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Fukata Y, Fukata M, MacGillavry HD, Nair D, Hosy E. Celebrating the Birthday of AMPA Receptor Nanodomains: Illuminating the Nanoscale Organization of Excitatory Synapses with 10 Nanocandles. J Neurosci 2024; 44:e2104232024. [PMID: 38839340 PMCID: PMC11154862 DOI: 10.1523/jneurosci.2104-23.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 06/07/2024] Open
Abstract
A decade ago, in 2013, and over the course of 4 summer months, three separate observations were reported that each shed light independently on a new molecular organization that fundamentally reshaped our perception of excitatory synaptic transmission (Fukata et al., 2013; MacGillavry et al., 2013; Nair et al., 2013). This discovery unveiled an intricate arrangement of AMPA-type glutamate receptors and their principal scaffolding protein PSD-95, at synapses. This breakthrough was made possible, thanks to advanced super-resolution imaging techniques. It fundamentally changed our understanding of excitatory synaptic architecture and paved the way for a brand-new area of research. In this Progressions article, the primary investigators of the nanoscale organization of synapses have come together to chronicle the tale of their discovery. We recount the initial inquiry that prompted our research, the preceding studies that inspired our work, the technical obstacles that were encountered, and the breakthroughs that were made in the subsequent decade in the realm of nanoscale synaptic transmission. We review the new discoveries made possible by the democratization of super-resolution imaging techniques in the field of excitatory synaptic physiology and architecture, first by the extension to other glutamate receptors and to presynaptic proteins and then by the notion of trans-synaptic organization. After describing the organizational modifications occurring in various pathologies, we discuss briefly the latest technical developments made possible by super-resolution imaging and emerging concepts in synaptic physiology.
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Affiliation(s)
- Yuko Fukata
- Division of Molecular and Cellular Pharmacology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
- Division of Membrane Physiology, Department of Molecular and Cellular Physiology, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi 444-8787, Japan
| | - Masaki Fukata
- Division of Membrane Physiology, Department of Molecular and Cellular Physiology, National Institute for Physiological Sciences, National Institutes of Natural Sciences, Okazaki, Aichi 444-8787, Japan
- Division of Neuropharmacology, Nagoya University Graduate School of Medicine, Nagoya, Aichi 466-8550, Japan
- Department of Physiological Sciences, School of Life Science, SOKENDAI (The Graduate University for Advanced Studies), Okazaki, Aichi 444-8585, Japan
| | - Harold D MacGillavry
- Division of Cell Biology, Neurobiology and Biophysics, Department of Biology, Faculty of Science, Utrecht University, Utrecht 3584 CH, The Netherlands
| | - Deepak Nair
- Centre for Neuroscience, Indian Institute of Science, Bangalore 560012, Karnataka, India
| | - Eric Hosy
- Interdisciplinary Institute for Neuroscience, University of Bordeaux, CNRS UMR5297, Bordeaux F-33000, France
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Papi C, Milano C, Spatola M. Mechanisms of autoimmune encephalitis. Curr Opin Neurol 2024; 37:305-315. [PMID: 38667756 DOI: 10.1097/wco.0000000000001270] [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: 04/30/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the pathogenic mechanisms involved in autoimmune encephalitides mediated by antibodies against neuronal surface antigens, with a focus on NMDAR and LGI1 encephalitis. RECENT FINDINGS In antibody-mediated encephalitides, binding of IgG antibodies to neuronal surface antigens results in different pathogenic effects depending on the type of antibody, IgG subclass and epitope specificity. NMDAR IgG1 antibodies cause crosslinking and internalization of the target, synaptic and brain circuitry alterations, as well as alterations of NMDAR expressing oligodendrocytes, suggesting a link with white matter lesions observed in MRI studies. LGI1 IgG4 antibodies, instead, induce neuronal dysfunction by disrupting the interaction with cognate proteins and altering AMPAR-mediated signaling. In-vitro findings have been corroborated by memory and behavioral changes in animal models obtained by passive transfer of patients' antibodies or active immunization. These models have been fundamental to identify targets for innovative therapeutic strategies, aimed at counteracting or preventing antibody effects, such as the use of soluble ephrin-B2, NMDAR modulators (e.g., pregnenolone, SGE-301) or chimeric autoantibody receptor T cells (CAART) in models of NMDAR encephalitis. SUMMARY A deep understanding of the pathogenic mechanisms underlying antibody-mediated encephalitides is crucial for the development of new therapeutic approaches targeting brain autoimmunity.
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Affiliation(s)
- Claudia Papi
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
| | - Chiara Milano
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Spatola
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
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Muñiz-Castrillo S, Honnorat J. Genetic predisposition to autoimmune encephalitis and paraneoplastic neurological syndromes. Curr Opin Neurol 2024; 37:329-337. [PMID: 38483154 DOI: 10.1097/wco.0000000000001263] [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: 04/30/2024]
Abstract
PURPOSE OF REVIEW We summarize the recent discoveries on genetic predisposition to autoimmune encephalitis and paraneoplastic neurological syndromes (PNS), emphasizing clinical and pathophysiological implications. RECENT FINDINGS The human leukocyte antigen (HLA) is the most studied genetic factor in autoimmune encephalitis and PNS. The HLA haplotype 8.1, which is widely known to be related to systemic autoimmunity, has been only weakly associated with a few types of autoimmune encephalitis and PNS. However, the strongest and most specific associations have been reported in a subgroup of autoimmune encephalitis that comprises antileucine-rich glioma-inactivated 1 (LGI1) limbic encephalitis, associated with DRB1∗07 : 01 , anticontactin-associated protein-like 2 (CASPR2) limbic encephalitis, associated with DRB1∗11 : 01 , and anti-IgLON5 disease, associated with DRB1∗10 : 01∼DQA1∗01∼DQB1∗05 . Non-HLA genes have been poorly investigated so far in autoimmune encephalitis, mainly in those lacking HLA associations such as anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, with only a few genome-wide association studies (GWAS) reporting equivocal results principally limited by small sample size. SUMMARY Genetic predisposition seems to be driven mostly by HLA in a group of autoimmune encephalitis characterized by being nonparaneoplastic and having predominantly IgG4 autoantibodies. The contribution of non-HLA genes, especially in those diseases lacking known or strong HLA associations, will require large cohorts enabling GWAS to be powerful enough to render meaningful results.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- Stanford Center for Sleep Sciences and Medicine, Stanford University, Palo Alto, California, USA
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon
- MeLiS Institute - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
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Smith KM, Budhram A, Geis C, McKeon A, Steriade C, Stredny CM, Titulaer MJ, Britton JW. Autoimmune-associated seizure disorders. Epileptic Disord 2024. [PMID: 38818801 DOI: 10.1002/epd2.20231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/28/2024] [Accepted: 04/13/2024] [Indexed: 06/01/2024]
Abstract
With the discovery of an expanding number of neural autoantibodies, autoimmune etiologies of seizures have been increasingly recognized. Clinical phenotypes have been identified in association with specific underlying antibodies, allowing an earlier diagnosis. These phenotypes include faciobrachial dystonic seizures with LGI1 encephalitis, neuropsychiatric presentations associated with movement disorders and seizures in NMDA-receptor encephalitis, and chronic temporal lobe epilepsy in GAD65 neurologic autoimmunity. Prompt recognition of these disorders is important, as some of them are highly responsive to immunotherapy. The response to immunotherapy is highest in patients with encephalitis secondary to antibodies targeting cell surface synaptic antigens. However, the response is less effective in conditions involving antibodies binding intracellular antigens or in Rasmussen syndrome, which are predominantly mediated by cytotoxic T-cell processes that are associated with irreversible cellular destruction. Autoimmune encephalitides also may have a paraneoplastic etiology, further emphasizing the importance of recognizing these disorders. Finally, autoimmune processes and responses to novel immunotherapies have been reported in new-onset refractory status epilepticus (NORSE) and febrile infection-related epilepsy syndrome (FIRES), warranting their inclusion in any current review of autoimmune-associated seizure disorders.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Christian Geis
- Department of Neurology and Section Translational Neuroimmunology, Jena University Hospital, Jena, Germany
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claude Steriade
- Department of Neurology, New York University Langone Health, New York, New York, USA
| | - Coral M Stredny
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maarten J Titulaer
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
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Sakharova T, Aringazina R, Lilyanov N, Monov D. Features of the clinical course of Autoimmune Encephalitis Associated with various antibodies. Neurol Sci 2024:10.1007/s10072-024-07604-7. [PMID: 38806881 DOI: 10.1007/s10072-024-07604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
Despite the increasing incidence of autoimmune encephalitis and the incomplete recovery observed in patients post-affliction, the issue of timely diagnosis remains unresolved. The primary objective of this study is identification the distinctive clinical presentation features evaluation the management strategies, and assess the outcomes of the disease in patients with various forms of autoimmune encephalitis. The research aims to contribute in a better understanding of the disease progression and facilitate the selection of optimal therapeutic interventions. A retrospective observational study enrolled 68 patients aged 18 years and older with verified autoimmune encephalitis who underwent treatment in state hospitals in Sofia, Bulgaria, from the beginning of 2014 to the end of 2022. The number of patients with pathology linked to antibodies against glycine receptors (Gly-R) was half as much, with 32 and 17 patients, respectively. The primary manifestations of autoimmune encephalitis included cognitive impairments observed in 51 patients, seizures occurring in 44 patients, and mood disorders observed in 22 patients. While the findings of imaging studies were nonspecific, hospitalizations for patients with this pathology, especially those with antibodies to CASPR2 and DPPX, were prolonged (114 and 232 days, respectively). In the vast majority of cases, incomplete recovery with residual symptoms was noted. Among the diverse forms of autoimmune encephalitis, the most prevalent is NMDA-R. Cognitive impairments predominate in the autoimmune encephalitis clinical presentation. Prolonged hospitalization periods and incomplete recovery of patients are characteristic features of autoimmune encephalitis, despite combined therapy involving intravenous administration of methylprednisolone and immunoglobulins.
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Affiliation(s)
- Tatyana Sakharova
- Department of Biology and General Genetics, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Raisa Aringazina
- Department of Internal Diseases № 1, Non-Commercial Joint-Stock Society «West Kazakhstan Marat Ospanov Medical University», Aktobe, Kazakhstan
| | - Nikolay Lilyanov
- Department of Anesthesiology and Intensive Care, Medical University of Sofia, Sofia, Bulgaria.
| | - Dimitar Monov
- Department of Anesthesiology and Intensive Care, Medical University of Sofia, Sofia, Bulgaria
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Cuhadar U, Calzado-Reyes L, Pascual-Caro C, Aberra AS, Ritzau-Jost A, Aggarwal A, Ibata K, Podgorski K, Yuzaki M, Geis C, Hallerman S, Hoppa MB, de Juan-Sanz J. Activity-driven synaptic translocation of LGI1 controls excitatory neurotransmission. Cell Rep 2024; 43:114186. [PMID: 38700985 PMCID: PMC11156761 DOI: 10.1016/j.celrep.2024.114186] [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: 06/28/2022] [Revised: 12/14/2023] [Accepted: 04/17/2024] [Indexed: 05/05/2024] Open
Abstract
The fine control of synaptic function requires robust trans-synaptic molecular interactions. However, it remains poorly understood how trans-synaptic bridges change to reflect the functional states of the synapse. Here, we develop optical tools to visualize in firing synapses the molecular behavior of two trans-synaptic proteins, LGI1 and ADAM23, and find that neuronal activity acutely rearranges their abundance at the synaptic cleft. Surprisingly, synaptic LGI1 is primarily not secreted, as described elsewhere, but exo- and endocytosed through its interaction with ADAM23. Activity-driven translocation of LGI1 facilitates the formation of trans-synaptic connections proportionally to the history of activity of the synapse, adjusting excitatory transmission to synaptic firing rates. Accordingly, we find that patient-derived autoantibodies against LGI1 reduce its surface fraction and cause increased glutamate release. Our findings suggest that LGI1 abundance at the synaptic cleft can be acutely remodeled and serves as a critical control point for synaptic function.
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Affiliation(s)
- Ulku Cuhadar
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | - Lorenzo Calzado-Reyes
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | - Carlos Pascual-Caro
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France
| | - Aman S Aberra
- Department of Biology, Dartmouth College, Hanover, NH 03755, USA
| | - Andreas Ritzau-Jost
- Carl-Ludwig-Institute of Physiology, Faculty of Medicine, Leipzig University, 04317 Leipzig, Germany
| | - Abhi Aggarwal
- Allen Institute for Brain Science, Seattle, WA 98109, USA
| | - Keiji Ibata
- Department of Neurophysiology, Keio University, Tokyo 160-8582, Japan
| | | | - Michisuke Yuzaki
- Department of Neurophysiology, Keio University, Tokyo 160-8582, Japan
| | - Christian Geis
- Department of Neurology, Section Translational Neuroimmunology, Jena University Hospital, 07747 Jena, Germany
| | - Stefan Hallerman
- Carl-Ludwig-Institute of Physiology, Faculty of Medicine, Leipzig University, 04317 Leipzig, Germany
| | - Michael B Hoppa
- Department of Biology, Dartmouth College, Hanover, NH 03755, USA
| | - Jaime de Juan-Sanz
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, APHP, Hôpital de la Pitié Salpêtrière, 75013 Paris, France.
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Pastene D, Lehrer E, Jubes S, Santamaria J, Iranzo A, Gaig C, Vilaseca I. Upper airway manifestations of anti-IgLON5 disease: Otorhinolaryngological point of view. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2024:S2173-5735(24)00051-6. [PMID: 38729239 DOI: 10.1016/j.otoeng.2024.04.001] [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: 02/14/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION Anti-IgLON5 disease is a recently described neurological disorder with multisystemic features. The disease is characterized by the presence of IgLON5 antibodies in serum and cerebrospinal fluid. Our objective is to describe in detail the otorhinolaryngological manifestations of this disease, which are frequent and may include dysphagia, dysarthria, vocal cord paralysis and laryngospasm. METHODS In this study, we present a series of 9 patients with anti-IgLON5 disease and otolaryngological manifestations. Patients were evaluated between July 2012 and March 2022 by video-polysomnography, fiber-optic laryngoscopy, and functional endoscopic evaluation of swallowing. RESULTS The median age was 71 years, and 5 (56%) were female. Video-polysomnography showed a NREM/REM parasomnia in 6 patients (67%), obstructive sleep apnea in 8 (88%), stridor during sleep in 7 (78%) and central apneas in 1 (11%). Six out of the 9 patients (67%) presented episodes of acute respiratory failure that required mechanical ventilation, 6 had vocal fold palsy with 4 of them requiring tracheostomy (3 had to be performed on an emergency basis). Dysphagia occurred in 8 patients (89%). Prominent upper airway secretion and sialorrhea was also present in 3 cases. CONCLUSION The anti-IgLON5 disease exhibits extensive otolaryngological symptoms, mainly affecting the upper airway. These symptoms affect the quality of life and can be life-threatening. Prompt acute management is essential for stridor, dyspnea, and dysphagia. Given the potential severity of the symptoms and rarity of the disease, it is important for otolaryngologists to be familiar with anti-IgLON5 disease. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Daniela Pastene
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Eduardo Lehrer
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain; Head Neck Cancer Unit, Hospital Clínic, Barcelona, Spain; Department of Surgery and Medical Surgical Specialties, School of Medicine, Universitat de Barcelona, Spain.
| | - Sara Jubes
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain
| | - Joan Santamaria
- Emeritus consultant and researcher, Hospital Clínic of Barcelona and Biomedical Research Institute (IDIBAPS) Barcelona, Spain
| | - Alex Iranzo
- Neurology Service, Sleep Disorders Center, Hospital Clínic de Barcelona, Barcelona, Spain, University of Barcelona, IDIBAPS, CIBERNED, Spain
| | - Carles Gaig
- Neurology Service, Sleep Disorders Center, Hospital Clínic de Barcelona, Barcelona, Spain, University of Barcelona, IDIBAPS, CIBERNED, Spain
| | - Isabel Vilaseca
- Otorhinolaryngology Department, Hospital Clínic, Barcelona, Spain; Head Neck Cancer Unit, Hospital Clínic, Barcelona, Spain; Department of Surgery and Medical Surgical Specialties, School of Medicine, Universitat de Barcelona, Spain
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Yamada K, Yaguchi H, Ishikawa K, Tanaka D, Oshima Y, Mizushima K, Uwatoko H, Shirai S, Takahashi-Iwata I, Matsushima M, Tanaka K, Yabe I. Lambert-Eaton Myasthenic Syndrome Complicated by Anti-GABA B Receptor Encephalitis. Intern Med 2024; 63:1295-1300. [PMID: 37743510 PMCID: PMC11116022 DOI: 10.2169/internalmedicine.2569-23] [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: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 09/26/2023] Open
Abstract
A 74-year-old man experienced diplopia, generalized muscle weakness, and acute respiratory failure. He was diagnosed with Lambert-Eaton myasthenic syndrome (LEMS) and treated with immunotherapy, but no improvement was observed, and additional symptoms, including central apnea and hallucinations, appeared. Subsequent serum and cerebrospinal fluid (CSF) analyses confirmed the presence of GABAB receptor antibodies, indicating the coexistence of autoimmune encephalitis. Although there were no findings of malignancy, it is highly likely that occult small-cell lung carcinoma was present. When atypical symptoms occur in patients with LEMS, it is important to consider the possibility of concomitant autoimmune encephalitis.
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Affiliation(s)
- Kazuki Yamada
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Kaede Ishikawa
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Daiki Tanaka
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Yuki Oshima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Keiichi Mizushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Hisashi Uwatoko
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Shinichi Shirai
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Ikuko Takahashi-Iwata
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Masaaki Matsushima
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
| | - Keiko Tanaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Japan
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Cui D, Feng J, Yang M, Dong Y, Lian Y. Acute Symptomatic Seizures and Risk of Seizure Recurrence in Patients with Anti-NMDAR, Anti-LGI1, and Anti-GABA BR Encephalitis. Neurol Sci 2024; 45:1609-1617. [PMID: 37940748 DOI: 10.1007/s10072-023-07165-1] [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: 06/03/2023] [Accepted: 10/25/2023] [Indexed: 11/10/2023]
Abstract
AIMS To analyze the clinical characteristics of acute symptomatic seizures and predict the risk factors for seizure recurrence in patients with anti-N-methyl-D-aspartate receptor (NMDAR), anti-leucine-rich glioma-inactivated 1 (LGI1), and anti-gamma-aminobutyric acid B receptor (GABABR) encephalitis. METHODS In this retrospective study, we included hospitalized patients who had been diagnosed with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis between November 2014 and April 2021. Binary logistic regression analysis was performed to identify the potential risk factors for seizure recurrence. RESULTS In total, 262 patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis were included, 197 (75.2%) of whom presented with acute symptomatic seizures. During follow-up, 42 patients exhibited seizure recurrence. In anti-NMDAR encephalitis, frontal lobe abnormality on brain magnetic resonance imaging, delayed immunotherapy, early seizures, and focal motor onset were associated with seizure recurrence. CONCLUSIONS Acute symptomatic seizure is a common clinical feature observed in patients with anti-NMDAR, anti-LGI1, and anti-GABABR encephalitis, with 50% of patients presenting with seizures as an initial symptom. The prognosis of patients with acute symptomatic seizures can be improved after receiving immunotherapy. Nevertheless, a minority of patients will experience seizure recurrence; therefore, restarting immunotherapy is recommended.
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Affiliation(s)
- Dingge Cui
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jilun Feng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mu Yang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Dong
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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10
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Li SJ, Wu YL, Chen JH, Shen SY, Duan J, Xu HE. Autoimmune diseases: targets, biology, and drug discovery. Acta Pharmacol Sin 2024; 45:674-685. [PMID: 38097717 PMCID: PMC10943205 DOI: 10.1038/s41401-023-01207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/20/2023] [Indexed: 03/17/2024] Open
Abstract
Autoimmune diseases (AIDs) arise from a breakdown in immunological self-tolerance, wherein the adaptive immune system mistakenly attacks healthy cells, tissues and organs. AIDs impose excessive treatment costs and currently rely on non-specific and universal immunosuppression, which only offer symptomatic relief without addressing the underlying causes. AIDs are driven by autoantigens, targeting the autoantigens holds great promise in transforming the treatment of these diseases. To achieve this goal, a comprehensive understanding of the pathogenic mechanisms underlying different AIDs and the identification of specific autoantigens are critical. In this review, we categorize AIDs based on their underlying causes and compile information on autoantigens implicated in each disease, providing a roadmap for the development of novel immunotherapy regimens. We will focus on type 1 diabetes (T1D), which is an autoimmune disease characterized by irreversible destruction of insulin-producing β cells in the Langerhans islets of the pancreas. We will discuss insulin as possible autoantigen of T1D and its role in T1D pathogenesis. Finally, we will review current treatments of TID and propose a potentially effective immunotherapy targeting autoantigens.
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Affiliation(s)
- Shu-Jie Li
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- Department of Traditional Chinese Medicine, Fujian Medical University Union Hospital, Fuzhou, 350000, China.
| | - Yan-Li Wu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Juan-Hua Chen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
| | - Shi-Yi Shen
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China
- University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Jia Duan
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- University of Chinese Academy of Sciences, Beijing, 100049, China.
- Zhongshan Institute for Drug Discovery, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Zhongshan, 528400, China.
| | - H Eric Xu
- State Key Laboratory of Drug Research, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, 201203, China.
- School of Life Science and Technology, Shanghai Tech University, Shanghai, 201210, China.
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11
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Zhang M, Meng H, Zhou Q, Chunyu H, He L, Meng H, Wang H, Wang Y, Sun C, Xi Y, Hai W, Huang Q, Li B, Chen S. Microglial Activation Imaging Using 18F-DPA-714 PET/MRI for Detecting Autoimmune Encephalitis. Radiology 2024; 310:e230397. [PMID: 38441089 DOI: 10.1148/radiol.230397] [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: 03/07/2024]
Abstract
Background Translocator protein (TSPO) PET has been used to visualize microglial activation in neuroinflammation and is a potential imaging tool for detecting autoimmune encephalitis (AIE). Purpose To compare the detection rate between TSPO radioligand fluorine 18 (18F) DPA-714 PET and conventional MRI and assess the relationship between 18F-DPA-714 uptake and clinical features in participants with AIE. Materials and Methods Healthy volunteers and patients with AIE were enrolled in this prospective study between December 2021 and April 2023. All participants underwent hybrid brain 18F-DPA-714 PET/MRI and antibody testing. Modified Rankin scale scoring and AIE-related symptoms were assessed in participants with AIE. Positive findings were defined as intensity of 18F-DPA-714 uptake above a threshold of the mean standardized uptake value ratio (SUVR) plus 2 SD inside the corresponding brain regions of healthy controls. The McNemar test was used to compare the positive detection rate between the two imaging modalities; the independent samples t test was used to compare continuous variables; and correlation with Bonferroni correction was used to assess the relationship between 18F-DPA-714 uptake and clinical features. Results A total of 25 participants with AIE (mean age, 39.24 years ± 19.03 [SD]) and 10 healthy controls (mean age, 28.70 years ± 5.14) were included. The positive detection rate of AIE was 72% (18 of 25) using 18F-DPA-714 PET compared to 44% (11 of 25) using conventional MRI, but the difference was not statistically significant (P = .065). Participants experiencing seizures exhibited significantly higher mean SUVR in the entire cortical region than those without seizures (1.23 ± 0.21 vs 1.15 ± 0.18; P = .003). Of the 13 participants with AIE who underwent follow-up PET/MRI, 11 (85%) demonstrated reduced uptake of 18F-DPA-714 accompanied by relief of symptoms after immunosuppressive treatment. Conclusion 18F-DPA-714 PET has potential value in supplementing MRI for AIE detection. Clinical trial registration no. NCT05293405 © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Zaharchuk in this issue.
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Affiliation(s)
- Min Zhang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Huanyu Meng
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Qinming Zhou
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Hangxing Chunyu
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Lu He
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Hongping Meng
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Hanzhong Wang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Yue Wang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Chenwei Sun
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Yun Xi
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Wangxi Hai
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Qiu Huang
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Biao Li
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
| | - Sheng Chen
- From the Departments of Nuclear Medicine (M.Z., H.C., Hongping Meng, Y.W., C.S., Y.X., W.H., B.L.) and Neurology (Huanyu Meng, Q.Z., L.H., S.C.), Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin 2nd Rd, Shanghai, China; Shanxi Medical University-Collaborative Innovation Center for Molecular Imaging of Precision Medicine, Taiyuan, China (M.Z., B.L.); School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China (H.W., Q.H.); and Co-Innovation Center of Neuroregeneration, Nantong University, Nantong, China (S.C.)
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Fattahzadeh Ardalani G, Samady Khanghah A, Jahanpanah M, Mokhtari D, Samady Khanghah P. Successfully treated anti-GAD limbic encephalitis in a 15-year-old diabetic boy with intravenous immunoglobulin: case report. Ann Med Surg (Lond) 2024; 86:1173-1181. [PMID: 38333287 PMCID: PMC10849452 DOI: 10.1097/ms9.0000000000001653] [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: 10/16/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction and importance Limbic encephalitides (LE) have symptoms and signs of new-onset seizures accompanied by cognitive impairment and signal changes in the MRI of the limbic system in the brain. Numerous antibodies against the neurons and synapses have been detected so far. Of those, antiglutamic acid decarboxylase antibody (Anti-GAD Ab) impairs the gamma amino butyric acid, one of the primary mediators that naturally prevents abnormal neuronal activity causing seizure. Case presentation The authors have reported a case of anti-GAD Ab LE in a diabetic male adolescent who responded dramatically to intravenous immunoglobulin and reviewed all similar pediatric cases for 15 years now. Clinical discussion The symptoms in children suffering from anti-GAD LE in three categories, systemic, psychiatric, and neurological, are heterogeneous. The most common manifestations were seizures followed by altered mental status and behavioral changes, respectively. The two main clinical scenarios described in GAD65-mediated autoimmune epilepsy are (1) an acute/subacute onset of seizures alone or seizures (including new-onset refractory status epilepticus, NORSE) accompanied by some degrees of cognitive and psychiatric manifestations, including amnesia and mesiotemporal inflammatory involvement consistent with LE and (2) epilepsy without clinical or MRI evidence of active central nervous system inflammation. Conclusion Although rare, the neurologist should consider the potential role of anti-GAD ab-associated encephalitis in the presence of diabetes mellitus.
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Affiliation(s)
| | | | - Mohammad Jahanpanah
- Department of Genetics and Pathology
- Department of Neurology, School of Medicine, Ardabil University of Medical Sciences
| | - Diana Mokhtari
- Department of Genetics and Pathology
- Department of Neurology, School of Medicine, Ardabil University of Medical Sciences
| | - Parisa Samady Khanghah
- Department of Cellular and Molecular Biology, University of Mohaghegh Ardabili, Ardabil, Iran
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Kalra S, Tripathi M, Tripathi M, Sonar RS, Pandey AK, Jaleel J, Singh RK, Kumar P, Damle NA, Bal C. Role of FDG PET/CT in definitive and presumed autoimmune encephalitis. Nucl Med Commun 2024; 45:121-127. [PMID: 37982572 DOI: 10.1097/mnm.0000000000001790] [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: 11/21/2023]
Abstract
OBJECTIVE F-18 Fluorodeoxyglucose PET/CT (FDG-PET) is emerging as a useful imaging adjunct to MRI in the initial diagnostic evaluation of autoimmune encephalitis (AIE)-though presently it is not included in the diagnostic criteria. MATERIALS AND METHODS In this prospective study we enrolled a total of 52 patients with clinically diagnosed and treated AIE. MRI evaluation was done in each case along with CSF and EEG where feasible. FDG-PET was done for all and images were interpreted visually and using SPM. RESULTS The mean age group of patients included was 38.5 ± 22.6 years with 31 females and 21 males. 23 antibody-positive cases underwent PET, the most common antibody detected was anti-NMDAR type followed by anti-LGI 1. Most common metabolic pattern in NMDARE was hypermetabolism in basal ganglia and hypometabolism in parieto-occipital cortices and ovarian teratoma was detected in two of these patients on whole-body PET. A metabolic pattern consistent with AIE was demonstrated in 22/29 (75.8%) antibody-negative patients with hypermetabolism in basal ganglia and mesial temporal cortices. The overall sensitivity of FDG PET was 86% (45/52). MRI abnormalities were detected in 22/52 (42%) cases, 10/23 antibody positive and 12/29 antibody negative cases. PET was positive in 23/30 (76%) MRI negative cases. CONCLUSION Sensitivity of FDG PET for supporting a diagnosis of AIE was higher compared to MRI in both antibody-positive (definitive) and antibody-negative (presumed) AIE. Specific metabolic patterns can be demonstrated on FDG PET in AIE, prompting an early diagnosis so that timely treatment can be instituted.
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Su M, Luo Q, Wu Z, Feng H, Zhou H. Thymoma-associated autoimmune encephalitis with myasthenia gravis: Case series and literature review. CNS Neurosci Ther 2024; 30:e14568. [PMID: 38421083 PMCID: PMC10850820 DOI: 10.1111/cns.14568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 11/20/2023] [Accepted: 12/02/2023] [Indexed: 03/02/2024] Open
Abstract
OBJECTIVES This comprehensive review aimed to compile cases of patients with thymoma diagnosed with both autoimmune encephalitis (AE) and myasthenia gravis (MG), and describe their clinical characteristics. METHODS Clinical records of 3 AE patients in the first affiliated hospital of Sun Yat-sen University were reviewed. All of them were diagnosed with AE between 1 November 2021 and 1 March 2022, and clinical evidence about thymoma and MG was found. All published case reports were searched for comprehensive literature from January 1990 to June 2022. RESULTS A total of 18 cases diagnosed with thymoma-associated autoimmune encephalitis (TAAE) and thymoma-associated myasthenia gravis (TAMG) were included in this complication, wherein 3 cases were in the first affiliated hospital of Sun Yat-sen University and the other 15 were published case reports. 5/18 patients had alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antibody (AMPAR-Ab) in their serum and cerebrospinal fluid (CSF). All of them had positive anti-acetylcholine receptor antibody (AChR-Ab). And 12/18 patients showed a positive response to thymectomy and immunotherapy. Besides, thymoma recurrences were detected because of AE onset. And the shortest interval between operation and AE onset was 2 years in patients with thymoma recurrence. CONCLUSIONS There was no significant difference in the clinical manifestations between these patients and others with only TAMG or TAAE. TAAE was commonly associated with AMPAR2-Ab. Significantly, AE more commonly heralded thymoma recurrences than MG onset. And the intervals of thymectomy and MG or AE onset had different meanings for thymoma recurrence and prognoses of patients.
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Affiliation(s)
- Miao Su
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Qiuyan Luo
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
- Department of NeurologyGuangzhou Women and Children's Medical CenterGuangzhouChina
| | - Zichao Wu
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Huiyu Feng
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
| | - Hongyan Zhou
- Department of NeurologyThe First Affiliated Hospital, Sun Yat‐sen UniversityGuangzhouChina
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Zhou Y, Chen H, Zhu M, Li M, Wang L, Xie Z, Zhou M, Wu X, Hong D. Clinical characteristics of autoimmune encephalitis with co-existence of multiple anti-neuronal antibodies. BMC Neurol 2024; 24:1. [PMID: 38163879 PMCID: PMC10759401 DOI: 10.1186/s12883-023-03514-x] [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: 02/04/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND An increasing number of cases of autoimmune encephalitis (AE) with co-existing multiple anti-neuronal antibodies have been reported in recent years. However, the clinical significance of the concurrent presence of multiple anti-neuronal antibodies in patients with AE remains unclear. METHODS We retrospectively enrolled AE patients with multiple anti-neuronal antibodies treated at our center between August 2019 and February 2022. We also reviewed cases reported in multiple literature databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed on selection process. And then the clinical and laboratory data of these cases were collected for review and summary. RESULTS A total of 83 AE cases with multiple antibodies (9 cases from our center and 74 cases from the literatures reviewed) were identified. In our center, nine patients presented with encephalitis symptoms, clinically characterized as disturbed consciousness, seizures, cognitive impairment, and psychiatric disorders. Of the 83 cases, 73 cases had co-existence of 2 types of antibodies, 8 cases had 3 types, and 2 cases had 4 types. Thirty-nine cases (39/83, 46.9%) were confirmed or suspected of also having a tumor, of which the most common was lung cancer (28/83, 33.7%). Partial or complete recovery was achieved in 57 cases (57/83, 68.6%), while 26 cases (26/83, 31.3%) died during treatment or follow-up. CONCLUSIONS AE with co-existing multiple anti-neuronal antibodies is a specific subgroup, that is increasingly recognized in clinical practice. The co-existence of multiple anti-neuronal antibodies has a major impact on clinical features, disease progression, and prognosis.
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Affiliation(s)
- Yiyi Zhou
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Hao Chen
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Min Zhu
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Menghua Li
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Lianqun Wang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zunchun Xie
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Meihong Zhou
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiaomu Wu
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
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Graus F. Clinical approach to diagnosis of paraneoplastic neurologic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:79-96. [PMID: 38494298 DOI: 10.1016/b978-0-12-823912-4.00007-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The correct diagnosis of a paraneoplastic neurologic syndrome (PNS) first requires the identification of the syndrome as one of those defined as high-risk (previously called classical) or intermediate-risk for cancer in the 2021 PNS diagnostic criteria. Testing for neuronal antibodies should be restricted to these syndromes as indiscriminate request decreases the diagnostic value of the antibodies. Identifying onconeural (high-risk for cancer) or intermediate-risk for cancer antibodies supports the paraneoplastic diagnosis and mandates the search for an underlying cancer. Tumor screening must follow the published guidelines. Repeated screening is indicated in neurologic syndromes with onconeural antibodies and patients with high-risk for cancer neurologic syndromes unless they present neuronal antibodies which are not associated with cancer. Neuronal antibodies should be screened by immunohistochemistry and confirmed by immunoblot (intracellular antigens) or cell-based assay (CBA) (surface antigens). Positive results only by immunoblot or CBA should be taken with caution. Although the 2021 diagnostic criteria for PNS do not capture all PNS, as they do not allow to diagnose definite PNS neurologic syndromes without neuronal antibodies, the updated criteria represent a step forward to differentiate true PNS from neurologic syndromes that coincide in time with cancer diagnosis without having a pathogenic link.
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Affiliation(s)
- Francesc Graus
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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Budhram A, Flanagan EP. Optimizing the diagnostic performance of neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:365-382. [PMID: 38494290 DOI: 10.1016/b978-0-12-823912-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The detection of neural antibodies in patients with paraneoplastic and autoimmune encephalitis has majorly advanced the diagnosis and management of neural antibody-associated diseases. Although testing for these antibodies has historically been restricted to specialized centers, assay commercialization has made this testing available to clinical chemistry laboratories worldwide. This improved test accessibility has led to reduced turnaround time and expedited diagnosis, which are beneficial to patient care. However, as the utilization of these assays has increased, so too has the need to evaluate how they perform in the clinical setting. In this chapter, we discuss assays for neural antibody detection that are in routine use, draw attention to their limitations and provide strategies to help clinicians and laboratorians overcome them, all with the aim of optimizing neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Dalmau J. Changing landscape in the field of paraneoplastic neurology: Personal perspectives over a 35-year career. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:11-32. [PMID: 38494272 DOI: 10.1016/b978-0-12-823912-4.00013-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes are a group of rare disorders that have fascinated neurologists for more than a century. The discovery in the 1980s that many of these disorders occurred in association with antibodies against neuronal proteins revived the interest for these diseases. This chapter first traces the history of the paraneoplastic neurologic syndromes during the era that preceded the discovery of immune mechanisms and then reviews the immunologic period during which many of these syndromes were found to be associated with antibodies against intracellular onconeuronal proteins and pathogenic cytotoxic T-cell mechanisms. Alongside these developments, investigations on the antibody-mediated disorders of the peripheral nervous system, such as the myasthenic syndromes or neuromyotonia, provided suggestions for the study of the central nervous system (CNS) syndromes. These converging areas of research culminated with the groundbreaking discovery of a new category of CNS disorders mediated by antibodies against neuronal surface proteins or receptors. These disorders are not always paraneoplastic, and the understanding of these syndromes and mechanisms has changed the landscape of neurology and neurosciences.
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Affiliation(s)
- Josep Dalmau
- IDIBAPS-Hospital Clinic, University of Barcelona, Barcelona, Spain; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
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Budhram A, Sechi E. Antibodies to neural cell surface and synaptic proteins in paraneoplastic neurologic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:347-364. [PMID: 38494289 DOI: 10.1016/b978-0-12-823912-4.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Among patients with paraneoplastic neurologic syndromes (PNS), emphasis has historically been placed on neural antibodies against intracellular proteins that have a strong association with malignancy. Because of the intracellular location of their antigenic targets, these antibodies are typically considered to be non-pathogenic surrogate markers of immune cell-mediated neural injury. Unfortunately, patients with these antibodies often have suboptimal response to immunotherapy and poor prognosis. Over the last two decades, however, dramatic advancements have been made in the discovery and clinical characterization of neural antibodies against extracellular targets. These antibodies are generally considered to be pathogenic, given their potential to directly alter antigen structure or function, and patients with these antibodies often respond favorably to prompt immunotherapy. These antibodies also associate with tumors and may thus occur as PNS, albeit more variably than neural antibodies against intracellular targets. The updated 2021 PNS diagnostic criteria, which classifies antibodies as high-risk, intermediate-risk, or lower-risk for an associated cancer, better clarifies how neural antibodies against extracellular targets relate to PNS. Using this recently created framework, the clinical presentations, ancillary test findings, oncologic associations, and treatment responses of syndromes associated with these antibodies are discussed.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Casagrande S, Zuliani L, Grisold W. Paraneoplastic encephalitis. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:131-149. [PMID: 38494274 DOI: 10.1016/b978-0-12-823912-4.00019-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The first reports of encephalitis associated with cancer date to the 1960s and were characterized by clinical and pathologic involvement of limbic areas. This specific association was called limbic encephalitis (LE). The subsequent discovery of several "onconeural" antibodies (Abs), i.e., Abs targeting an antigen shared by neurons and tumor cells, supported the hypothesis of an autoimmune paraneoplastic etiology of LE and other forms of rapidly progressive encephalopathy. Over the past 20 years, similar clinical pictures with different clinical courses have been described in association with novel Abs-binding neuronal membrane proteins and proved to be pathogenic. The most well-known encephalitis in this group was described in 2007 as an association of a complex neuro-psychiatric syndrome, N-methyl-d-aspartate (NMDA) receptor-Abs, and ovarian teratoma in young women. Later on, nonparaneoplastic cases of NMDA receptor encephalitis were also described. Since then, the historical concept of LE and Ab associated encephalitis has changed. Some of these occur in fact more commonly in the absence of a malignancy (e.g., anti-LG1 Abs). Lastly, seronegative cases were also described. The term paraneoplastic encephalitis nowadays encompasses different syndromes that may be triggered by occult tumors.
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Affiliation(s)
- Silvia Casagrande
- Neurology Unit, Rovereto Hospital, Trento, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Luigi Zuliani
- Department of Neurology, San Bortolo Hospital, Azienda ULSS8 Berica, Vicenza, Italy
| | - Wolfgang Grisold
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, Vienna, Austria
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Quinot V, Höftberger R. Pathogenesis and immunopathology of paraneoplastic disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:33-54. [PMID: 38494287 DOI: 10.1016/b978-0-12-823912-4.00027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes (PNS) represent a rare group of immune-mediated complications associated with an underlying tumor. Ectopic protein expression in neoplastic cells or an aberrant immune regulation in the course of hematooncologic diseases or thymomas trigger an autoimmune response that may affect any part of the central and/or peripheral nervous system. Recent advances in drug therapies as well as novel animal models and neuropathologic studies have led to further insights on the immune pathomechanisms of PNS. Although the syndromes share common paths in pathogenesis, they may differ in the disease course, prognosis, and therapy targets, depending on the localization and type of antibody epitope. Neuropathologic hallmarks of PNS associated with antibodies directed against intracellular epitopes are characterized by T cell-dominated inflammation, reactive gliosis including microglial nodules, and neuronal degeneration. By contrast, the neuropathology of cell surface antibody-mediated PNS strongly depends on the targeted antigen and varies from B cell/plasma cell-dominated inflammation and well-preserved neurons together with a reduced expression of the target antigen in anti-NMDAR encephalitis to irreversible Purkinje cell loss in anti-P/Q-type VGCC antibody-associated paraneoplastic cerebellar degeneration. The understanding of different pathomechanisms in PNS is important because they strongly correspond with therapy response and prognosis, and should guide treatment decisions.
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Affiliation(s)
- Valérie Quinot
- Division of Neuropathology and Neurochemistry, 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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Masciocchi S, Businaro P, Scaranzin S, Morandi C, Franciotta D, Gastaldi M. General features, pathogenesis, and laboratory diagnostics of autoimmune encephalitis. Crit Rev Clin Lab Sci 2024; 61:45-69. [PMID: 37777038 DOI: 10.1080/10408363.2023.2247482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Autoimmune encephalitis (AE) is a group of inflammatory conditions that can associate with the presence of antibodies directed to neuronal intracellular, or cell surface antigens. These disorders are increasingly recognized as an important differential diagnosis of infectious encephalitis and of other common neuropsychiatric conditions. Autoantibody diagnostics plays a pivotal role for accurate diagnosis of AE, which is of utmost importance for the prompt recognition and early treatment. Several AE subgroups can be identified, either according to the prominent clinical phenotype, presence of a concomitant tumor, or type of neuronal autoantibody, and recent diagnostic criteria have provided important insights into AE classification. Antibodies to neuronal intracellular antigens typically associate with paraneoplastic neurological syndromes and poor prognosis, whereas antibodies to synaptic/neuronal cell surface antigens characterize many AE subtypes that associate with tumors less frequently, and that are often immunotherapy-responsive. In addition to the general features of AE, we review current knowledge on the pathogenic mechanisms underlying these disorders, focusing mainly on the potential role of neuronal antibodies in the most frequent conditions, and highlight current theories and controversies. Then, we dissect the crucial aspects of the laboratory diagnostics of neuronal antibodies, which represents an actual challenge for both pathologists and neurologists. Indeed, this diagnostics entails technical difficulties, along with particularly interesting novel features and pitfalls. The novelties especially apply to the wide range of assays used, including specific tissue-based and cell-based assays. These assays can be developed in-house, usually in specialized laboratories, or are commercially available. They are widely used in clinical immunology and in clinical chemistry laboratories, with relevant differences in analytic performance. Indeed, several data indicate that in-house assays could perform better than commercial kits, notwithstanding that the former are based on non-standardized protocols. Moreover, they need expertise and laboratory facilities usually unavailable in clinical chemistry laboratories. Together with the data of the literature, we critically evaluate the analytical performance of the in-house vs commercial kit-based approach. Finally, we propose an algorithm aimed at integrating the present strategies of the laboratory diagnostics in AE for the best clinical management of patients with these disorders.
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Affiliation(s)
- Stefano Masciocchi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Pietro Businaro
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Morandi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
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Ryding M, Mikkelsen AW, Nissen MS, Nilsson AC, Blaabjerg M. Pathophysiological Effects of Autoantibodies in Autoimmune Encephalitides. Cells 2023; 13:15. [PMID: 38201219 PMCID: PMC10778077 DOI: 10.3390/cells13010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The heterogeneity of autoantibody targets in autoimmune encephalitides presents a challenge for understanding cellular and humoral pathophysiology, and the development of new treatment strategies. Thus, current treatment aims at autoantibody removal and immunosuppression, and is primarily based on data generated from other autoimmune neurological diseases and expert consensus. There are many subtypes of autoimmune encephalitides, which now entails both diseases with autoantibodies targeting extracellular antigens and classical paraneoplastic syndromes with autoantibodies targeting intracellular antigens. Here, we review the current knowledge of molecular and cellular effects of autoantibodies associated with autoimmune encephalitis, and evaluate the evidence behind the proposed pathophysiological mechanisms of autoantibodies in autoimmune encephalitis.
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Affiliation(s)
- Matias Ryding
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne With Mikkelsen
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | | | - Anna Christine Nilsson
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | - Morten Blaabjerg
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark;
- Brain Research—Inter Disciplinary Guided Excellence (BRIDGE), 5000 Odense, Denmark
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Goertzen A, Altawashi AK, Rieck J, Veh RW. Autoimmune processes in neurological patients are much more common than presently suspected. J Neurol 2023; 270:5866-5877. [PMID: 37603074 PMCID: PMC10632246 DOI: 10.1007/s00415-023-11901-0] [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: 06/11/2023] [Revised: 07/23/2023] [Accepted: 07/25/2023] [Indexed: 08/22/2023]
Abstract
Autoimmune encephalitides are seldom diseases. How rare they actually are, however, is not known. The low incidence combined with the problematic identification may dampen efforts of neurologists, to identify patients with unclear symptoms as suffering from autoimmune encephalitis. Here, we aim to obtain a better estimate, how many patients with autoimmune disorders should be expected among 100 inpatients in a conventional neurological department. From a total number of 2603 non-stroke patients attended in a 2-year period (2018-2019) 460 CSFs were obtained. From this collection 187 samples (40.7%, > 500 sections) could be analyzed with our immunocytochemical technique. Autoreactive antibodies were detected in 102 (55%) of these 187 CSF samples. Certainly, the presence of autoreactive antibodies does not necessarily indicate that the patient suffers from an autoimmune disease. Our data indicate that from roughly 2000 patients during 1 year about 125 patients with autoreactive CSF antibodies should be expected in a conventional neurological department. This represents the about 35-fold value of what is generally expected at present. Being aware of this high incidence may intensify the efforts of neurologist to identify patients with any type of autoimmune encephalitis. This will be beneficial for patients, because they often profit from immunomodulatory therapy. Interestingly, some CFSs from our patients react with the CA2 subdivision of the hippocampus. While long neglected, recent research places this area into an important position to influence hippocampal network physiology. Autoreactive antibodies in the CSF may disturb the function of CA2 neurons, thereby explaining some neuropsychiatric symptoms in patients with autoimmune encephalitides.
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Affiliation(s)
- Angelika Goertzen
- AMEOS Klinikum St. Clemens Oberhausen, Wilhelmstrasse 34, D-46145, Oberhausen, Germany
| | | | - Julian Rieck
- Institut für Zell- und Neurobiologie, Centrum 2, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany
| | - Rüdiger W Veh
- Institut für Zell- und Neurobiologie, Centrum 2, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117, Berlin, Germany.
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Klein da Costa B, de Oliveira Pinto P, Staub L, Hansel G, Vanik Pinto G, Porcello Schilling L, Rodrigues Dos Passos G, Alves Martins W, Becker J, Machado Castilhos R, Palmini A, Sato DK. Neurological syndromes and potential triggers associated with antibodies to neuronal surface antigens. Mult Scler Relat Disord 2023; 80:105022. [PMID: 37864878 DOI: 10.1016/j.msard.2023.105022] [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: 06/18/2023] [Revised: 09/05/2023] [Accepted: 09/23/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Autoantibodies against surface neuronal antigens have been associated with specific neurological presentations including autoimmune encephalitis (AE), with variable association with neoplasia and infections. METHODS We described the phenotype and environmental associations of patients with neurological syndromes associated with antibodies against neuronal surface antigens who were referred to a tertiary center in the South of Brazil. All patients were tested for neuronal autoantibodies using cell-based assays. Clinical, radiological, and laboratory findings were retrospectively reviewed. RESULTS We identified 16 patients, 15 had subacute, and one had a progressive disease course. Among patients with subacute onset, 11 (73 %) were N-Methyl-d-Aspartate receptor (NMDAr-IgG)+, 3 (20 %) were Leucine-rich Glioma-Inactivated-1 (LGI1-IgG)+, and 1 (6 %) was positive for Glycine receptor-IgG. The patient with a progressive disease course had antibodies against IgLON5. Most patients had disease onset in spring and summer suggesting environmental factors for the development of AE. Also, we observed a different pattern of brain lesions when NMDAr-IgG encephalitis followed herpes encephalitis and a previously unreported association with Rosai-Dorfman-Destombe disease. All patients with encephalopathy met criteria for possible AE and all proven NMDAr-IgG+ met criteria for NMDAr-IgG encephalitis. However, only one LGI1-IgG+ patient fulfilled clinical criteria for limbic encephalitis. All but one received high-dose intravenous methylprednisolone, 11 also had intravenous human immunoglobulin, and 4 plasma exchange. Furthermore, all patients received second-line immunotherapy. Importantly, most patients improved with immunotherapy, even when initiated later in the disease course. CONCLUSION We identified seasonal variability associated with neuronal surface antibodies suggesting environmental triggers. Also, we described the coexistence of NMDAr-IgG encephalitis with histiocytosis. In our series, most patients received second-line immunotherapy. We observed neurologic improvement after treatment even in cases of delayed diagnosis. Increasing the recognition and availability of tests and treatments for these conditions is of paramount importance in low- and middle-income countries.
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Affiliation(s)
- Bruna Klein da Costa
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Paula de Oliveira Pinto
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lia Staub
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gisele Hansel
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Guilherme Vanik Pinto
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucas Porcello Schilling
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Giordani Rodrigues Dos Passos
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - William Alves Martins
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Jefferson Becker
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Raphael Machado Castilhos
- Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - André Palmini
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Douglas Kazutoshi Sato
- Hospital São Lucas/ Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
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Akkus S, Elkhooly M, Amatya S, Shrestha K, Sharma K, Kagzi Y, Khan E, Gupta R, Piquet AL, Jaiswal S, Wen S, Tapia M, Samant R, Sista SR, Sriwastava S. Autoimmune and paraneoplastic neurological disorders: A review of relevant neuroimaging findings. J Neurol Sci 2023; 454:120830. [PMID: 37856996 DOI: 10.1016/j.jns.2023.120830] [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: 08/21/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
INTRODUCTION Paraneoplastic neurologic syndromes (PNS) and autoimmune encephalitis (AIE) are immune-mediated disorders. PNS is linked to cancer, while AIE may not Their clinical manifestations and imaging patterns need further elucidation. OBJECTIVE/AIMS To investigate the clinical profiles, antibody associations, neuroimaging patterns, treatments, and outcomes of PNS and AIE. METHODS A systematic review of 379 articles published between 2014 and 2023 was conducted. Of the 55 studies screened, 333 patients were diagnosed with either PNS or AIE and tested positive for novel antibodies. Data on demographics, symptoms, imaging, antibodies, cancer associations, treatment, and outcomes were extracted. RESULTS The study included 333 patients (mean age 54 years, 67% males) with PNS and AIE positive for various novel antibodies. 84% had central nervous system issues like cognitive impairment (53%), rhombencephalitis (17%), and cerebellar disorders (24%). Neuroimaging revealed distinct patterns with high-risk antibodies associated with brainstem lesions in 98%, cerebellar in 91%, hippocampal in 98%, basal ganglia in 75%, and spinal cord in 91%, while low/intermediate-risk antibodies were associated with medial temporal lobe lesions in 71% and other cortical/subcortical lesions in 55%. High-risk antibodies were associated with younger males, deep brain lesions, and increased mortality of 61%, while low/intermediate-risk antibodies were associated with females, cortical/subcortical lesions, and better outcomes with 39% mortality. Associated cancers included seminomas (23%), lung (19%), ovarian (2%), and breast (2%). Treatments included IVIG, chemotherapy, and plasmapheresis. Overall mortality was 25% in this cohort. CONCLUSION PNS and AIE have distinct clinical and radiological patterns based on antibody profiles. High-risk antibodies are associated with increased mortality while low/intermediate-risk antibodies are associated with improved outcomes. Appropriate imaging and antibody testing are critical for accurate diagnosis.
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Affiliation(s)
- Sema Akkus
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mahmoud Elkhooly
- Department of Neurology, Wayne state University, Detroit, MI, USA; Department of Neurology, Southern Illinois university, Springfield, IL, USA; Department of Neuropsychiatry, Minia University, Egypt
| | - Suban Amatya
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kriti Shrestha
- Department of Medicine, Patan Academy of Health Sciences, Kathmandu, Nepal
| | - Kanika Sharma
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Yusuf Kagzi
- Mahatma Gandhi Memorial Medical College, Indore, India
| | - Erum Khan
- Department of Neurology, University of Alabama at Birmingham, Al, USA
| | - Rajesh Gupta
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Amanda L Piquet
- Neuroimmunology, Neuroinfectious Disease and Neurohospitalist Sections, University of Colorado School of Medicine, CO, USA
| | - Shruti Jaiswal
- Department of Neuro-oncology, MD Anderson Cancer Center, Houston, TX, USA
| | - Sijin Wen
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Michaela Tapia
- West Virginia Clinical Transitional Science, Morgantown, WV, USA
| | - Rohan Samant
- Department of Neuroradiology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sri Raghav Sista
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA
| | - Shitiz Sriwastava
- Division of Multiple Sclerosis and Neuroimmunology Department of Neurology, McGovern Medical School (UT Health), University of Texas Health Science Center at Houston, Houston, TX,USA.
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Jesuthasan A, Barwick T, Dixon L, Molloy S, Johnson MR, Tomlinson JAP. LGI1 Encephalitis and IgG4-Related Disease: Rare Conditions Collide. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200158. [PMID: 37582616 PMCID: PMC10427142 DOI: 10.1212/nxi.0000000000200158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/28/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Leucine-rich glioma-inactivated 1 (LGI1) encephalitis and IgG4-related disease (IgG4RD) have traditionally been regarded as 2 distinct disease entities. METHODS We detail the presentation, investigations, and management of a patient who showed typical signs and symptoms of LGI1 encephalitis and also found to possess pancreatic changes and a serum profile in keeping with IgG4RD. RESULTS Serum and CSF analyses at presentation showed a significant hyponatraemia (117 mmol/L), elevated IgG4 concentration (1.73 g/L), and the presence of LGI1 antibodies. MRI revealed symmetrical diffuse T2-weighted hyperintensity and mild swelling throughout both medial temporal lobes. CT of the chest, abdomen and pelvis revealed an edematous, bulky pancreas with loss of lobulation, typical for IgG4RD. A glucocorticoid weaning regimen was commenced, facilitated by 2 rituximab infusions, with the patient showing an effective treatment response. HLA testing confirmed the presence of HLA DRB1 and HLA DQB1 risk alleles. DISCUSSION This case suggests that there may be shared mechanisms between LGI1 encephalitis and IgG4RD, supported by common risk HLA associations and treatment strategies/responses. To our knowledge, this represents the first instance that LGI1 encephalitis and IgG4RD have been reported in the same patient and emphasizes the continued development of our understanding of the wide range of IgG4-mediated conditions.
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Affiliation(s)
- Aaron Jesuthasan
- From the Charing Cross Hospital (A.J.); Department of Radiology (T.B.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer (L.D.), Faculty of Medicine, Imperial College London, United Kingdom; London North West University Healthcare NHS Trust (S.M.); Department of Brain Sciences (M.R.J.), Faculty of Medicine, Imperial College London; and Renal Department (J.A.P.T.), Imperial College Healthcare NHS Trust, London, United Kingdom.
| | - Tara Barwick
- From the Charing Cross Hospital (A.J.); Department of Radiology (T.B.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer (L.D.), Faculty of Medicine, Imperial College London, United Kingdom; London North West University Healthcare NHS Trust (S.M.); Department of Brain Sciences (M.R.J.), Faculty of Medicine, Imperial College London; and Renal Department (J.A.P.T.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Luke Dixon
- From the Charing Cross Hospital (A.J.); Department of Radiology (T.B.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer (L.D.), Faculty of Medicine, Imperial College London, United Kingdom; London North West University Healthcare NHS Trust (S.M.); Department of Brain Sciences (M.R.J.), Faculty of Medicine, Imperial College London; and Renal Department (J.A.P.T.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sophie Molloy
- From the Charing Cross Hospital (A.J.); Department of Radiology (T.B.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer (L.D.), Faculty of Medicine, Imperial College London, United Kingdom; London North West University Healthcare NHS Trust (S.M.); Department of Brain Sciences (M.R.J.), Faculty of Medicine, Imperial College London; and Renal Department (J.A.P.T.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Michael R Johnson
- From the Charing Cross Hospital (A.J.); Department of Radiology (T.B.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer (L.D.), Faculty of Medicine, Imperial College London, United Kingdom; London North West University Healthcare NHS Trust (S.M.); Department of Brain Sciences (M.R.J.), Faculty of Medicine, Imperial College London; and Renal Department (J.A.P.T.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - James A P Tomlinson
- From the Charing Cross Hospital (A.J.); Department of Radiology (T.B.), Imperial College Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer (L.D.), Faculty of Medicine, Imperial College London, United Kingdom; London North West University Healthcare NHS Trust (S.M.); Department of Brain Sciences (M.R.J.), Faculty of Medicine, Imperial College London; and Renal Department (J.A.P.T.), Imperial College Healthcare NHS Trust, London, United Kingdom
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28
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Ceanga M, Rahmati V, Haselmann H, Schmidl L, Hunter D, Brauer AK, Liebscher S, Kreye J, Prüss H, Groc L, Hallermann S, Dalmau J, Ori A, Heckmann M, Geis C. Human NMDAR autoantibodies disrupt excitatory-inhibitory balance, leading to hippocampal network hypersynchrony. Cell Rep 2023; 42:113166. [PMID: 37768823 DOI: 10.1016/j.celrep.2023.113166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023] Open
Abstract
Anti-NMDA receptor autoantibodies (NMDAR-Abs) in patients with NMDAR encephalitis cause severe disease symptoms resembling psychosis and cause cognitive dysfunction. After passive transfer of patients' cerebrospinal fluid or human monoclonal anti-GluN1-autoantibodies in mice, we find a disrupted excitatory-inhibitory balance resulting from CA1 neuronal hypoexcitability, reduced AMPA receptor (AMPAR) signaling, and faster synaptic inhibition in acute hippocampal slices. Functional alterations are also reflected in widespread remodeling of the hippocampal proteome, including changes in glutamatergic and GABAergic neurotransmission. NMDAR-Abs amplify network γ oscillations and disrupt θ-γ coupling. A data-informed network model reveals that lower AMPAR strength and faster GABAA receptor current kinetics chiefly account for these abnormal oscillations. As predicted in silico and evidenced ex vivo, positive allosteric modulation of AMPARs alleviates aberrant γ activity, reinforcing the causative effects of the excitatory-inhibitory imbalance. Collectively, NMDAR-Ab-induced aberrant synaptic, cellular, and network dynamics provide conceptual insights into NMDAR-Ab-mediated pathomechanisms and reveal promising therapeutic targets that merit future in vivo validation.
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Affiliation(s)
- Mihai Ceanga
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, 07747 Jena, Germany
| | - Vahid Rahmati
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, 07747 Jena, Germany
| | - Holger Haselmann
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, 07747 Jena, Germany
| | - Lars Schmidl
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, 07747 Jena, Germany
| | - Daniel Hunter
- Université de Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, UMR 5297, 33000 Bordeaux, France
| | - Anna-Katherina Brauer
- Institute of Clinical Neuroimmunology, Klinikum der Universität München, Ludwig Maximilians University Munich, Martinsried, Germany; Biomedical Center, Ludwig Maximilians University Munich, Martinsried, Germany
| | - Sabine Liebscher
- Institute of Clinical Neuroimmunology, Klinikum der Universität München, Ludwig Maximilians University Munich, Martinsried, Germany; Biomedical Center, Ludwig Maximilians University Munich, Martinsried, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Jakob Kreye
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Pediatric Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Harald Prüss
- Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
| | - Laurent Groc
- Université de Bordeaux, CNRS, Interdisciplinary Institute for Neuroscience, UMR 5297, 33000 Bordeaux, France
| | - Stefan Hallermann
- Carl Ludwig Institute for Physiology, Faculty of Medicine, Leipzig University, 04103 Leipzig, Germany
| | - Josep Dalmau
- Catalan Institution for Research and Advanced Studies (ICREA) and IDIBAPS-Hospital Clinic, University of Barcelona, 08036 Barcelona, Spain
| | - Alessandro Ori
- Leibniz Institute on Aging - Fritz Lipmann Institute (FLI), 07745 Jena, Germany
| | - Manfred Heckmann
- Department of Neurophysiology, Institute of Physiology, University of Würzburg, 97070 Würzburg, Germany
| | - Christian Geis
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, 07747 Jena, Germany.
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Cheng X, Li Y, Wang Y, Sun Y, Lian Y. Impact of blood-brain barrier disruption on clinical features and treatment response in patients with newly diagnosed autoimmune encephalitis. J Neuroimmunol 2023; 383:578203. [PMID: 37740995 DOI: 10.1016/j.jneuroim.2023.578203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/01/2023] [Accepted: 09/18/2023] [Indexed: 09/25/2023]
Abstract
AIMS Blood-brain barrier (BBB) breakdown is an essential mechanism in inflammatory diseases of the central nervous system. However, the association between BBB integrity and autoimmune encephalitis (AE) has not been investigated. Our study aimed to analyze this relationship in patients with AE between BBB integrity with clinical manifestations and therapeutic responses. METHODS Our study enrolled 147 patients with AE who were newly diagnosed at the First Affiliated Hospital of Zhengzhou University between August 2015 and December 2021. Patients were classified into normal or damaged BBB groups based on cerebrospinal fluid (CSF) albumin/serum albumin (QAlb). To evaluate the severity of the illness, we used the modified Rankin Scale (mRS) and the Clinical Assessment Scale for Autoimmune Encephalitis (CASE). RESULTS We found a higher proportion of males, higher CSF protein, immunoglobulin IgG, and 24-h intrathecal IgG synthesis rate in the damaged BBB group. The improvement rate was lower in the damaged BBB group, but we found that double- or triple-combination immunotherapy had better clinical outcomes than single immunotherapy. In addition, there was a positive correlation between the CASE score and mRS score, and a positive correlation between the CASE score or mRS score and QAlb on admission. CONCLUSIONS BBB integrity is closely related to the clinical features and treatment responses of newly diagnosed AE. Patients with AE and a damaged BBB may benefit from combination immunotherapy.
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Affiliation(s)
- Xuan Cheng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| | - Yimeng Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaoyao Wang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yidi Sun
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yajun Lian
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Olivero G, Roggeri A, Pittaluga A. Anti-NMDA and Anti-AMPA Receptor Antibodies in Central Disorders: Preclinical Approaches to Assess Their Pathological Role and Translatability to Clinic. Int J Mol Sci 2023; 24:14905. [PMID: 37834353 PMCID: PMC10573896 DOI: 10.3390/ijms241914905] [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: 09/08/2023] [Revised: 09/30/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Autoantibodies against NMDA and AMPA receptors have been identified in the central nervous system of patients suffering from brain disorders characterized by neurological and psychiatric symptoms. It has been demonstrated that these autoantibodies can affect the functions and/or the expression of the targeted receptors, altering synaptic communication. The importance to clarify, in preclinical models, the molecular mechanisms involved in the autoantibody-mediated effects has emerged in order to understand their pathogenic role in central disorders, but also to propose new therapeutic approaches for preventing the deleterious central consequences. In this review, we describe some of the available preclinical literature concerning the impact of antibodies recognizing NMDA and AMPA receptors in neurons. This review discusses the cellular events that would support the detrimental roles of the autoantibodies, also illustrating some contrasting findings that in our opinion deserve attention and further investigations before translating the preclinical observations to clinic.
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Affiliation(s)
- Guendalina Olivero
- Department of Pharmacy (DiFar), University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy; (G.O.); (A.R.)
| | - Alessandra Roggeri
- Department of Pharmacy (DiFar), University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy; (G.O.); (A.R.)
| | - Anna Pittaluga
- Center of Excellence for Biomedical Research, 3Rs Center, Department of Pharmacy (DiFar), University of Genoa, Viale Cembrano 4, 16148 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16145 Genoa, Italy
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Takekoshi A, Kimura A, Yoshikura N, Yamakawa I, Urushitani M, Nakamura K, Yoshida K, Shimohata T. Clinical Features and Neuroimaging Findings of Neuropil Antibody-Positive Idiopathic Sporadic Ataxia of Unknown Etiology. CEREBELLUM (LONDON, ENGLAND) 2023; 22:915-924. [PMID: 36057079 DOI: 10.1007/s12311-022-01468-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
Idiopathic sporadic ataxia (ISA) is the clinical term for nonfamilial ataxia with adult-onset and a slowly progressive course. However, immune-mediated cerebellar ataxia cannot be completely excluded from ISA. The current study investigated the neuropil antibodies against cell-surface antigens and clarified the clinical features and neuroimaging findings of patients with these antibodies. Using tissue-based immunofluorescence assays (TBAs), we examined antibodies against the cerebellum in serum samples from 67 patients who met the ISA diagnostic criteria, including 30 patients with multiple system atrophy with predominant cerebellar features (MSA-C) and 20 patients with hereditary ataxia (HA), and 18 healthy control subjects. According to the TBA results, we divided subjects into three groups: subjects positive for neuropil antibodies, subjects positive for intracellular antibodies only, and subjects negative for antibodies. We compared clinical features and neuroimaging findings in ISA patients among these three groups. The prevalence of neuropil antibodies in ISA (17.9%) was significantly higher than that in MSA-C (3.3%), HA (0%), or healthy subjects (0%). The neuropil antibody-positive ISA patients showed pure cerebellar ataxia more frequently than the other ISA patients. Two neuropil antibody-positive patients showed significant improvement of cerebellar ataxia after immunotherapy. We detected neuropil antibodies in 17.9% of ISA patients. Characteristic clinical features of neuropil antibody-positive ISA patients were pure cerebellar ataxia. Some cases of neuropil antibody-positive ISA responded to immunotherapy.
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Affiliation(s)
- Akira Takekoshi
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Nobuaki Yoshikura
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Isamu Yamakawa
- Department of Neurology, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Japan
| | - Makoto Urushitani
- Department of Neurology, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Japan
| | - Katsuya Nakamura
- Department of Neurology (Neurology and Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Kunihiro Yoshida
- Department of Brain Disease Research, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
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Pathak A, Patel J, Tran G, Mrlik M, Zhong N, Lui F. An Unusual Case of LGI1 (Leucine-Rich Glioma-Inactivated Protein 1) Limbic Encephalitis With Anti-acetylcholine Receptor and Anti-striational Autoantibodies. Cureus 2023; 15:e46491. [PMID: 37927656 PMCID: PMC10624515 DOI: 10.7759/cureus.46491] [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] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Autoimmune encephalitis (AE) results from immune-mediated damage to the central nervous system (CNS) with varying clinical manifestations depending on autoimmune antibodies present and the antigens they target. Leucine-rich glioma-inactivated protein 1 (LGI1) has been recognized as one of the leading causes of limbic encephalitis (LE), presenting with seizures, memory loss, and faciobrachial dystonic seizures. A better understanding of the unique presentations of these AE allows for quick and effective diagnosis and treatment. We are presenting a very unusual case of LGI1 autoimmune LE with two additional autoantibodies, anti-acetylcholine receptor (AChR) and anti-striational, in a patient with an underlying thymoma. We will discuss the pathophysiology and common clinical presentation of anti-LGI1 autoimmune LE.
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Affiliation(s)
- Akash Pathak
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Jay Patel
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Giselle Tran
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Matthew Mrlik
- Neurology, California Northstate University College of Medicine, Elk Grove, USA
| | - Ning Zhong
- Neurology, Kaiser Permanente Sacramento Medical Center, Sacramento, USA
| | - Forshing Lui
- Clinical Sciences, California Northstate University College of Medicine, Elk Grove, USA
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Guo K, Zheng B, Hao X. Anti-Caspr2 encephalitis coexisting with neurosyphilis: a rare case report. Acta Neurol Belg 2023; 123:2023-2025. [PMID: 36085402 DOI: 10.1007/s13760-022-02087-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/01/2022] [Indexed: 11/01/2022]
Affiliation(s)
- Kundian Guo
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu, 610041, Sichuan, China
| | - Bo Zheng
- Department of Neurology, Yaan People's Hospital, Yaan, 625000, Sichuan, China.
| | - Xiaoting Hao
- Department of Neurology, West China Hospital, Sichuan University, No.37 Guoxue Road, Chengdu, 610041, Sichuan, China.
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Khan AA, Alzahrani WM, Bagadood RM, Alweshah BM, Alsulaimi JF, Abualela HM. Autoimmune epilepsy, retrospective case series of clinical features, management, and outcomes. NEUROSCIENCES (RIYADH, SAUDI ARABIA) 2023; 28:264-269. [PMID: 37844942 PMCID: PMC10827037 DOI: 10.17712/nsj.2023.4.20230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To evaluate the clinical and electrographic features of patients with autoimmune epilepsy and assess the influence of early diagnosis and treatment on reducing seizure frequency. METHODS A retrospective observational case series was conducted utilizing medical records from King Abdullah Medical Hospital between 2017 and 2022. Cases of newly diagnosed seizures were chosen based on laboratory-proven autoimmunity. RESULTS Five female inpatients were identified, primarily presenting with seizures suggestive of an autoimmune origin. Autoimmune antibodies were detected in all patients as follows: GAD (3), NMDA-R (2). One patient exhibited unilateral temporal lobe onset while three displayed bilateral onset. One patient had an associated malignancy. Rituximab was administered as an immunomodulatory therapy to four patients, resulting in successful seizure reduction post-immunotherapy initiation. CONCLUSION Autoimmune epilepsy is recognized as a distinct condition. The clinical presentation can be complex and antibody testing may warrant repetition if initial results are negative or if specific antibodies are not detected. Early initiation of immunosuppression, coupled with prompt treatment escalation when required, is vital for achieving optimal patient outcomes.
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Affiliation(s)
- Abrar A. Khan
- From the Department of Neurology (khan, Alzahrani, Bagadood, Abualela), and from the Department of Neurophysiology (Alweshah, Alsulaimi), King Abdullah Medical City, Makkah Al-Mukarramah, Kingdom of Saudi Arabia
| | - Waleed M. Alzahrani
- From the Department of Neurology (khan, Alzahrani, Bagadood, Abualela), and from the Department of Neurophysiology (Alweshah, Alsulaimi), King Abdullah Medical City, Makkah Al-Mukarramah, Kingdom of Saudi Arabia
| | - Reem M. Bagadood
- From the Department of Neurology (khan, Alzahrani, Bagadood, Abualela), and from the Department of Neurophysiology (Alweshah, Alsulaimi), King Abdullah Medical City, Makkah Al-Mukarramah, Kingdom of Saudi Arabia
| | - Baker M. Alweshah
- From the Department of Neurology (khan, Alzahrani, Bagadood, Abualela), and from the Department of Neurophysiology (Alweshah, Alsulaimi), King Abdullah Medical City, Makkah Al-Mukarramah, Kingdom of Saudi Arabia
| | - Jwana F. Alsulaimi
- From the Department of Neurology (khan, Alzahrani, Bagadood, Abualela), and from the Department of Neurophysiology (Alweshah, Alsulaimi), King Abdullah Medical City, Makkah Al-Mukarramah, Kingdom of Saudi Arabia
| | - Hanadi M. Abualela
- From the Department of Neurology (khan, Alzahrani, Bagadood, Abualela), and from the Department of Neurophysiology (Alweshah, Alsulaimi), King Abdullah Medical City, Makkah Al-Mukarramah, Kingdom of Saudi Arabia
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Huang Y, Zhou M, Zhou J, Wu B, Yang X, Min W, Li Z. Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor encephalitis developed after ovarian cancer cytoreduction surgery: a case report and literature review. BMC Womens Health 2023; 23:507. [PMID: 37735388 PMCID: PMC10512534 DOI: 10.1186/s12905-023-02636-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis, a rare subtype of autoimmune encephalitis (AE), is often found associated with tumors such as thymoma, lung cancer, ovarian tumors, and breast cancer, and the tumors were generally detected during the screening process after the encephalitis initiated. The tumor is considered a trigger of AE, but the mechanism remains unclear. CASE PRESENTATION A 53-year-old woman presented short-term memory loss two days after the primary cytoreduction for high-grade serous ovarian cancer (HGSOC, FIGO stage IC3). Cell-based assay found AMPAR CluA2 IgG positive in both serum (1:3.2) and cerebrospinal fluid (1:32). Moreover, mild AMPAR GluA1 and strong GluA2 expressions were also found positive in the paraffin sections of ovarian tumor tissue, indicating the ovarian cytoreduction surgery might stimulate the release of receptor antigens into the circulation system. The patient's condition deteriorated within two weeks, developing consciousness and autonomic dysfunction, leading to ICU admission. With oral steroids, intravenous immunoglobulin, plasmapheresis, and rituximab treatment, the patient's consciousness markedly improved after three months. CONCLUSION We presented the first case of anti-AMPAR encephalitis developed right after the primary cytoreduction of a patient with HGSOC and retrieved paraneoplastic anti-AMPAR encephalitis cases (n = 66). Gynecologists should pay attention to patients who develop cognitive dysfunction or psychiatric symptoms shortly after the ovarian tumor resection and always include AE in the differentiation diagnosis.
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Affiliation(s)
- Yue Huang
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China
| | - Muke Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Jing Zhou
- Department of Gynecology and Obstetrics, Chengdu Fifth People's Hospital, Chengdu, 610041, People's Republic of China
| | - Bo Wu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Xi Yang
- Department of Anesthesiology, West China Hospital, Sichuan university, Chengdu, 610041, People's Republic of China
| | - Wenjiao Min
- Department of Psychosomatic Medicine, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, 610041, People's Republic of China
| | - Zhengyu Li
- Department of Gynecology and Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, People's Republic of China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, People's Republic of China.
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Neațu M, Jugurt A, Covaliu A, Davidescu EI, Popescu BO. Autoimmune Encephalitis-A Multifaceted Pathology. Biomedicines 2023; 11:2176. [PMID: 37626673 PMCID: PMC10452276 DOI: 10.3390/biomedicines11082176] [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: 06/30/2023] [Revised: 07/30/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
Autoimmune encephalitis is a complex and multifaceted pathology that involves immune-mediated inflammation of the brain. It is characterized by the body's immune system attacking the brain tissue, leading to a cascade of inflammatory processes. What makes autoimmune encephalitis vast is the wide range of causes, mechanisms, clinical presentations, and diagnostic challenges associated with the condition. The clinical presentations of autoimmune encephalitis are broad and can mimic other neurological disorders, making it a challenging differential diagnosis. This diverse clinical presentation can overlap with other conditions, making it crucial for healthcare professionals to maintain a high level of suspicion for autoimmune encephalitis when evaluating patients. The diagnostic challenges associated with autoimmune encephalitis further contribute to its vastness. Due to the variable nature of the condition, there is no definitive diagnostic test that can confirm autoimmune encephalitis in all cases. In this context, personalized patient management is crucial for achieving favorable outcomes. Each patient's treatment plan should be tailored to their specific clinical presentation, underlying cause, and immune response. Our objective is to raise awareness about the frequent yet underdiagnosed nature of autoimmune encephalitis by sharing five cases we encountered, along with a brief literature review.
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Affiliation(s)
- Monica Neațu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.N.); (A.J.); (A.C.); (B.O.P.)
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Ana Jugurt
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.N.); (A.J.); (A.C.); (B.O.P.)
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Anca Covaliu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.N.); (A.J.); (A.C.); (B.O.P.)
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Eugenia Irene Davidescu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.N.); (A.J.); (A.C.); (B.O.P.)
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
| | - Bogdan Ovidiu Popescu
- Department of Clinical Neurosciences, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.N.); (A.J.); (A.C.); (B.O.P.)
- Department of Neurology, Colentina Clinical Hospital, 020125 Bucharest, Romania
- Department of Cell Biology, Neurosciences and Experimental Myology, “Victor Babeș” National Institute of Pathology, 050096 Bucharest, Romania
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Schulz P, Lütt A, Stöcker W, Teegen B, Holtkamp M, Prüss H. High frequency of cerebrospinal fluid autoantibodies in patients with seizures or epilepsies of unknown etiology. Front Neurol 2023; 14:1211812. [PMID: 37475738 PMCID: PMC10356105 DOI: 10.3389/fneur.2023.1211812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 06/09/2023] [Indexed: 07/22/2023] Open
Abstract
Introduction The increasing identification of specific autoantibodies against brain structures allows further refinement of the group of autoimmune-associated epilepsies and affects diagnostic and therapeutic algorithms. The early etiological allocation of a first seizure is particularly challenging, and the contribution of cerebrospinal fluid (CSF) analysis is not fully understood. Methods In this retrospective study with a mean of 7.8 years follow-up involving 39 well-characterized patients with the initial diagnosis of new-onset seizure or epilepsy of unknown etiology and 24 controls, we determined the frequency of autoantibodies to brain proteins in CSF/serum pairs using cell-based assays and unbiased immunofluorescence staining of unfixed murine brain sections. Results Autoantibodies were detected in the CSF of 30.8% of patients. Underlying antigens involved glial fibrillary acidic protein (GFAP) and N-methyl-D-aspartate (NMDA) receptors, but also a range of yet undetermined epitopes on neurons, glial and vascular cells. While antibody-positive patients had higher frequencies of cancer, they did not differ from antibody-negative patients with respect to seizure type, electroencephalography (EEG) and cranial magnetic resonance imaging (cMRI) findings, neuropsychiatric comorbidities or pre-existing autoimmune diseases. In 5.1% of patients with seizures or epilepsy of initially presumed unknown etiology, mostly CSF findings resulted in etiological reallocation as autoimmune-associated epilepy. Discussion These findings strengthen the potential role for routine CSF analysis. Further studies are needed to understand the autoantibody contribution to etiologically unclear epilepsies, including determining the antigenic targets of underlying autoantibodies.
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Affiliation(s)
- Paulina Schulz
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Alva Lütt
- Psychiatric University Hospital Charité at St. Hedwig Hospital, Berlin, Germany
- Department of Psychiatry and Neurosciences, CCM, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität and Humboldt-Universität zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | | | - Bianca Teegen
- Institute for Experimental Immunology, Lübeck, Germany
| | - Martin Holtkamp
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
- Epilepsy-Center Berlin-Brandenburg, Institute for Diagnostics of Epilepsy, Berlin, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
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Lu YT, Lin CH, Ho CJ, Chen SY, Tsai MH. Validating Prediction Tools for Autoimmune Encephalitis in Adult Taiwanese Patients: A Retrospective Study. Biomedicines 2023; 11:1906. [PMID: 37509545 PMCID: PMC10377279 DOI: 10.3390/biomedicines11071906] [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: 05/05/2023] [Revised: 06/28/2023] [Accepted: 06/29/2023] [Indexed: 07/30/2023] Open
Abstract
Autoimmune encephalitis (AE) is a neurological emergency. We aimed to analyze the application and effectiveness of the currently available prediction tools for AE patients in Taiwan. We retrospectively collected 27 AE patients between January 2008 and December 2019. Antibody Prevalence in Epilepsy (APE) score, Response to Immunotherapy in Epilepsy (RITE) score, and anti-NMDAR Encephalitis One Year Functional Status (NEOS) score were applied to validate their usability. Based on the defined cutoff values, the sensitivity and specificity of each score were calculated. A receiver operating characteristic (ROC) curve and the area under the curve (AUC) were generated for each scoring system. The AUC value of APE was 0.571. The AUC value of RITE was 0.550. The AUC values for the NEOS score at discharge and long-term follow-up were 0.645 and 0.796, respectively. The performance of APE and RITE scores was suboptimal in the Taiwanese cohort, probably due to the limitations of the small sample size and single ethnicity. On the other hand, the NEOS score performed better on long-term follow-up than at discharge.
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Affiliation(s)
- Yan-Ting Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Chih-Hsiang Lin
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Chen-Jui Ho
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Shih-Ying Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
| | - Meng-Han Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 833401, Taiwan
- College of Medicine, Medical School, Chang Gung University, Taoyuan 333323, Taiwan
- Genomics and Proteomics Core Laboratory, Department of Medical Research, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
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Ariño H, Ruiz García R, Rioseras B, Naranjo L, Martinez-Hernandez E, Saiz A, Graus F, Dalmau J. Frequency and Referral Patterns of Neural Antibody Studies During the COVID-19 Pandemic: Experience From an Autoimmune Neurology Center. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200129. [PMID: 37311644 DOI: 10.1212/nxi.0000000000200129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/10/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine whether the frequency of paraneoplastic or autoimmune encephalitis antibodies examined in a referral center changed during the COVID-19 pandemic. METHODS The number of patients who tested positive for neuronal or glial (neural) antibodies during pre-COVID-19 (2017-2019) and COVID-19 (2020-2021) periods was compared. The techniques used for antibody testing did not change during these periods and included a comprehensive evaluation of cell-surface and intracellular neural antibodies. The chi-square test, Spearman correlation, and Python programming language v3 were used for statistical analysis. RESULTS Serum or CSF from 15,390 patients with suspected autoimmune or paraneoplastic encephalitis was examined. The overall positivity rate for antibodies against neural-surface antigens was similar in the prepandemic and pandemic periods (neuronal 3.2% vs 3.5%; glial 6.1 vs 5.2) with a mild single-disease increase in the pandemic period (anti-NMDAR encephalitis). By contrast, the positivity rate for antibodies against intracellular antigens was significantly increased during the pandemic period (2.8% vs 3.9%, p = 0.01), particularly Hu and GFAP. DISCUSSION Our findings do not support that the COVID-19 pandemic led to a substantial increase of known or novel encephalitis mediated by antibodies against neural-surface antigens. The increase in Hu and GFAP antibodies likely reflects the progressive increased recognition of the corresponding disorders.
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Affiliation(s)
- Helena Ariño
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Raquel Ruiz García
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Beatriz Rioseras
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Laura Naranjo
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Eugenia Martinez-Hernandez
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Albert Saiz
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Francesc Graus
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA
| | - Josep Dalmau
- From the Consorci Institut D'Investigacions Biomediques August Pi i Sunyer (H.A., R.R.G., E.M.-H., A.S., F.G., J.D.); Neurology Service, Hospital Clínic de Barcelona (R.R.G., L.N., E.M.-H., A.S., J.D.); University of Barcelona (A.S., J.D.); Hospital Universitario Central de Asturias (B.R.), Oviedo; Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid; Catalan Institution for Research and Advanced Studies (J.D.) Barcelona, Spain; and Department of Neurology, University of Pennsylvania (J.D.), Philadelphia, PA.
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Ciano-Petersen NL, Robert M, Muñiz-Castrillo S, Wucher V, Klich A, Vogrig A, Villagrán García M, Farina A, Goncalves D, Picard G, Rogemond V, Joubert B, Oliver-Martos B, Serrano-Castro PJ, Maucort-Boulch D, Honnorat J. Prognostic Value of Persistent CSF Antibodies at 12 Months in Anti-NMDAR Encephalitis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/4/e200108. [PMID: 37147137 PMCID: PMC10162705 DOI: 10.1212/nxi.0000000000200108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 02/07/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Anti-NMDA receptor (NMDAR) encephalitis is defined by the presence of antibodies (Abs) targeting the NMDAR in the CSF. This study aimed to determine the prognostic value of persistent CSF NMDAR-Abs during follow-up. METHODS This retrospective observational study included patients diagnosed with anti-NMDAR encephalitis in the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis and for whom CSF samples were obtained at diagnosis and >4 months of follow-up to evaluate CSF NMDAR-Ab persistence. Because patients were tested for CSF NMDAR-Abs at different time points, samples were stratified into different periods of follow-up (i.e., 12 months was considered for the 9- to 16-month follow-up period). RESULTS Among the 501 patients diagnosed with anti-NMDAR encephalitis between January 2007 and June 2020, 89 (17%) were tested between 4 and 120 months for CSF NMDAR-Abs after clinical improvement and included in the study (75/89 women, 84%; median age 20 years, interquartile range [IQR] 16-26). During follow-up, 21 of 89 (23%) patients had a relapse after a median time of 29 months (IQR 18-47), and 20 of 89 (22%) had a poor outcome (mRS ≥3) after a median last follow-up of 36 months (IQR 19-64). Most patients (69/89, 77%) were tested at the 12-month follow-up period, and 42 of 69 (60%) of them had persistent CSF NMDAR-Abs. When comparing patients with persistent or absent CSF NMDAR-Abs at 12 months, poor outcome at the last follow-up was more frequent in the former (38% vs 8%, p = 0.01), who had relapses more often (23% vs 7%), which also appeared earlier in the course of the disease (90% during the following 4 years of follow-up vs 20%), although no significant difference was observed at long-term follow-up (p = 0.15). In addition, patients with persistent CSF NMDAR-Abs at 12 months had higher titers of CSF NMDAR-Abs at diagnosis. DISCUSSION In this study, patients with persistent CSF NMDAR-Abs at 12 months were more likely to have subsequent relapses and a poor long-term outcome. However, these findings should be interpreted with caution because of the variability in the time of sampling of this study. Future prospective studies are required to validate these results in larger cohorts.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Mélisse Robert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Sergio Muñiz-Castrillo
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Valentin Wucher
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Amna Klich
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Alberto Vogrig
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Macarena Villagrán García
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Antonio Farina
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - David Goncalves
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Geraldine Picard
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Veronique Rogemond
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Bastien Joubert
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Begoña Oliver-Martos
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Pedro J Serrano-Castro
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Delphine Maucort-Boulch
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain
| | - Jerome Honnorat
- From the French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Hospices Civils de Lyon, Hôpital Neurologique, Bron; SynatAc Team (N.L.C.-P., M.R., S.M.-C., V.W., A.V., M.V.G., A.F., D.G., G.P., V.R., B.J., J.H.), Institute MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, Université Claude Bernard Lyon 1, France; Neuroimmunology and Neuroinflammation Group (N.L.C.-P., B.O.-M., P.J.S.-C.), Institute of Biomedical Research of Málaga - IBIMA; Andalusian Network of Clinical and Translational Research in Neurology (NeuroRECA) (N.L.C.-P., B.O.-M., P.J.S.-C.); Universidad de Málaga (N.L.C.-P., P.J.S.-C.), Andalucía Tech, Facultad de Medicina, Campus de Teatinos s/n, Spain; Service de Biostatistique - Bioinformatique (A.K., D.M.-B.), Pôle Santé Publique, Hospices Civils de Lyon; Laboratoire de Biométrie et Biologie Évolutive (A.K., D.M.-B.), Équipe Biostatistique-Santé, CNRS, UMR5558, Université Lyon 1, Université de Lyon, Villeurbanne; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Department of Cellular Biology, Genetics, and Physiology (B.O.-M.), Faculty of Sciences, University of Málaga, Spain.
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Hemmeter L, Bien CG, Bien CI, Tipold A, Neßler J, Bathen‐Nöthen A, Matiasek K, Dahlhoff M, Rusbridge C, Rotter Black C, Rentmeister K, Volk HA, Fischer A. Investigation of the presence of specific neural antibodies in dogs with epilepsy or dyskinesia using murine and human assays. J Vet Intern Med 2023; 37:1409-1417. [PMID: 37232512 PMCID: PMC10365065 DOI: 10.1111/jvim.16744] [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: 09/15/2022] [Accepted: 05/07/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Autoimmune mechanisms represent a novel category for causes of seizures and epilepsies in humans, and LGI1-antibody associated limbic encephalitis occurs in cats. HYPOTHESIS/OBJECTIVES To investigate the presence of neural antibodies in dogs with epilepsy or dyskinesia of unknown cause using human and murine assays modified for use in dogs. ANIMALS Fifty-eight dogs with epilepsy of unknown cause or suspected dyskinesia and 57 control dogs. METHODS Serum and CSF samples were collected prospectively as part of the diagnostic work-up. Clinical data including onset and seizure/episode type were retrieved from the medical records. Screening for neural antibodies was done with cell-based assays transfected with human genes for typical autoimmune encephalitis antigens and tissue-based immunofluorescence assays on mouse hippocampus slices in serum and CSF samples from affected dogs and controls. The commercial human und murine assays were modified with canine-specific secondary antibody. Positive controls were from human samples. RESULTS The commercial assays used in this study did not provide unequivocal evidence for presence of neural antibodies in dogs including one dog with histopathologically proven limbic encephalitis. Low titer IgLON5 antibodies were present in serum from one dog from the epilepsy/dyskinesia group and in one dog from the control group. CONCLUSION AND CLINICAL IMPORTANCE Specific neural antibodies were not detected using mouse and human target antigens in dogs with epilepsy and dyskinesia of unknown origin. These findings emphasize the need for canine-specific assays and the importance of control groups.
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Affiliation(s)
- Lea Hemmeter
- Section of Neurology, Centre for Clinical Veterinary MedicineLMU MunichMunichGermany
| | - Christian G. Bien
- Department of Epileptology (Krankenhaus Mara)Bielefeld University, Medical SchoolBielefeldGermany
- Laboratory KroneBad SalzuflenGermany
| | | | - Andrea Tipold
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine Hannover FoundationHannoverGermany
| | - Jasmin Neßler
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine Hannover FoundationHannoverGermany
| | | | - Kaspar Matiasek
- Section of Clinical & Comparative Neuropathology, Centre for Clinical Veterinary MedicineLMU MunichMunichGermany
| | - Maik Dahlhoff
- Institute of In Vivo and In Vitro Models, University of Veterinary Medicine ViennaViennaAustria
| | - Clare Rusbridge
- Fitzpatrick Referrals, Halfway LaneSurreyUK
- School of Veterinary Medicine, Faculty of Health & Medical SciencesUniversity of SurreySurreyUK
| | | | | | - Holger A. Volk
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine Hannover FoundationHannoverGermany
| | - Andrea Fischer
- Section of Neurology, Centre for Clinical Veterinary MedicineLMU MunichMunichGermany
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Chen L, Su T, Liu Y. Clinical characteristics of Leucine-rich glioma-inactivated protein 1 antibody-mediated autoimmune encephalitis in a 6-year-old girl: case report and literature reviews. BMC Neurol 2023; 23:253. [PMID: 37391712 DOI: 10.1186/s12883-023-03299-z] [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: 10/19/2022] [Accepted: 06/16/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Autoimmune encephalitis related to the leucine-rich glioma-inactivated protein 1(LGI1) antibody is the most prevalent in older adults, manifesting as seizures, faciobrachial dystonic seizures (FBDS), cognitive impairment, memory disturbance, hyponatremia and neuropsychiatric disorders. However the data pertaining to children affected by the disease is still limited. CASE PRESENTATION AND LITERATURE REVIEWS This study presents a detailed report of a 6-year-old Chinese girl who experienced nose aches and faciobrachial dystonic seizures (FBDS). Electrolyte testing revealed that she had hyponatremia and brain MRI showed an abnormality in the left temporal pole. Additionally, anti-LGI1 antibodies were detected in both her serum (1:100) and CSF (1:30). The patient was treated with immunotherapy and symptom management, which proved effective. Furthermore, we provide a summary of 25 pediatric cases of anti-LGI1 encephalitis. Pediatric patients rarely exhibited FBDS and hyponatremia, and some cases presented with isolated syndromes. But the therapeutic outcomes of pediatric patients were generally good. CONCLUSIONS In this report, we describe a patient who developed a rare symptom of nose aches possibly as one of symptoms of anti-LGI1 encephalitis, which highlights the possibility of atypical symptoms in children that may be misdiagnosed. Reviewing the literature, the clinical features differed between pediatric and adult cases. Therefore, it is crucial to collect and analyze data from more cases to promote accurate diagnosis and timely treatment.
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Affiliation(s)
- Liqing Chen
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tangfeng Su
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Liu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Valinčiūtė J, Jucevičiūtė N, Balnytė R, Jurkevičienė G, Gelžinienė G. GAD65 Antibody-Associated Epilepsy. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1135. [PMID: 37374339 DOI: 10.3390/medicina59061135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/03/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Autoimmune processes are an increasingly recognized cause of seizures. Antibodies against neuronal surface antigens are implicated in the development of acute symptomatic seizures secondary to autoimmune encephalitis, whereas antibodies against intracellular antigens (anti-glutamic acid decarboxylase (GAD) and onconeural antibodies) are found in cases of autoimmune-associated epilepsy (AAE). AAE is described as isolated drug-resistant epilepsy without any specific magnetic resonance imaging (MRI) or cerebrospinal fluid changes and with a very limited response to immunotherapy. We present a clinical case and a literature review on autoimmune-associated epilepsy to increase awareness of this disease and illustrate its complexity. This is a clinical case of a female with a history of refractory focal epilepsy. The patient had been given several trials of multiple antiepileptic drugs and their combinations without any clear effect. Multiple evaluations including brain MRI, PET, and interictal and ictal electroencephalograms were performed. An APE2 score was calculated with a result of 4 and, in the presence of anti-GAD65 antibodies in the serum, the diagnosis of AAE was confirmed. There was no effect after five sessions of plasma exchange; however, after a course of intravenous immunoglobulin, a positive but temporary clinical effect was noticed: anti-GAD65 levels initially decreased but rebounded to previous levels 6 months later.
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Affiliation(s)
- Justina Valinčiūtė
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Neringa Jucevičiūtė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Renata Balnytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Giedrė Jurkevičienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
| | - Giedrė Gelžinienė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, 44307 Kaunas, Lithuania
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Dalmau J, Graus F. Diagnostic criteria for autoimmune encephalitis: utility and pitfalls for antibody-negative disease. Lancet Neurol 2023; 22:529-540. [PMID: 37210100 DOI: 10.1016/s1474-4422(23)00083-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/25/2023] [Accepted: 02/09/2023] [Indexed: 05/22/2023]
Abstract
Increased awareness of autoimmune encephalitis has led to two unintended consequences: a high frequency of misdiagnoses and the inappropriate use of diagnostic criteria for antibody-negative disease. Misdiagnoses typically occur for three reasons: first, non-adherence to reported clinical requirements for considering a disorder as possible autoimmune encephalitis; second, inadequate assessment of inflammatory changes in brain MRI and CSF; and third, absent or limited use of brain tissue assays along with use of cell-based assays that include only a narrow range of antigens. For diagnosis of possible autoimmune encephalitis and probable antibody-negative autoimmune encephalitis, clinicians should adhere to published criteria for adults and children, focusing particularly on exclusion of alternative disorders. Moreover, for diagnosis of probable antibody-negative autoimmune encephalitis, the absence of neural antibodies in CSF and serum should be well substantiated. Neural antibody testing should use tissue assays along with cell-based assays that include a broad range of antigens. Live neuronal studies in specialised centres can assist in resolving inconsistencies with respect to syndrome-antibody associations. Accurate diagnosis of probable antibody-negative autoimmune encephalitis will identify patients with similar syndromes and biomarkers, which will provide homogeneous populations for future assessments of treatment response and outcome.
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Affiliation(s)
- Josep Dalmau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Neurology Department, Institute of Neuroscience, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.
| | - Francesc Graus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
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Gagliano A, Carta A, Tanca MG, Sotgiu S. Pediatric Acute-Onset Neuropsychiatric Syndrome: Current Perspectives. Neuropsychiatr Dis Treat 2023; 19:1221-1250. [PMID: 37251418 PMCID: PMC10225150 DOI: 10.2147/ndt.s362202] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/03/2023] [Indexed: 05/31/2023] Open
Abstract
Pediatric acute-onset neuropsychiatric syndrome (PANS) features a heterogeneous constellation of acute obsessive-compulsive disorder (OCD), eating restriction, cognitive, behavioral and/or affective symptoms, often followed by a chronic course with cognitive deterioration. An immune-mediated etiology is advocated in which the CNS is hit by different pathogen-driven (auto)immune responses. This narrative review focused on recent clinical (ie, diagnostic criteria, pre-existing neurodevelopmental disorders, neuroimaging) and pathophysiological (ie, CSF, serum, genetic and autoimmune findings) aspects of PANS. We also summarized recent points to facilitate practitioners with the disease management. Relevant literature was obtained from PubMed database which included only English-written, full-text clinical studies, case reports, and reviews. Among a total of 1005 articles, 205 were pertinent to study inclusion. Expert opinions are converging on PANS as the effect of post-infectious events or stressors leading to "brain inflammation", as it is well-established for anti-neuronal psychosis. Interestingly, differentiating PANS from either autoimmune encephalitides and Sydenham's chorea or from alleged "pure" psychiatric disorders (OCD, tics, Tourette's syndrome), reveals several overlaps and more analogies than differences. Our review highlights the need for a comprehensive algorithm to help both patients during their acute distressing phase and physicians during their treatment decision. A full agreement on the hierarchy of each therapeutical intervention is missing owing to the limited number of randomized controlled trials. The current approach to PANS treatment emphasizes immunomodulation/anti-inflammatory treatments in association with both psychotropic and cognitive-behavioral therapies, while antibiotics are suggested when an active bacterial infection is established. A dimensional view, taking into account the multifactorial origin of psychiatric disorders, should suggest neuro-inflammation as a possible shared substrate of different psychiatric phenotypes. Hence, PANS and PANS-related disorders should be considered as a conceptual framework describing the etiological and phenotypical complexity of many psychiatric disorders.
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Affiliation(s)
- Antonella Gagliano
- Department of Health Science, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
- Department of Biomedical Sciences, University of Cagliari & "A. Cao" Paediatric Hospital, Child & Adolescent Neuropsychiatry Unit, Cagliari, Italy
| | - Alessandra Carta
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Unit of Child Neuropsychiatry, Sassari, Italy
| | - Marcello G Tanca
- Department of Biomedical Sciences, University of Cagliari & "A. Cao" Paediatric Hospital, Child & Adolescent Neuropsychiatry Unit, Cagliari, Italy
| | - Stefano Sotgiu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Unit of Child Neuropsychiatry, Sassari, Italy
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Tellez-Martinez A, Restrepo-Martinez M, Espinola-Nadurille M, Martinez-Angeles V, Martínez-Carrillo F, Easton A, Pollak T, Ramirez-Bermudez J. Suicidal Thoughts and Behaviors in Anti-NMDA Receptor Encephalitis: Psychopathological Features and Clinical Outcomes. J Neuropsychiatry Clin Neurosci 2023; 35:368-373. [PMID: 37151035 DOI: 10.1176/appi.neuropsych.20220200] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE A wide variety of neuropsychiatric symptoms are described during the acute phase of anti-N-methyl-d-aspartate receptor encephalitis (ANMDARE), including psychosis, mania, depression, and catatonia, but there are few reports on suicidal thought and behaviors in ANMDARE. To address this gap in the literature, the authors measured the presence of suicidal thoughts and behaviors among a large cohort of Mexican patients diagnosed with definite ANMDARE. METHODS This observational and longitudinal study included patients with definite ANMDARE hospitalized at the National Institute of Neurology and Neurosurgery of Mexico between 2014 and 2021. Suicidal thoughts and behaviors were assessed before and after treatment by means of a clinical interview with relatives and a direct clinical assessment with each patient. Thoughts of engaging in suicide-related behavior and acts of suicidal and nonsuicidal self-directed violence before and during hospitalization were recorded. RESULTS From a total sample of 120 patients who fulfilled the diagnostic criteria for definite ANMDARE, 15 patients (13%) had suicidal thoughts and behaviors during the acute phase of the disease. All 15 of these patients experienced psychosis and had suicidal ideation with intention. Three patients engaged in preparatory behaviors and seven carried out suicidal self-directed violence. Psychotic depression and impulsivity were more frequent among those patients with suicidal thoughts and behaviors than among those without any form of suicidality. Four patients engaged in self-directed violence during hospitalization. Remission was sustained in 14 of 15 patients, with suicidal ideation and self-directed violence persisting during follow-up in only one patient. CONCLUSIONS Suicidal thoughts and behaviors are not uncommon during the acute phase of ANMDARE. On the basis of our sample, the persistence of these features after immunotherapy is rare but may be observed. A targeted assessment of suicidal risk should be strongly considered in this population.
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Affiliation(s)
- Alberto Tellez-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Miguel Restrepo-Martinez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Mariana Espinola-Nadurille
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Victoria Martinez-Angeles
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Francisco Martínez-Carrillo
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Ava Easton
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Thomas Pollak
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
| | - Jesus Ramirez-Bermudez
- Neuropsychiatry Unit, National Institute of Neurology and Neurosurgery of Mexico (Tellez-Martinez, Restrepo-Martinez, Espinola-Nadurille, Martinez-Angeles, Martínez-Carrillo, Ramirez-Bermudez); Encephalitis Society, Malton, and Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom (Easton); Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London (Pollak)
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Sell J, Rahmati V, Kempfer M, Irani SR, Ritzau-Jost A, Hallermann S, Geis C. Comparative Effects of Domain-Specific Human Monoclonal Antibodies Against LGI1 on Neuronal Excitability. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/3/e200096. [PMID: 37028941 PMCID: PMC10099296 DOI: 10.1212/nxi.0000000000200096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 01/04/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Autoantibodies to leucine-rich glioma inactivated protein 1 (LGI1) cause an autoimmune limbic encephalitis with frequent focal seizures and anterograde memory dysfunction. LGI1 is a neuronal secreted linker protein with 2 functional domains: the leucine-rich repeat (LRR) and epitempin (EPTP) regions. LGI1 autoantibodies are known to interfere with presynaptic function and neuronal excitability; however, their epitope-specific mechanisms are incompletely understood. METHODS We used patient-derived monoclonal autoantibodies (mAbs), which target either LRR or EPTP domains of LGI1 to investigate long-term antibody-induced alteration of neuronal function. LRR- and EPTP-specific effects were evaluated by patch-clamp recordings in cultured hippocampal neurons and compared with biophysical neuron modeling. Kv1.1 channel clustering at the axon initial segment (AIS) was quantified by immunocytochemistry and structured illumination microscopy techniques. RESULTS Both EPTP and LRR domain-specific mAbs decreased the latency of first somatic action potential firing. However, only the LRR-specific mAbs increased the number of action potential firing together with enhanced initial instantaneous frequency and promoted spike-frequency adaptation, which were less pronounced after the EPTP mAb. This also led to an effective reduction in the slope of ramp-like depolarization in the subthreshold response, suggesting Kv1 channel dysfunction. A biophysical model of a hippocampal neuron corroborated experimental results and suggests that an isolated reduction of the conductance of Kv1-mediated K+ currents largely accounts for the antibody-induced alterations in the initial firing phase and spike-frequency adaptation. Furthermore, Kv1.1 channel density was spatially redistributed from the distal toward the proximal site of AIS under LRR mAb treatment and, to a lesser extant, under EPTP mAb. DISCUSSION These findings indicate an epitope-specific pathophysiology of LGI1 autoantibodies. The pronounced neuronal hyperexcitability and SFA together with dropped slope of ramp-like depolarization after LRR-targeted interference suggest disruption of LGI1-dependent clustering of K+ channel complexes. Moreover, considering the effective triggering of action potentials at the distal AIS, the altered spatial distribution of Kv1.1 channel density may contribute to these effects through impairing neuronal control of action potential initiation and synaptic integration.
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Affiliation(s)
- Josefine Sell
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany
| | - Vahid Rahmati
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany
| | - Marin Kempfer
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany
| | - Sarosh R Irani
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany
| | - Andreas Ritzau-Jost
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany
| | - Stefan Hallermann
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany
| | - Christian Geis
- From the Section Translational Neuroimmunology (J.S., V.R., M.K., C.G.), Department of Neurology, Jena University Hospital, Germany; Oxford Autoimmune Neurology Group (S.R.I.), Nuffield Department of Clinical Neurosciences, University of Oxford, UK; Department of Neurology (S.R.I.), Oxford University Hospitals, UK; and Carl-Ludwig-Institute of Physiology (A.R.-J., S.H.), Faculty of Medicine, Leipzig University, Germany.
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48
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Schwab JM, Haider C, Kopp MA, Zrzavy T, Endmayr V, Ricken G, Kubista H, Haider T, Liebscher T, Lübstorf T, Blex C, Serdani-Neuhaus L, Curt A, Cinelli P, Scivoletto G, Fehlings MG, May C, Guntermann A, Marcus K, Meisel C, Dirnagl U, Martus P, Prüss H, Popovich PG, Lassmann H, Höftberger R. Lesional Antibody Synthesis and Complement Deposition Associate With De Novo Antineuronal Antibody Synthesis After Spinal Cord Injury. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200099. [PMID: 37019668 PMCID: PMC10075523 DOI: 10.1212/nxi.0000000000200099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/06/2023] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Spinal cord injury (SCI) disrupts the fine-balanced interaction between the CNS and immune system and can cause maladaptive aberrant immune responses. The study examines emerging autoantibody synthesis after SCI with binding to conformational spinal cord epitopes and surface peptides located on the intact neuronal membrane. METHODS This is a prospective longitudinal cohort study conducted in acute care and inpatient rehabilitation centers in conjunction with a neuropathologic case-control study in archival tissue samples ranging from acute injury (baseline) to several months thereafter (follow-up). In the cohort study, serum autoantibody binding was examined in a blinded manner using tissue-based assays (TBAs) and dorsal root ganglia (DRG) neuronal cultures. Groups with traumatic motor complete SCI vs motor incomplete SCI vs isolated vertebral fracture without SCI (controls) were compared. In the neuropathologic study, B cell infiltration and antibody synthesis at the spinal lesion site were examined by comparing SCI with neuropathologically unaltered cord tissue. In addition, the CSF in an individual patient was explored. RESULTS Emerging autoantibody binding in both TBA and DRG assessments was restricted to an SCI patient subpopulation only (16%, 9/55 sera) while being absent in vertebral fracture controls (0%, 0/19 sera). Autoantibody binding to the spinal cord characteristically detected the substantia gelatinosa, a less-myelinated region of high synaptic density involved in sensory-motor integration and pain processing. Autoantibody binding was most frequent after motor complete SCI (grade American Spinal Injury Association impairment scale A/B, 22%, 8/37 sera) and was associated with neuropathic pain medication. In conjunction, the neuropathologic study demonstrated lesional spinal infiltration of B cells (CD20, CD79a) in 27% (6/22) of patients with SCI, the presence of plasma cells (CD138) in 9% (2/22). IgG and IgM antibody syntheses colocalized to areas of activated complement (C9neo) deposition. Longitudinal CSF analysis of an additional single patient demonstrated de novo (IgM) intrathecal antibody synthesis emerging with late reopening of the blood-spinal cord barrier. DISCUSSION This study provides immunologic, neurobiological, and neuropathologic proof-of-principle for an antibody-mediated autoimmunity response emerging approximately 3 weeks after SCI in a patient subpopulation with a high demand of neuropathic pain medication. Emerging autoimmunity directed against specific spinal cord and neuronal epitopes suggests the existence of paratraumatic CNS autoimmune syndromes.
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Affiliation(s)
- Jan M Schwab
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria.
| | - Carmen Haider
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Marcel A Kopp
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Tobias Zrzavy
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Verena Endmayr
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Gerda Ricken
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Helmut Kubista
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Thomas Haider
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Thomas Liebscher
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Tom Lübstorf
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Christian Blex
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Leonarda Serdani-Neuhaus
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Armin Curt
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Paolo Cinelli
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Giorgio Scivoletto
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Michael G Fehlings
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Caroline May
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Annika Guntermann
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Katrin Marcus
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Christian Meisel
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Ulrich Dirnagl
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Peter Martus
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Harald Prüss
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Phillip G Popovich
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Hans Lassmann
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria
| | - Romana Höftberger
- From the The Belford Center for Spinal Cord Injury (J.M.S., P.G.P.), The Ohio State University, Wexner Medical Center, Columbus; Departments of Neurology (J.M.S.), Physical Medicine and Rehabilitation, and Neurosciences, The Ohio State University, Columbus; Department of Neurology and Experimental Neurology (J.M.S., M.A.K., T. Liebscher, T. Lübstorf, C.B., L.S.-N., U.D., H.P.), Spinal Cord Injury Research (Neuroparaplegiology), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Division of Neuropathology and Neurochemistry (C.H., V.E., G.R., R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (T.Z.), Medical University of Vienna, Austria; Department of Neurophysiology and Neuropharmacology (Center for Physiology and Pharmacology) (H.K.), Medical University of Vienna, Austria; Department of Orthopaedics and Trauma Surgery (T.H.), Medical University of Vienna, Austria; Treatment Centre for Spinal Cord Injuries (Thomas Liebscher), BG Hospital Unfallkrankenhaus Berlin, Germany; Spinal Cord Injury Center (A.C.), Balgrist University Hospital, Zurich, Switzerland; Division of Trauma Surgery (P.C.), University Hospital Zürich, Switzerland; IRCCS Fondazione S. Lucia (G.S.), Spinal Cord Unit, Rome, Italy; Division of Neurosurgery and Spine Program (M.G.F.), University of Toronto, ON, Canada; Ruhr-University Bochum (C. May, A.G., K.M.), Center for Protein Diagnostics (PRODI), Medical Proteome Center, Universitätsstraße 150, Bochum, Germany; Institute of Medical Immunology (C. Meisel), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Department of Immunology (C. Meisel), Labor Berlin-Charité Vivantes GmbH, Germany; Berlin Institute of Health (U.D.), QUEST-Center for Transforming Biomedical Research, Germany; Department of Clinical Epidemiology and Applied Biostatistics (P.M.), Eberhard Karls Universität Tübingen, Germany; Department of Neurosciences (P.G.P.), The Ohio State University, Columbus; and Center for Brain Research (H.L.), Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health (C.H., T.Z., V.E., G.R., R.H.), Medical University of Vienna, Austria.
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Jia Y, Li M, Hu S, Leng H, Yang X, Xue Q, Zhang M, Wang H, Huang Z, Wang H, Ye J, Liu A, Wang Y. Psychiatric features in NMDAR and LGI1 antibody-associated autoimmune encephalitis. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01606-w. [PMID: 37029805 DOI: 10.1007/s00406-023-01606-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 03/29/2023] [Indexed: 04/09/2023]
Abstract
Patients with autoimmune encephalitis (AE) often developed psychiatric features during the disease course. Many studies focused on the psychiatric characteristic in anti-NMDAR encephalitis (NMDAR-E), but anti-LGI1 encephalitis (LGI1-E) had received less attention regarding the analysis of psychiatric features, and no study compared psychiatric characteristic between these two groups. The clinical data of AE patients (62 NMDAR-E and 20 LGI1-E) who developed psychiatric symptoms were analyzed in this study. In NMDAR-E, the most common higher-level feature was "behavior changes" (60/62, 96.8%) and the lower-level feature "incoherent speech" was observed in 33 patients (33/62, 53.2%), followed by "agitation" (29/62, 46.8%) and "incongruent laughter/crying" (20/62, 32.3%). Similar to NMDAR-E, "behavior changes" was most common in LGI1-E (17/20, 85.0%), but the features of suicidality, eating, and obsessive-compulsive were not reported. The top three lower-level features were visual hallucinations (9/20, 45.0%), incoherent speech (8/20, 40.0%), and mood instability (7/20, 35.0%). The comparative study found that "incongruent laughter/crying", in lower-level features, was more frequently observed in NMDAR-E (32.3% vs. 0%, p = 0.002). Moreover, the Bush Francis Catatonia Rating Scale (BFCRS) assessing the catatonic symptoms in NMDAR-E were higher than LGI1-E, but the 18 item-Brief Psychiatric Rating Scale (BPRS-18) showed no difference in the two groups. In summary, both NMDAR-E and LGI1-E often developed psychiatric symptoms. In contrast with LGI1-E, the psychiatric feature "incongruent laughter/crying" was more frequently associated with NMDAR-E, and catatonic symptoms were more severe in NMDAR-E.
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Affiliation(s)
- Yu Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Mingyu Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Shimin Hu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Haixia Leng
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Xiaotong Yang
- Department of Neurology, Youanmen Hospital, Fengtai, Beijing, China
| | - Qing Xue
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Mengyao Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Huifang Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Zhaoyang Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
- Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
| | - Hongxing Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
| | - Jing Ye
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China
| | - Yuping Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45 ChangChun Street, XiCheng District, Beijing, 100053, China.
- Beijing Key Laboratory of Neuromodulation, Capital Medical University, Beijing, China.
- Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Ministry of Science and Technology, Beijing, China.
- Institute of Sleep and Consciousness Disorders, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
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50
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Zhang Y, Cheng YK, Yang CF, Jin LM, Li YM. Therapeutic plasma exchange in anti-N-methyl-D-aspartate receptor encephalitis. Ther Apher Dial 2023; 27:197-206. [PMID: 36165337 DOI: 10.1111/1744-9987.13934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/05/2022] [Accepted: 09/22/2022] [Indexed: 11/29/2022]
Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is the most commonly identified cause of autoimmune encephalitis. Therapeutic plasma exchange has been increasingly employed to treat this disease. This expansion is a consequence of improved techniques and apheresis instruments, as well as the recognition of its applicability in neurological diseases. However, several aspects of treatment remain incompletely clarified, and treatment strategies are still heterogeneous, especially with regard to therapeutic plasma exchange in anti-NMDAR encephalitis. This review provides an overview of the use of therapeutic plasma exchange including the principle and mechanisms, the evidence, initial time, efficiency and complications in anti-NMDAR encephalitis.
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Affiliation(s)
- Yuan Zhang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Yong-Kang Cheng
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Chun-Feng Yang
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Lin-Mei Jin
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
| | - Yu-Mei Li
- Department of Pediatric Intensive Care Unit, The First Hospital of Jilin University, Jilin, China
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