-related symptomatology and disorders should be included in the routine evaluation of patients with autoimmune neurological diseases. Clinicians should be aware of the typical clinical presentation of certain neuroimmunological disorders mainly affecting sleep.
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Affiliation(s)
| | - Alex Iranzo
- Sleep Disorders Centre, Neurology Service, Hospital Clínic Barcelona, Universitat de Barcelona, IDIBAPS, CIBERNED: CB06/05/0018-ISCIII, Barcelona, Spain.
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17
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Vakrakou AG, Karachaliou E, Chroni E, Zouvelou V, Tzanetakos D, Salakou S, Papadopoulou M, Tzartos S, Voumvourakis K, Kilidireas C, Giannopoulos S, Tsivgoulis G, Tzartos J. Immunotherapies in MuSK-positive Myasthenia Gravis; an IgG4 antibody-mediated disease. Front Immunol 2023; 14:1212757. [PMID: 37564637 PMCID: PMC10410455 DOI: 10.3389/fimmu.2023.1212757] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Muscle-specific kinase (MuSK) Myasthenia Gravis (MG) represents a prototypical antibody-mediated disease characterized by predominantly focal muscle weakness (neck, facial, and bulbar muscles) and fatigability. The pathogenic antibodies mostly belong to the immunoglobulin subclass (Ig)G4, a feature which attributes them their specific properties and pathogenic profile. On the other hand, acetylcholine receptor (AChR) MG, the most prevalent form of MG, is characterized by immunoglobulin (Ig)G1 and IgG3 antibodies to the AChR. IgG4 class autoantibodies are impotent to fix complement and only weakly bind Fc-receptors expressed on immune cells and exert their pathogenicity via interfering with the interaction between their targets and binding partners (e.g. between MuSK and LRP4). Cardinal differences between AChR and MuSK-MG are the thymus involvement (not prominent in MuSK-MG), the distinct HLA alleles, and core immunopathological patterns of pathology in neuromuscular junction, structure, and function. In MuSK-MG, classical treatment options are usually less effective (e.g. IVIG) with the need for prolonged and high doses of steroids difficult to be tapered to control symptoms. Exceptional clinical response to plasmapheresis and rituximab has been particularly observed in these patients. Reduction of antibody titers follows the clinical efficacy of anti-CD20 therapies, a feature implying the role of short-lived plasma cells (SLPB) in autoantibody production. Novel therapeutic monoclonal against B cells at different stages of their maturation (like plasmablasts), or against molecules involved in B cell activation, represent promising therapeutic targets. A revolution in autoantibody-mediated diseases is pharmacological interference with the neonatal Fc receptor, leading to a rapid reduction of circulating IgGs (including autoantibodies), an approach already suitable for AChR-MG and promising for MuSK-MG. New precision medicine approaches involve Chimeric autoantibody receptor T (CAAR-T) cells that are engineered to target antigen-specific B cells in MuSK-MG and represent a milestone in the development of targeted immunotherapies. This review aims to provide a detailed update on the pathomechanisms involved in MuSK-MG (cellular and humoral aberrations), fostering the understanding of the latest indications regarding the efficacy of different treatment strategies.
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Affiliation(s)
- Aigli G. Vakrakou
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Karachaliou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Elisabeth Chroni
- Department of Neurology, School of Medicine, University of Patras, Patras, Greece
| | - Vasiliki Zouvelou
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Tzanetakos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavroula Salakou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Physiotherapy, University of West Attica, Athens, Greece
| | - Socrates Tzartos
- Tzartos NeuroDiagnostics, Athens, Greece
- Department of Neurobiology, Hellenic Pasteur Institute, Athens, Greece
- Department of Pharmacy, University of Patras, Patras, Greece
| | - Konstantinos Voumvourakis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Constantinos Kilidireas
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, Henry Dunant Hospital Center, Athens, Greece
| | - Sotirios Giannopoulos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - John Tzartos
- Second Department of Neurology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
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18
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Iacolucci CM, Urso D, Zoccolella S, Vitulli A, Barone R, Logroscino G. Clinical Conundrum: Dysphagia Associated with Sleep Disorders. Dysphagia 2023; 38:726-728. [PMID: 35751739 DOI: 10.1007/s00455-022-10474-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/31/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Carlo Maria Iacolucci
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy.
| | - Daniele Urso
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
- Department of Neurosciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Stefano Zoccolella
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
| | - Alessandra Vitulli
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
| | - Roberta Barone
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy
| | - Giancarlo Logroscino
- Center for Neurodegenerative Diseases and the Aging Brain, Department of Clinical Research in Neurology, University of Bari 'Aldo Moro', "Pia Fondazione Cardinale G. Panico", Via San Pio X, 4, 73039, Tricase, Lecce, Italy.
- Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari 'Aldo Moro', Bari, Italy.
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Ramanathan S, Brilot F, Irani SR, Dale RC. Origins and immunopathogenesis of autoimmune central nervous system disorders. Nat Rev Neurol 2023; 19:172-190. [PMID: 36788293 DOI: 10.1038/s41582-023-00776-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 02/16/2023]
Abstract
The field of autoimmune neurology is rapidly evolving, and recent discoveries have advanced our understanding of disease aetiologies. In this article, we review the key pathogenic mechanisms underlying the development of CNS autoimmunity. First, we review non-modifiable risk factors, such as age, sex and ethnicity, as well as genetic factors such as monogenic variants, common variants in vulnerability genes and emerging HLA associations. Second, we highlight how interactions between environmental factors and epigenetics can modify disease onset and severity. Third, we review possible disease mechanisms underlying triggers that are associated with the loss of immune tolerance with consequent recognition of self-antigens; these triggers include infections, tumours and immune-checkpoint inhibitor therapies. Fourth, we outline how advances in our understanding of the anatomy of lymphatic drainage and neuroimmune interfaces are challenging long-held notions of CNS immune privilege, with direct relevance to CNS autoimmunity, and how disruption of B cell and T cell tolerance and the passage of immune cells between the peripheral and intrathecal compartments have key roles in initiating disease activity. Last, we consider novel therapeutic approaches based on our knowledge of the immunopathogenesis of autoimmune CNS disorders.
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Affiliation(s)
- Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Sydney, New South Wales, Australia
| | - Fabienne Brilot
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, New South Wales, Australia.
- Sydney Medical School, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia.
- TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, New South Wales, Australia.
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Anti-IgLON5 disease exacerbated by asymptomatic SARS-CoV-2 infection. NEUROIMMUNOLOGY REPORTS 2023:100166. [PMCID: PMC9899159 DOI: 10.1016/j.nerep.2023.100166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective To report a case of anti-IgLON5 disease unmasked by asymptomatic SARS-CoV-2 infection. Background Anti-IgLON5 disease is a clinically heterogeneous disease that shares features of both neurodegeneration and neuroinflammation. The onset can be insidious, posing diagnostic challenges and often resulting in treatment delay. Infectious trigger was rarely reported in this disease. Case report A 64-year-old male initially presented with 1-year history of progressive parasomnia and mild cognitive decline that precipitously worsened over the course of 1 month following asymptomatic SARS-CoV-2 infection, resulting in dysphagia, parkinsonism, weight loss and dependence on all activities of daily living. He was found to have high titer (1:3840) of anti-IgLON5 antibody in the serum, confirming the diagnosis of anti-IgLON5 disease. Conclusion Anti-IgLON5 disease as a potentially reversible cause of neurodegenerative syndrome in patients with atypical features. Timely diagnosis and treatment may improve clinical outcomes. It is also worth noting that symptoms precipitously worsened following SARS-CoV-2 infection. We suspect that a COVID-19-mediated immune activation response exacerbated the underlying autoimmune encephalitis process, unmasking his symptoms.
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21
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Li Y, Zhang L, Wang Y. Anti-IgLON5 disease complicated with rectal adenocarcinoma: a case report. BMC Neurol 2023; 23:1. [PMID: 36597054 PMCID: PMC9809029 DOI: 10.1186/s12883-022-03044-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/26/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Anti-IgLON5 disease is a rare chronic autoimmune-mediated tauopathy, featured by the sleep disturbance. Several studies have described its clinical characteristics, however, the simultaneous occurrence of anti-IgLON5 disease and rectal cancer has not been reported. We described an unusual entity of anti-IgLON5 disease complicated with rectal cancer. CASE PRESENTATION A 76-year-old man initially presented with slurred speech and limb tremors, followed by epileptic-like seizures, lethargy, and sleep apnea. IgG anti-IgLON5 antibodies were positive in both serum and cerebrospinal fluid. The patient responded well to the treatment of plasma exchange and a pulse and gradual reduction of steroids therapy. When the oral steroids started, mycophenolate mofetil was added. Two months later, the patient had bloody stools and pathological-confirmed moderately differentiated adenocarcinoma of the rectum. CONCLUSIONS Whereas sleep disturbance is the most common feature in patients with anti-IgLON5 disease, our case presented with slurred speech and limb tremors. Anti-IgLON5 disease complicated with rectal cancer is very rare. Tumor screening should be considered in patients with anti-IgLON5 disease to investigate the association between tumor and this disease.
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Affiliation(s)
- Yi Li
- grid.449428.70000 0004 1797 7280Clinical Medical College, Jining Medical University, Jining, Shandong Province China
| | - Lili Zhang
- grid.452252.60000 0004 8342 692XDepartment of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province China
| | - Yuzhong Wang
- grid.452252.60000 0004 8342 692XDepartment of Neurology, Affiliated Hospital of Jining Medical University, Jining, Shandong Province China ,grid.452252.60000 0004 8342 692XMedical Research Centre, Affiliated Hospital of Jining Medical University, Jining, Shandong Province China
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22
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Wang Y, Wang Y, Zhao X, Zhang S, Geng Y, Zhang Z, Jin B, Aung T. Epileptic seizures in patients with anti-IgLON5 disease. J Neuroimmunol 2022; 373:577999. [PMID: 36395637 DOI: 10.1016/j.jneuroim.2022.577999] [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: 08/23/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anti-IgLON5 is a rare neurologic disease that can present with epileptic seizures. However, epileptic seizures have not been characterized and are underreported. We aimed to investigate the clinical characteristics and demographics of epileptic seizures in patients with anti-IgLON5 disease. METHODS We reported a case of anti-IgLON5 disease presenting with epileptic seizures and presented a comprehensive literature review on epileptic seizures in patients with the anti-IgLON5 disease. We searched the Medline, Pubmed, and Web of Science databases using the following search algorithm: "IgLON5" or "anti-IgLON5" or "IgLON5 antibody" limited to publications in English. RESULTS We identified 183 cases from 66 publications. In addition to our case, nine (4.9%) patients with anti-IgLON5 disease had reported epileptic seizures, either focal or generalized. Of those, epileptic seizures were one of the main reasons for neurology consultation in six (3.2%). Patients with epileptic seizures affected both sexes similarly and usually developed in middle age. In addition to epileptic seizures, a majority of patients had sleep disorders and cognitive impairment. The frequency of epileptic seizures was reduced with the treatment of immunotherapy and antiseizure medication. CONCLUSION Anti-IgLON5 disease can present with epileptic seizures, and our study expands the clinical spectrum of the anti-IgLON5 disease.
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Affiliation(s)
- Ying Wang
- Nursing Department, The Second Affiliated Hospital of Zhejiang University School of Medicine, China
| | - Yiqi Wang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Xiaoyu Zhao
- Department of Neurophysiology, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Yu Geng
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Zheyu Zhang
- Department of Neurology, Ningbo First Hospital, Ningbo, China.
| | - Bo Jin
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.
| | - Thandar Aung
- Department of Neurology, Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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23
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Grossauer A, Hussl A, Mahlknecht P, Peball M, Heidbreder A, Deisenhammer F, Djamshidian A, Seppi K, Heim B. Anti-IgLON5 Disease with Isolated Hemichorea: A Case Report and Review of the Literature. Mov Disord Clin Pract 2022; 10:115-119. [PMID: 36698996 PMCID: PMC9847301 DOI: 10.1002/mdc3.13614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/13/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anti-IgLON5 disease is an autoimmune encephalopathy with sleep disturbances as a hallmark in the majority of reported cases. Additional clinical symptoms are heterogenous and include movement disorders, bulbar dysfunction, autonomic disorders, and neurocognitive impairment. Case Here, we report the case of an 87-year-old woman presenting with isolated progressive hemichorea. An extensive diagnostic work-up revealed antibodies against IgLON5 in the serum. Neither history nor polysomnography (PSG) unveiled signs and features of sleep dysfunction typically reported in anti-IgLON5 disease. Literature Review In an extensive literature review we identified twelve other studies reporting about patients with confirmed anti-IgLON5 disease and chorea as extrapyramidal movement disorder in their clinical phenotype. Subsequently, clinical characteristics of these patients were carefully evaluated. Conclusions Our results support the diversity of clinical phenotypes in anti-IgLON5 disease, adding isolated hemichorea to the spectrum of presenting symptoms. As sleep-related disorders are often not the leading reason for consultation and only revealed by PSG examination, we suggest that screening for antibodies against IgLON5 should be considered in patients presenting with unexplained movement disorders, including isolated hemichorea.
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Affiliation(s)
- Anna Grossauer
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Hussl
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Marina Peball
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Anna Heidbreder
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | | | - Atbin Djamshidian
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Klaus Seppi
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
| | - Beatrice Heim
- Department of NeurologyMedical University of InnsbruckInnsbruckAustria
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24
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Zhang YZ, Ni Y, Gao YN, Shen DD, He L, Yin D, Meng HY, Zhou QM, Hu J, Chen S. Anti-IgLON5 disease: a novel topic beyond neuroimmunology. Neural Regen Res 2022; 18:1017-1022. [PMID: 36254983 PMCID: PMC9827781 DOI: 10.4103/1673-5374.355742] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Anti-IgLON5 disease is a recently defined autoimmune disorder of the nervous system associated with autoantibodies against IgLON5. Given its broad clinical spectrum and extremely complex pathogenesis, as well as difficulties in its early diagnosis and treatment, anti-IgLON5 disease has become the subject of considerable research attention in the field of neuroimmunology. Anti-IgLON5 disease has characteristics of both autoimmunity and neurodegeneration due to the unique activity of the anti-IgLON5 antibody. Neuropathologic examination revealed the presence of a tauopathy preferentially affecting the hypothalamus and brainstem tegmentum, potentially broadening our understanding of tauopathies. In contrast to that seen with other autoimmune encephalitis-related antibodies, basic studies have demonstrated that IgLON5 antibody-induced neuronal damage and degeneration are irreversible, indicative of a potential link between autoimmunity and neurodegeneration in anti-IgLON5 disease. Herein, we comprehensively review and discuss basic and clinical studies relating to anti-IgLON5 disease to better understand this complicated disorder.
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Affiliation(s)
- Yi-ZongHeng Zhang
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - You Ni
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Ning Gao
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ding-Ding Shen
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China
| | - Lu He
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dou Yin
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan-Yu Meng
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qin-Ming Zhou
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China,Correspondence to: Sheng Chen, ; Ji Hu, ; Qin-Ming Zhou, .
| | - Ji Hu
- Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China,School of Life Science and Technology, ShanghaiTech University, Shanghai, China,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai, China,Correspondence to: Sheng Chen, ; Ji Hu, ; Qin-Ming Zhou, .
| | - Sheng Chen
- Department of Neurology & Institute of Neurology, Ruijin Hospital, Affiliated with Shanghai Jiao Tong University School of Medicine, Shanghai, China,Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu Province, China,Correspondence to: Sheng Chen, ; Ji Hu, ; Qin-Ming Zhou, .
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25
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Molsberry SA, Hughes KC, Schwarzschild MA, Ascherio A. Who to Enroll in Parkinson Disease Prevention Trials? The Case for Composite Prodromal Cohorts. Neurology 2022; 99:26-33. [PMID: 35970591 DOI: 10.1212/wnl.0000000000200788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 04/11/2022] [Indexed: 11/15/2022] Open
Abstract
Significant progress has been made in expanding our understanding of prodromal Parkinson disease (PD), particularly for recognition of early motor and nonmotor signs and symptoms. Although identification of these prodromal features may improve our understanding of the earliest stages of PD, they are individually insufficient for early disease detection and enrollment of participants in prevention trials in most cases because of low sensitivity, specificity, and positive predictive value. Composite cohorts, composed of individuals with multiple co-occurring prodromal features, are an important resource for conducting prodromal PD research and eventual prevention trials because they are more representative of the population at risk for PD, allow investigators to evaluate the efficacy of an intervention across individuals with varying prodromal feature patterns, are able to produce larger sample sizes, and capture individuals at different stages of prodromal PD. A key challenge in identifying individuals with prodromal disease for composite cohorts and prevention trial participation is that we know little about the natural history of prodromal PD. To move toward prevention trials, it is critical that we better understand common prodromal feature patterns and be able to predict the probability of progression and phenoconversion. Ongoing research in cohort studies and administrative databases is beginning to address these questions, but further longitudinal analyses in a large population-based sample are necessary to provide a convincing and definitive strategy for identifying individuals to be enrolled in a prevention trial.
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Affiliation(s)
- Samantha A Molsberry
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA.
| | - Katherine C Hughes
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael A Schwarzschild
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Alberto Ascherio
- From the Department of Nutrition (S.A.M., A.A.), Harvard T.H. Chan School of Public Health; Epidemiology (K.C.H.), Optum; Department of Neurology (M.A.S.), and MassGeneral Institute for Neurodegenerative Disease (M.A.S.), Massachusetts General Hospital; Department of Epidemiology (A.A.), Harvard T.H. Chan School of Public Health; and Channing Division of Network Medicine (A.A.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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26
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Cao TQ, Harris GR, Lineback CM, Sokol LL, Mencacci N, Opal P. Clinical Reasoning: A 77-Year-Old Man With Involuntary Movements, Sleep Changes, Falls, Bulbar Symptoms, and Cognitive Complaints. Neurology 2022; 99:26-30. [PMID: 35487699 PMCID: PMC9259088 DOI: 10.1212/wnl.0000000000200705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
A 77-year-old-man presents with chorea, parasomnias, dysarthria and dysphagia, and cognitive issues. A broad workup reveals positive anti-IgLON5 antibody. This case report represents a textbook example of anti-IgLON5 syndrome.
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Affiliation(s)
- Toni Qian Cao
- From the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Glenn R Harris
- From the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Christina M Lineback
- From the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Leonard L Sokol
- From the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Niccolo Mencacci
- From the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Puneet Opal
- From the Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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27
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Ralls F, Cutchen L, Grigg-Damberger MM. What Is the Prognostic Significance of Rapid Eye Movement Sleep Without Atonia in a Polysomnogram? J Clin Neurophysiol 2022; 39:346-355. [PMID: 35239559 DOI: 10.1097/wnp.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SUMMARY Freud said we are lucky to be paralyzed during sleep, so we cannot act out our dreams. Atonia of skeletal muscles normally present during rapid eye movement sleep prevents us from acting out our dreams. Observing rapid eye movement sleep without atonia in a polysomnogram in older adults first and foremost warrants consideration of rapid eye movement behavior disorder. Seventy-five to 90% of older adults with isolated rapid eye movement behavior disorder will develop a neurodegenerative disease within 15 years, most often a synucleinopathy. Rapid eye movement sleep without atonia in those younger than 50 years is commonly found in individuals with narcolepsy and those taking antidepressant medications.
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Affiliation(s)
- Frank Ralls
- New Mexico Sleep Labs, Rio Rancho, New Mexico, U.S.A
| | - Lisa Cutchen
- Omni Sleep, Albuquerque, New Mexico, U.S.A.; and
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28
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Abstract
PURPOSE OF REVIEW Autoimmune encephalitis (AE) refers to immune-mediated neurological syndromes often characterised by the detection of pathogenic autoantibodies in serum and/or cerebrospinal fluid which target extracellular epitopes of neuroglial antigens. There is increasing evidence these autoantibodies directly modulate function of their antigens in vivo. Early treatment with immunotherapy improves outcomes. Yet, these patients commonly exhibit chronic disability. Importantly, optimal therapeutic strategies at onset and during escalation remain poorly understood. In this review of a rapidly emerging field, we evaluate recent studies on larger cohorts, registries, and meta-analyses to highlight existing evidence for contemporary therapeutic approaches in AE. RECENT FINDINGS We highlight acute and long-term treatments used in specific AE syndromes, exemplify how understanding disease pathogenesis can inform precision therapy and outline challenges of defining disability outcomes in AE. SUMMARY Early first-line immunotherapies, including corticosteroids and plasma exchange, improve outcomes, with emerging evidence showing second-line immunotherapies (especially rituximab) reduce relapse rates. Optimal timing of immunotherapy escalation remains unclear. Routine reporting of outcome measures which incorporate cognitive impairment, fatigue, pain, and mental health will permit more accurate quantification of residual disability and comprehensive comparisons between international multicentre cohorts, and enable future meta-analyses with the aim of developing evidence-based therapeutic guidelines.
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Affiliation(s)
- Benjamin P Trewin
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Isaak Freeman
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neurology, Concord Hospital, Sydney, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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29
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Fu Y, Zou X, Liu L. Epileptic Seizures and Right-Sided Hippocampal Swelling as Presenting Symptoms of Anti-IgLON5 Disease: A Case Report and Systematic Review of the Literature. Front Neurol 2022; 13:800298. [PMID: 35620785 PMCID: PMC9127316 DOI: 10.3389/fneur.2022.800298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 04/11/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Objective Anti-IgLON5 disease is an uncommon neurological disorder characterized by diverse clinical manifestations. Although many relevant cases have been reported, our understanding of this disorder is still quite restricted. We present a rare case of anti-IgLON5 disease and performed a comprehensive systematic review of all published cases to expand the clinical spectrum of this disorder. Methods We report a 61-year-old woman with an atypical presentation of epileptic seizures with abnormal signals in her right hippocampus on brain magnetic resonance imaging (MRI). A systematic review was performed of electronic databases, including PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), WanFang and VIP China Science. Results We identified 161 cases from 65 publications. With heterogeneous clinical manifestations, we found that bulbar dysfunction, sleep apnea, gait instability and neurocognitive and behavioral symptoms are the most common symptoms of anti-IgLON5 disease. Anti-IgLON5 antibodies presented a higher positive rate and titer in the serum than in the cerebrospinal fluid (CSF). Haplotype DRB1*10:01-DQB1*05:01 is highly correlated with anti-IgLON5 disease. Only 38 patients have presented distinctive MRI alterations (26.2%). Approximately half of the cases are responsive to immunosuppressive or immunomodulatory treatment. Conclusion Anti-IgLON5 disease is characterized by various clinical manifestations and laboratory findings. Immunotherapy may be effective in treating anti-IgLON5 disease, but the results are far from satisfactory. Studies with larger sample sizes are required to improve the current understanding of this disorder.
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Affiliation(s)
- Yaoqi Fu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xiangting Zou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ling Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
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30
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Rare antibody-mediated and seronegative autoimmune encephalitis: An update. Autoimmun Rev 2022; 21:103118. [PMID: 35595048 DOI: 10.1016/j.autrev.2022.103118] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/15/2022] [Indexed: 01/14/2023]
Abstract
Paralleling advances with respect to more common antibody-mediated encephalitides, such as anti-N-methyl-D-aspartate receptor (NMDAR) and anti-leucine-rich glioma-inactivated 1 (LGI1) Ab-mediated encephalitis, the discovery and characterisation of novel antibody-mediated encephalitides accelerated over the past decade, adding further depth etiologically to the spectrum of antibody-mediated encephalitis. Herein, we review the major mechanistic, clinical features and management considerations with respect to anti-γ-aminobutyric acid B (GABAB)-, anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropinoic receptor- (AMPAR), anti-GABAA-, anti-dipeptidyl-peptidase-like protein-6 (DPPX) Ab-mediated encephalitides, delineate rarer subtypes and summarise findings to date regarding seronegative autoimmune encephalitis.
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31
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Macías‐García D, Balint B. Disentangling the phenotypes of
anti‐IgLON5
disease: when clinical suspicion matters. Mov Disord Clin Pract 2022; 9:456-457. [PMID: 35586538 PMCID: PMC9092746 DOI: 10.1002/mdc3.13446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/08/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- Daniel Macías‐García
- Unidad de Trastornos del Movimiento, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío/Universidad de Sevilla, Seville, Spain. Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED) Madrid Spain
- Department of Clinical and Movement Neurosciences UCL Queen Square Institute of Neurology London UK
| | - Bettina Balint
- Department of Neurology University Hospital Zurich, University of Zurich Zurich Switzerland
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32
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Kyle K, Bordelon Y, Venna N, Linnoila J. Autoimmune and Paraneoplastic Chorea: A Review of the Literature. Front Neurol 2022; 13:829076. [PMID: 35370928 PMCID: PMC8972589 DOI: 10.3389/fneur.2022.829076] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 02/22/2022] [Indexed: 01/17/2023] Open
Abstract
Autoimmune chorea syndromes represent a vast array of paraneoplastic, parainfectious and idiopathic disorders. It is increasingly apparent that familiarity with these disorders is critically important, as they may be treatable or may be part of a syndrome requiring further work-up and monitoring. These disorders are mediated by an aberrant immunologic attack with resultant neuronal dysfunction, manifesting as chorea. These conditions are typically accompanied by other neurologic or systemic manifestations. In this review we outline the clinical features, epidemiologic factors, and delineate the specific antibodies associated with each of these autoimmune mediated disorders. We highlight up to date information regarding this heterogeneous group of disorders, including a discussion of parainfectious Sydenham's chorea; paraneoplastic syndromes associated with CRMP-5 (collapsin response mediated protein-5/CV2) and ANNA-1 (antineuronal nuclear antibody / Hu) antibodies, in addition to neuronal antibody-associated disorders including anti-NMDAR, LGI1 (leucine-rich glioma inactivated-1) and CASPR2 (contactin associated protein-2). We discuss the more recently described entities of IgLON5, which has evidence of both immunologic and degenerative pathophysiology, in addition to PDE-10A antibody-associated chorea. We also outline chorea secondary to systemic diseases including Systemic Lupus Erythematosus (SLE) and Primary Antiphospholipid Syndrome (PAPS). We provide a framework for diagnosis and treatment.
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Affiliation(s)
- Kevin Kyle
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- *Correspondence: Kevin Kyle
| | - Yvette Bordelon
- Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nagagopal Venna
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jenny Linnoila
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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33
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Alvente S, Matteoli G, Molina-Porcel L, Landa J, Alba M, Bastianini S, Berteotti C, Graus F, Lo Martire V, Sabater L, Zoccoli G, Silvani A. Pilot Study of the Effects of Chronic Intracerebroventricular Infusion of Human Anti-IgLON5 Disease Antibodies in Mice. Cells 2022; 11:cells11061024. [PMID: 35326477 PMCID: PMC8947551 DOI: 10.3390/cells11061024] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Anti-IgLON5 disease is a rare late-onset neurological disease associated with autoantibodies against IgLON5, neuronal accumulation of phosphorylated Tau protein (p-Tau), and sleep, respiratory, and motor alterations. Purpose: We performed a pilot study of whether the neuropathological and clinical features of anti-IgLON5 disease may be recapitulated in mice with chronic intracerebroventricular infusion of human anti-IgLON5 disease IgG (Pt-IgG). Methods: Humanized transgenic hTau mice expressing human Tau protein and wild-type (WT) control mice were infused intracerebroventricularly with Pt-IgG or with antibodies from a control subject for 14 days. The sleep, respiratory, and motor phenotype was evaluated at the end of the antibody infusion and at least 30 days thereafter, followed by immunohistochemical assessment of p-Tau deposition. Results: In female hTau and WT mice infused with Pt-IgG, we found reproducible trends of diffuse neuronal cytoplasmic p-Tau deposits in the brainstem and hippocampus, increased ventilatory period during sleep, and decreased inter-lick interval during wakefulness. These findings were not replicated on male hTau mice. Conclusion: The results of our pilot study suggest, but do not prove, that chronic ICV infusion of mice with Pt-IgG may elicit neuropathological, respiratory, and motor alterations. These results should be considered as preliminary until replicated in larger studies taking account of potential sex differences in mice.
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Affiliation(s)
- Sara Alvente
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
| | - Gabriele Matteoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
| | - Laura Molina-Porcel
- Hospital Clínic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (L.M.-P.); (J.L.); (M.A.); (F.G.); (L.S.)
- Alzheimer’s Disease and Other Cognitive Disorders Unit, Neurology Service, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
- Neurological Tissue Bank, Biobanc, Hospital Clínic, IDIBAPS, 08036 Barcelona, Spain
| | - Jon Landa
- Hospital Clínic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (L.M.-P.); (J.L.); (M.A.); (F.G.); (L.S.)
| | - Mercedes Alba
- Hospital Clínic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (L.M.-P.); (J.L.); (M.A.); (F.G.); (L.S.)
| | - Stefano Bastianini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
| | - Chiara Berteotti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
| | - Francesc Graus
- Hospital Clínic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (L.M.-P.); (J.L.); (M.A.); (F.G.); (L.S.)
| | - Viviana Lo Martire
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
| | - Lidia Sabater
- Hospital Clínic, Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain; (L.M.-P.); (J.L.); (M.A.); (F.G.); (L.S.)
- Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER), 46010 Valencia, Spain
| | - Giovanna Zoccoli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
| | - Alessandro Silvani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, 40123 Bologna, Italy; (S.A.); (G.M.); (S.B.); (C.B.); (V.L.M.); (G.Z.)
- Correspondence:
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Strippel C, Heidbreder A, Schulte-Mecklenbeck A, Korn L, Warnecke T, Melzer N, Wiendl H, Pawlowski M, Gross CC, Kovac S. Increased Intrathecal B and Plasma Cells in Patients With Anti-IgLON5 Disease: A Case Series. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/2/00. [PMID: 35031586 PMCID: PMC8759718 DOI: 10.1212/nxi.0000000000001137] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 12/03/2021] [Indexed: 12/14/2022]
Abstract
Background and Objectives Despite detection of autoantibodies, anti-IgLON5 disease was historically considered a tau-associated neurodegenerative disease, with limited treatment options and detrimental consequences for the patients. Observations in increasing case numbers hint toward underlying inflammatory mechanisms that, early detection provided, open a valuable window of opportunity for therapeutic intervention. We aimed to further substantiate this view by studying the CSF of patients with anti-IgLON5. Methods We identified 11 patients with anti-IgLON5 from our database and compared clinical, MRI, and CSF findings with a cohort of 20 patients with progressive supranuclear palsy (PSP) (as a noninflammatory tauopathy) and 22 patients with functional neurologic disorder. Results Patients with anti-IgLON5 show inflammatory changes in routine CSF analysis, an increase in B-lymphocyte frequency, and the presence of plasma cells in comparison to the PSP-control group and functional neurologic disease controls. Patients with intrathecal plasma cells showed a clinical response to rituximab. Discussion Our findings indicate the importance of inflammatory mechanisms, in particular in early and acute anti-IgLON5 cases, which may support the use of immune-suppressive treatments in these cases. The main limitation of the study is the small number of cases due to the rarity of the disease.
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Affiliation(s)
- Christine Strippel
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Anna Heidbreder
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Andreas Schulte-Mecklenbeck
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Lisanne Korn
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Tobias Warnecke
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Nico Melzer
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Heinz Wiendl
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Matthias Pawlowski
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Catharina C Gross
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany
| | - Stjepana Kovac
- From the Department of Neurology with Institute of Translational Neurology (C.S., A.S.-M., L.K., T.W., H.W., M.P., C.C.G., S.K.), University of Münster, Germany; Department of Neurology (A.H.), Medical University Innsbruck, Austria; and Department of Neurology (N.M.), Medical Faculty, Heinrich-Heine University of Düsseldorf, Germany.
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Madetko N, Marzec W, Kowalska A, Przewodowska D, Alster P, Koziorowski D. Anti-IgLON5 Disease - The Current State of Knowledge and Further Perspectives. Front Immunol 2022; 13:852215. [PMID: 35300333 PMCID: PMC8921982 DOI: 10.3389/fimmu.2022.852215] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 01/15/2023] Open
Abstract
Anti-IgLON5 disease is a relatively new neurological entity with the first cases reported in 2014. So far, less than 70 articles on this topic have been published. Due to its unspecific symptomatology, diverse progression, novelty and ambiguous character, it remains a difficulty for both clinical practitioners and scientists. The aim of this review is to summarize the current knowledge concerning anti-IgLON5 disease; mechanisms underlying its cause, symptomatology, clinical progression, differential diagnosis and treatment, which could be helpful in clinical practice and future research.
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Affiliation(s)
- Natalia Madetko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Weronika Marzec
- Students’ Scientific Circle of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Agata Kowalska
- Students’ Scientific Circle of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Dominika Przewodowska
- Students’ Scientific Circle of the Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Alster
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
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36
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Videnovic A, Babu S, Zhao B, Reda HM, Linnoila JJ. Case 1-2022: A 67-Year-Old Man with Motor Neuron Disease and Odd Behaviors during Sleep. N Engl J Med 2022; 386:173-180. [PMID: 35020988 DOI: 10.1056/nejmcpc2115844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Aleksandar Videnovic
- From the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Massachusetts General Hospital, and the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Harvard Medical School - both in Boston
| | - Suma Babu
- From the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Massachusetts General Hospital, and the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Harvard Medical School - both in Boston
| | - Brian Zhao
- From the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Massachusetts General Hospital, and the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Harvard Medical School - both in Boston
| | - Haatem M Reda
- From the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Massachusetts General Hospital, and the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Harvard Medical School - both in Boston
| | - Jenny J Linnoila
- From the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Massachusetts General Hospital, and the Departments of Neurology (A.V., S.B., H.M.R., J.J.L.) and Radiology (B.Z.), Harvard Medical School - both in Boston
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37
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Mulroy E, Balint B, Bhatia KP. Homer-3 Antibody Disease: A Potentially Treatable MSA-C Mimic. Mov Disord Clin Pract 2022; 9:178-182. [PMID: 35146057 PMCID: PMC8810419 DOI: 10.1002/mdc3.13404] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/19/2021] [Accepted: 12/21/2021] [Indexed: 01/11/2023] Open
Affiliation(s)
- Eoin Mulroy
- Department of clinical and movement neurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
| | - Bettina Balint
- Department of Neurology, University Hospital ZürichUniversity of ZürichZürichSwitzerland
| | - Kailash P. Bhatia
- Department of clinical and movement neurosciencesUCL Queen Square Institute of NeurologyLondonUnited Kingdom
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38
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Niederschweiberer J, Schumacher NU, Kumpfmüller D, Lingg C, Graf S, Ikenberg B, Mühlau M, Lingor P, Hemmer B, Knier B. [The anti-IgLON5 syndrome in clinical neurology-Report of two cases]. DER NERVENARZT 2022; 93:1247-1249. [PMID: 35704066 PMCID: PMC9718859 DOI: 10.1007/s00115-022-01344-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Johanna Niederschweiberer
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland.
| | - Nicolas U Schumacher
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Daniela Kumpfmüller
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Charlotte Lingg
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Simone Graf
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Benno Ikenberg
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Mark Mühlau
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Paul Lingor
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
| | - Bernhard Hemmer
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
- Munich Cluster for Systems Neurology (SyNergy), München, Deutschland
| | - Benjamin Knier
- Klinik und Poliklinik für Neurologie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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39
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Shimohata T, Kimura A. [Clinical features of anti-IgLON5 disease]. Rinsho Shinkeigaku 2021; 61:825-832. [PMID: 34789633 DOI: 10.5692/clinicalneurol.cn-001673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anti-IgLON5 diseases were first reported in 2014 as sleep disorders such as parasomnia and obstructive sleep apnea. The pathological findings were suggestive of tauopathies and eight clinical subtypes have been reported so far. Serum and cerebrospinal fluid anti-IgLON5 antibodies should be measured in patients with sleep-related disorders with parasomnia as well as in patients with movement disorders, motor neuron disease or dementia with characteristic parasominia. The prognosis is generally poor, but some patients have been reported to improve with immunotherapy. Early diagnosis and early immunotherapy may improve the prognosis.
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Affiliation(s)
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine
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40
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Ni Y, Shen D, Zhang Y, Song Y, Gao Y, Zhou Q, He L, Yin D, Wang Y, Song F, Chen M, Lian Y, Chen Y, Zhao X, Zhang X, Chen X, Wang Y, Zhang L, Mo N, Lv D, Liu J, Mao Z, Peng L, Chen S. Expanding the clinical spectrum of anti-IgLON5 disease: A multicenter retrospective study. Eur J Neurol 2021; 29:267-276. [PMID: 34543501 DOI: 10.1111/ene.15117] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND We conducted this study to describe detailed the clinical characteristics, ancillary test results and treatment response of a group of Chinese patients with anti-IgLON5 disease. METHODS We recruited 13 patients with positive IgLON5 antibodies in serum and/or cerebrospinal fluid from nine tertiary referral centers. Patients were enrolled from February 2017 to July 2021. We retrospectively collected information on the presenting and main symptoms, treatment response and follow-up outcomes. RESULTS The median age of onset for symptoms was 60 (range: 33-73) years and six of the 13 patients were females. The predominant clinical presentations included sleep disturbance (eight patients) and cognitive impairment (seven patients), followed by movement disorders (six patients). Parainfectious cause seemed plausible. Notably, we identified the first case of possible Epstein-Barr virus (EBV)-related anti-IgLON5 disease. Coexisting neural autoantibodies were identified in two patients. Furthermore, two patients had other autoimmune diseases. The IgG subclass was determined in four patients, including two with dominant IgG4 subtype and two with dominant IgG1 subtype. Additionally, 10 patients were treated with immunotherapy and four patients exhibited improvement. Overall, six of 10 patients for whom follow-up results were assessable had favorable clinical outcomes (modified Rankin Scale score ≤2). CONCLUSIONS The clinical spectrum of anti-IgLON5 disease is variable. Our results highlight a boarder spectrum of anti-IgLON5 disease.
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Affiliation(s)
- You Ni
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dingding Shen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
| | - Ying Zhang
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaying Song
- Department of Neurology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yining Gao
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qinming Zhou
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu He
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Dou Yin
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying Wang
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Fan Song
- Department of Neurology, The First Affiliated Hospital of Dalian Medical University, Liaoning, China
| | - Meiyuan Chen
- Department of Neurology, The Affiliated Hospital of Hangzhou Normal University, Zhejiang, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuan Chen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xing Zhao
- Department of Neurology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Xiang Zhang
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, Shanghai, China
| | - Xiangjun Chen
- Department of Neurology, Huashan Hospital and Institute of Neurology, Fudan University, Shanghai, China
| | - Yuting Wang
- Department of Neurology, Tangshan Gongren Hospital, Hebei, China
| | - Ling Zhang
- Neuroimmunology Group, KingMed Diagnostic laboratory, Guangzhou, China
| | - Nanxun Mo
- Neuroimmunology Group, KingMed Diagnostic laboratory, Guangzhou, China
| | - Dong Lv
- Department of Psychiatry, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jun Liu
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhifeng Mao
- Neuroimmunology Group, KingMed Diagnostic laboratory, Guangzhou, China.,Department of Clinical Medicine, Medical School, Xiangnan University, Chenzhou, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Sheng Chen
- Department of Neurology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Co-innovation Center of Neuroregeneration, Nantong University, Nantong, China
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Shambrook P, Hesters A, Marois C, Zemba D, Servan J, Gaymard B, Pico F, Delorme C, Lubetzki C, Arnulf I, Psimaras D, Honnorat J, Gales A, Méneret A. Delayed Benefit From Aggressive Immunotherapy in Waxing and Waning Anti-IgLON5 Disease. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/4/e1009. [PMID: 33986128 PMCID: PMC8192057 DOI: 10.1212/nxi.0000000000001009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 03/10/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Pauline Shambrook
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Adèle Hesters
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Clémence Marois
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Daniel Zemba
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Jérôme Servan
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Bertrand Gaymard
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Fernando Pico
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Cécile Delorme
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Catherine Lubetzki
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Isabelle Arnulf
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Dimitri Psimaras
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Jérôme Honnorat
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Ana Gales
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France
| | - Aurélie Méneret
- From the Department of Neurology (P.S., A.H., C.M., C.D., C.L., A.M.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Department of Neurology (D.Z., J.S., F.P.), Versailles Hospital, Le Chesnay, France; Department of Neurology (D.Z.), CHU Yalgado Ouédraogo, Ouagadougou, Burkina Faso; Department of Neurophysiology (B.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Sorbonne University (C.L., I.A., A.M.), Paris, France; Sleep Disorder Unit (I.A., A.G.), Pitié-Salpêtrière Hospital, AP-HP, Paris, France; Service de Neurologie 2-Mazarin (D.P.), Groupe Hospitalier Pitié-Salpêtrière et Université Pierre et Marie Curie-Paris 6, AP-HP, Centre de Compétence des Syndromes Neurologiques Paranéoplasiques et Encéphalites Autoimmunes, Paris, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (J.H.), Hospices Civils de Lyon, Institut NeuroMyoGene, INSERM U1217/CNRS UMR5310, Université de Lyon, Université Claude Bernard Lyon 1, France.
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42
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Zografou C, Vakrakou AG, Stathopoulos P. Short- and Long-Lived Autoantibody-Secreting Cells in Autoimmune Neurological Disorders. Front Immunol 2021; 12:686466. [PMID: 34220839 PMCID: PMC8248361 DOI: 10.3389/fimmu.2021.686466] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 05/28/2021] [Indexed: 12/24/2022] Open
Abstract
As B cells differentiate into antibody-secreting cells (ASCs), short-lived plasmablasts (SLPBs) are produced by a primary extrafollicular response, followed by the generation of memory B cells and long-lived plasma cells (LLPCs) in germinal centers (GCs). Generation of IgG4 antibodies is T helper type 2 (Th2) and IL-4, -13, and -10-driven and can occur parallel to IgE, in response to chronic stimulation by allergens and helminths. Although IgG4 antibodies are non-crosslinking and have limited ability to mobilize complement and cellular cytotoxicity, when self-tolerance is lost, they can disrupt ligand-receptor binding and cause a wide range of autoimmune disorders including neurological autoimmunity. In myasthenia gravis with predominantly IgG4 autoantibodies against muscle-specific kinase (MuSK), it has been observed that one-time CD20+ B cell depletion with rituximab commonly leads to long-term remission and a marked reduction in autoantibody titer, pointing to a short-lived nature of autoantibody-secreting cells. This is also observed in other predominantly IgG4 autoantibody-mediated neurological disorders, such as chronic inflammatory demyelinating polyneuropathy and autoimmune encephalitis with autoantibodies against the Ranvier paranode and juxtaparanode, respectively, and extends beyond neurological autoimmunity as well. Although IgG1 autoantibody-mediated neurological disorders can also respond well to rituximab induction therapy in combination with an autoantibody titer drop, remission tends to be less long-lasting and cases where titers are refractory tend to occur more often than in IgG4 autoimmunity. Moreover, presence of GC-like structures in the thymus of myasthenic patients with predominantly IgG1 autoantibodies against the acetylcholine receptor and in ovarian teratomas of autoimmune encephalitis patients with predominantly IgG1 autoantibodies against the N‐methyl‐d‐aspartate receptor (NMDAR) confers increased the ability to generate LLPCs. Here, we review available information on the short-and long-lived nature of ASCs in IgG1 and IgG4 autoantibody-mediated neurological disorders and highlight common mechanisms as well as differences, all of which can inform therapeutic strategies and personalized medical approaches.
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Affiliation(s)
- C Zografou
- Institute of Neuropathology, University of Zurich, Zurich, Switzerland
| | - A G Vakrakou
- First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - P Stathopoulos
- First Department of Neurology, National and Kapodistrian University of Athens Medical School, Athens, Greece
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43
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Abstract
Autoimmune encephalitis defines brain inflammation caused by a misdirected immune response against self-antigens expressed in the central nervous system. It comprises a heterogeneous group of disorders that are at least as common as infectious causes of encephalitis. The rapid and ongoing expansion of this field has been driven by the identification of several pathogenic autoantibodies that cause polysymptomatic neurological and neuropsychiatric diseases. These conditions often show highly distinctive cognitive, seizure and movement disorder phenotypes, making them clinically recognisable. Their early identification and treatment improve patient outcomes, and may aid rapid diagnosis of an underlying associated tumour. Here we summarise the well-known autoantibody-mediated encephalitis syndromes with neuronal cell-surface antigens. We focus on practical aspects of their diagnosis and treatment, offer our clinical experiences of managing such cases and highlight more basic neuroimmunological advances that will inform their future diagnosis and treatments.
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Affiliation(s)
- Christopher E Uy
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford, UK.,Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford, UK.,Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford, UK .,Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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Seifert-Held T, Eberhard K, Lechner C, Macher S, Hegen H, Moser T, Jacob GB, Puttinger G, Topakian R, Guger M, Kacar E, Zoche L, De Simoni D, Seiser A, Oberndorfer S, Baumgartner C, Struhal W, Zimprich F, Sellner J, Deisenhammer F, Enzinger C, Reindl M, Rauschka H, Berger T, Höftberger R. Functional Recovery in Autoimmune Encephalitis: A Prospective Observational Study. Front Immunol 2021; 12:641106. [PMID: 34093529 PMCID: PMC8175889 DOI: 10.3389/fimmu.2021.641106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 05/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background Prospective observations of functional recovery are lacking in patients with autoimmune encephalitis defined by antibodies against synaptic proteins and neuronal cell surface receptors. Methods Adult patients with a diagnosis of autoimmune encephalitis were included into a prospective registry. At 3, 6 and 12 months of follow-up, the patients’ modified Rankin Scale (mRS) was obtained. Results Patients were stratified into three groups according to their antibody (Ab) status: anti-NMDAR-Ab (n=12; group I), anti-LGI1/CASPR2-Ab (n=35; group II), and other antibodies (n=24; group III). A comparably higher proportion of patients in group I received plasma exchange/immunoadsorption and second line immunosuppressive treatments at baseline. A higher proportion of patients in group II presented with seizures. Group III mainly included patients with anti-GABABR-, anti-GAD65- and anti-GlyR-Ab. At baseline, one third of them had cancer. Patients in groups I and III had much higher median mRS scores at 3 months compared to patients in group II. A median mRS of 1 was found at all follow-up time points in group II. Conclusions The different dynamics in the recovery of patients with certain autoimmune encephalitides have important implications for clinical trials. The high proportion of patients with significant disability at 3 months after diagnosis in groups I and III points to the need for improving treatment options. More distinct scores rather than the mRS are necessary to differentiate potential neurological improvements in patients with anti-LGI1-/CASPR2-encephalitis.
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Affiliation(s)
| | - Katharina Eberhard
- Core Facility Computational Bioanalytics, Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Christian Lechner
- Division of Pediatric Neurology, Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria.,Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Harald Hegen
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Tobias Moser
- Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Gregor Brecl Jacob
- Department of Neurology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Gertraud Puttinger
- Department of Neurology 1, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Raffi Topakian
- Department of Neurology, Academic Teaching Hospital Wels-Grieskirchen, Wels, Austria
| | - Michael Guger
- Department of Neurology 2, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Emrah Kacar
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Lea Zoche
- Department of Neurology, Hospital Hietzing, Vienna, Austria
| | - Desiree De Simoni
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Andreas Seiser
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | - Stefan Oberndorfer
- Department of Neurology, University Clinic St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Christoph Baumgartner
- Department of Neurology, Hospital Hietzing, Vienna, Austria.,Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Walter Struhal
- Department of Neurology, University Clinic Tulln, Karl Landsteiner University of Health Sciences, Tulln, Austria
| | | | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria
| | | | | | - Markus Reindl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Helmut Rauschka
- Department of Neurology, Hospital Donaustadt, Vienna, Austria.,Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Diseases, Vienna, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
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Ryding M, Gamre M, Nissen MS, Nilsson AC, Okarmus J, Poulsen AAE, Meyer M, Blaabjerg M. Neurodegeneration Induced by Anti-IgLON5 Antibodies Studied in Induced Pluripotent Stem Cell-Derived Human Neurons. Cells 2021; 10:cells10040837. [PMID: 33917676 PMCID: PMC8068068 DOI: 10.3390/cells10040837] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022] Open
Abstract
Anti-IgLON5 disease is a progressive neurological disorder associated with autoantibodies against a neuronal cell adhesion molecule, IgLON5. In human postmortem brain tissue, the neurodegeneration and accumulation of hyperphosphorylated tau (p-tau) are found. Whether IgLON5 antibodies induce neurodegeneration or neurodegeneration provokes an immune response causing inflammation and antibody formation remains to be elucidated. We investigated the effects of anti-IgLON5 antibodies on human neurons. Human neural stem cells were differentiated for 14–48 days and exposed from Days 9 to 14 (short-term) or Days 13 to 48 (long-term) to either (i) IgG from a patient with confirmed anti-IgLON5 antibodies or (ii) IgG from healthy controls. The electrical activity of neurons was quantified using multielectrode array assays. Cultures were immunostained for β-tubulin III and p-tau and counterstained with 4′,6-Diamidine-2′-phenylindole dihydrochloride (DAPI). To study the impact on synapses, cultures were also immunostained for the synaptic proteins postsynaptic density protein 95 (PSD95) and synaptophysin. A lactate dehydrogenase release assay and nuclei morphology analysis were used to assess cell viability. Cultures exposed to anti-IgLON5 antibodies showed reduced neuronal spike rate and synaptic protein content, and the proportion of neurons with degenerative appearance including p-tau (T205)-positive neurons was higher when compared to cultures exposed to control IgG. In addition, cell death was increased in cultures exposed to anti-IgLON5 IgG for 21 days. In conclusion, pathological anti-IgLON5 antibodies induce neurodegenerative changes and cell death in human neurons. This supports the hypothesis that autoantibodies may induce the neurodegenerative changes found in patients with anti-IgLON5-mediated disease. Furthermore, this study highlights the potential use of stem cell-based in vitro models for investigations of antibody-mediated diseases. As anti-IgLON5 disease is heterogeneous, more studies with different IgLON5 antibody samples tested on human neurons are needed.
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Affiliation(s)
- Matias Ryding
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (M.R.); (M.G.); (J.O.); (M.M.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark; (M.S.N.); (A.A.E.P.)
| | - Mattias Gamre
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (M.R.); (M.G.); (J.O.); (M.M.)
| | - Mette S. Nissen
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark; (M.S.N.); (A.A.E.P.)
- Department of Clinical Research, Odense University Hospital, 5000 Odense, Denmark
| | - Anna C. Nilsson
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | - Justyna Okarmus
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (M.R.); (M.G.); (J.O.); (M.M.)
| | - Anne A. E. Poulsen
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark; (M.S.N.); (A.A.E.P.)
| | - Morten Meyer
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (M.R.); (M.G.); (J.O.); (M.M.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark; (M.S.N.); (A.A.E.P.)
- Department of Clinical Research, Odense University Hospital, 5000 Odense, Denmark
- BRIDGE—Brain Research Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Morten Blaabjerg
- Department of Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark; (M.R.); (M.G.); (J.O.); (M.M.)
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark; (M.S.N.); (A.A.E.P.)
- Department of Clinical Research, Odense University Hospital, 5000 Odense, Denmark
- BRIDGE—Brain Research Inter-Disciplinary Guided Excellence, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
- Correspondence: ; Tel.: +45-2068-3863
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Balint B. Are Antibody Panels Under-Utilized in Movement Disorders Diagnosis? Yes. Mov Disord Clin Pract 2021; 8:341-346. [PMID: 33816660 PMCID: PMC8015910 DOI: 10.1002/mdc3.13171] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 11/21/2022] Open
Affiliation(s)
- Bettina Balint
- Department of Neurology University Hospital Heidelberg Heidelberg Germany
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Abstract
PURPOSE OF REVIEW Autoimmune encephalitides are established diagnoses in contemporary neurology. Their management poses a regular challenge for almost all neurologists. One may ask if the concept of 1st line and 2nd line treatment is still up to date, which new data on the antibody-defined encephalitis types exist, and how to organize long-term management. RECENT FINDINGS The 1st line/2nd line concept of initial immunological intervention is accepted worldwide. A randomized controlled trial confirmed that one 1st line compound (intravenous immunoglobulins) is superior to a placebo in patients with antibodies against leucine-rich glioma inactivated protein 1. Rituximab, a 2nd line compound, is increasingly and apparently successfully used in treating different types of autoimmune encephalitis. It may find its place even earlier in the treatment cascade. Long-term management needs to be improved and is under development. SUMMARY There have been no groundbreaking new developments in the field. The published experience confirms existing suggestions. Aspects of long-term management including rehabilitation measures and counseling about driving eligibility require further research.
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Affiliation(s)
- Christian G Bien
- Bielefeld University, Medical School, Department of Epileptology (Krankenhaus Mara), Campus Bielefeld-Bethel, Bielefeld
- Laboratory Krone, Bad Salzuflen, Germany
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48
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Stoyanov A, McDougall A, Urriola N. Musical hallucinations: a rare and atypical presentation of anti-IgLON5 disease responsive to immunosuppressive therapy. BMJ Case Rep 2021; 14:14/2/e236963. [PMID: 33602757 PMCID: PMC7896582 DOI: 10.1136/bcr-2020-236963] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
IgLON5 antibodies are typically associated with the insidious onset of sleep disorder, parasomnia, gait disturbance and abnormal movements, with variable response to immunosuppressive therapy. We describe a case of a 50-year-old man who presented with acute speech difficulties, headache and focal seizures followed by well-formed visual hallucinations, and later, musical hallucinations of mainstream popular music. MRI of the brain demonstrated right temporal lobe changes with corresponding epileptiform activity seen on electroencephalogram. Subsequently, IgLON5 antibodies were detected in the serum. The patient was treated with anticonvulsants, as well as azathioprine with a tapering oral prednisone course with a complete resolution of the symptoms. Our case demonstrates an unusual presentation of the rare but increasingly described anti-IgLON5 disease, with musical hallucinations. The case highlights the variable and evolving clinical phenotypes that can be seen in autoimmune central nervous system disorders.
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Affiliation(s)
- Alex Stoyanov
- Department of Clinical Immunology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Alan McDougall
- Neurology Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Nicolas Urriola
- Department of Clinical Immunology, Liverpool Hospital, Liverpool, New South Wales, Australia
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49
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Devine MF, St Louis EK. Sleep Disturbances Associated with Neurological Autoimmunity. Neurotherapeutics 2021; 18:181-201. [PMID: 33786802 PMCID: PMC8116412 DOI: 10.1007/s13311-021-01020-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2021] [Indexed: 12/29/2022] Open
Abstract
Associations between sleep disorders and neurological autoimmunity have been notably expanding recently. Potential immune-mediated etiopathogenesis has been proposed for various sleep disorders including narcolepsy, Kleine-Levin syndrome, and Morvan syndrome. Sleep manifestations are also common in various autoimmune neurological syndromes, but may be underestimated as overriding presenting (and potentially dangerous) neurological symptoms often require more urgent attention. Even so, sleep dysfunction has been described with various neural-specific antibody biomarkers, including IgLON5; leucine-rich, glioma-inactivated protein 1 (LGI1); contactin-associated protein 2 (CASPR2); N-methyl-D-aspartate (NMDA)-receptor; Ma2; dipeptidyl-peptidase-like protein-6 (DPPX); alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPA-R); anti-neuronal nuclear antibody type-1 (ANNA-1, i.e., Hu); anti-neuronal nuclear antibody type-2 (ANNA-2, i.e., Ri); gamma-aminobutyric acid (GABA)-B-receptor (GABA-B-R); metabotropic glutamate receptor 5 (mGluR5); and aquaporin-4 (AQP-4). Given potentially distinctive findings, it is possible that sleep testing could potentially provide objective biomarkers (polysomnography, quantitative muscle activity during REM sleep, cerebrospinal fluid hypocretin-1) to support an autoimmune diagnosis, monitor therapeutic response, or disease progression/relapse. However, more comprehensive characterization of sleep manifestations is needed to better understand the underlying sleep disruption with neurological autoimmunity.
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Affiliation(s)
- Michelle F Devine
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
- Department of Medicine (Division of Pulmonary, Critical Care, and Sleep Medicine), Rochester, MN, USA.
- Department of Neurology, Mayo Clinic Health System Southwest Wisconsin-La Crosse, Mayo Clinic and Foundation, Rochester, MN, USA.
- Olmsted Medical Center, MN, Rochester, USA.
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
| | - Erik K St Louis
- Mayo Clinic Center for Sleep Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Mayo Sleep Behavior and Neurophysiology Research Laboratory, Rochester, MN, USA
- Department of Medicine (Division of Pulmonary, Critical Care, and Sleep Medicine), Rochester, MN, USA
- Department of Neurology, Mayo Clinic Health System Southwest Wisconsin-La Crosse, Mayo Clinic and Foundation, Rochester, MN, USA
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
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Villacieros-Álvarez J, Ordás CM, Torres-Gaona G, Díez-Barrio A, Prieto-Jurczynska C, Gaig C. Teaching Video NeuroImages: Anti-IgLON5 Disease: A Long-Course Presentation With a Response to Immunotherapy. Neurology 2020; 96:e2901-e2902. [PMID: 33361260 DOI: 10.1212/wnl.0000000000011381] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Javier Villacieros-Álvarez
- From the Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Rey Juan Carlos, Móstoles; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Infanta Elena, Valdemoro; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital General de Villalba, Collado Villalba, Madrid; and Department of Neurology (C.G.), Hospital Clinic, Barcelona, Spain.
| | - Carlos Manuel Ordás
- From the Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Rey Juan Carlos, Móstoles; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Infanta Elena, Valdemoro; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital General de Villalba, Collado Villalba, Madrid; and Department of Neurology (C.G.), Hospital Clinic, Barcelona, Spain
| | - Gustavo Torres-Gaona
- From the Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Rey Juan Carlos, Móstoles; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Infanta Elena, Valdemoro; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital General de Villalba, Collado Villalba, Madrid; and Department of Neurology (C.G.), Hospital Clinic, Barcelona, Spain
| | - Ana Díez-Barrio
- From the Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Rey Juan Carlos, Móstoles; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Infanta Elena, Valdemoro; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital General de Villalba, Collado Villalba, Madrid; and Department of Neurology (C.G.), Hospital Clinic, Barcelona, Spain
| | - Cristina Prieto-Jurczynska
- From the Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Rey Juan Carlos, Móstoles; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Infanta Elena, Valdemoro; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital General de Villalba, Collado Villalba, Madrid; and Department of Neurology (C.G.), Hospital Clinic, Barcelona, Spain
| | - Carles Gaig
- From the Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Rey Juan Carlos, Móstoles; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital Universitario Infanta Elena, Valdemoro; Department of Neurology (J.V.-Á., C.M.O., G.T.-G., A.D.-B., C.P.-J.), Hospital General de Villalba, Collado Villalba, Madrid; and Department of Neurology (C.G.), Hospital Clinic, Barcelona, Spain
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