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Peng Y, Yang H, Xue YH, Chen Q, Jin H, Liu S, Yao SY, Du MQ. An update on malignant tumor-related stiff person syndrome spectrum disorders: clinical mechanism, treatment, and outcomes. Front Neurol 2023; 14:1209302. [PMID: 37859648 PMCID: PMC10582361 DOI: 10.3389/fneur.2023.1209302] [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: 06/21/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023] Open
Abstract
Stiff person syndrome (SPS) is a rare central nervous system disorder associated with malignancies. In this review, we retrieved information from PubMed, up until August 2023, using various search terms and their combinations, including SPS, stiff person syndrome spectrum disorders (SPSSDs), paraneoplastic, cancer, and malignant tumor. Data from peer-reviewed journals printed in English were organized to explain the possible relationships between different carcinomas and SPSSD subtypes, as well as related autoantigens. From literature searching, it was revealed that breast cancer was the most prevalent carcinoma linked to SPSSDs, followed by lung cancer and lymphoma. Furthermore, classic SPS was the most common SPSSD subtype, followed by stiff limb syndrome and progressive encephalomyelitis with rigidity and myoclonus. GAD65 was the most common autoantigen in patients with cancer and SPSSDs, followed by amphiphysin and GlyR. Patients with cancer subtypes might have multiple SPSSD subtypes, and conversely, patients with SPSSD subtypes might have multiple carcinoma subtypes. The first aim of this review was to highlight the complex nature of the relationships among cancers, autoantigens, and SPSSDs as new information in this field continues to be generated globally. The adoption of an open-minded approach to updating information on new cancer subtypes, autoantigens, and SPSSDs is recommended to renew our database. The second aim of this review was to discuss SPS animal models, which will help us to understand the mechanisms underlying the pathogenesis of SPS. In future, elucidating the relationship among cancers, autoantigens, and SPSSDs is critical for the early prediction of cancer and discovery of new therapeutic modalities.
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Affiliation(s)
- Yong Peng
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ya-hui Xue
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
| | - Quan Chen
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
| | - Hong Jin
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
| | - Shu Liu
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
| | - Shun-yu Yao
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
| | - Miao-qiao Du
- Department of Neurology, Affiliated First Hospital of Hunan Traditional Chinese Medical College, Zhuzhou, Hunan, China
- The Third Affiliated Hospital of Hunan University of Chinese Medicine, Zhuzhou, Hunan, China
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Kalampokini S, Motkova I, Bargiotas P, Artemiadis A, Zis P, Hadjigeorgiou GM. A case of unusual presentation with anti-glycine receptor (GlyR) and myelin oligodentrocyte glycoprotein (MOG) antibody. Clin Park Relat Disord 2023; 8:100195. [PMID: 37091118 PMCID: PMC10119963 DOI: 10.1016/j.prdoa.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 02/15/2023] [Accepted: 03/26/2023] [Indexed: 04/04/2023] Open
Abstract
Movement disorders can be a prominent feature in autoimmune encephalitis. Here we present a rare case of a 73-year-old woman, who presented with a complex phenotype with encephalopathy, parkinsonism, cervical dystonia, left-sided hemidystonia and hemifacial spasm of subacute onset and was found to have breast cancer and positive anti-Glycine Receptor (GlyR) and Myelin Oligodentrocyte Glycoprotein (MOG) antibodies.
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Su Y, Cui L, Zhu M, Liang Y, Zhang Y. Progressive Encephalomyelitis With Rigidity and Myoclonus With Thymoma: A Case Report and Literature Review. Front Neurol 2020; 11:1017. [PMID: 33071929 PMCID: PMC7533529 DOI: 10.3389/fneur.2020.01017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/03/2020] [Indexed: 12/20/2022] Open
Abstract
Progressive encephalomyelitis with rigidity and myoclonus (PERM) is part of the variant type of the Stiff Person Syndrome (SPS) and is a rare neurological disease. We report here a patient with PERM who had thymoma and was positive for anti-glutamic acid decarboxylase (anti-GAD) antibodies. Her symptoms improved after treatment with hormones and gamma globulin. We also summarized the literature review of patients with PERM accompanied by tumors reported.
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Affiliation(s)
- Yana Su
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Li Cui
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Mingqin Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yixuan Liang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Ying Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Lee EJ, Kim K, Choi JY, Park KS. Successful Treatment of Glycine-Receptor-Antibody-Mediated Progressive Encephalomyelitis with Rigidity and Myoclonus by Combining Steroids and Azathioprine. J Clin Neurol 2019; 15:581-582. [PMID: 31591852 PMCID: PMC6785484 DOI: 10.3988/jcn.2019.15.4.581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 06/03/2019] [Accepted: 06/10/2019] [Indexed: 01/17/2023] Open
Affiliation(s)
- Eung Joon Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kitae Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jeong Yoon Choi
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung Seok Park
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
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Degeneffe A, Dagonnier M, D’hondt A, Elosegi JA. A case report of rigidity and recurrent lower limb myoclonus: progressive encephalomyelitis rigidity and myoclonus syndrome, a chameleon. BMC Neurol 2018; 18:173. [PMID: 30336789 PMCID: PMC6193294 DOI: 10.1186/s12883-018-1176-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 10/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Progressive encephalomyelitis with rigidity and myoclonus (PERM) syndrome is a rare neurological condition. Its clinical characteristics include axial and limb muscle rigidity, myoclonus, painful spasms and hyperekplexia. Diagnosis of this disease can be very challenging and optimal long-term treatment is unclear. CASE PRESENTATION We report a case of a 62 year old patient admitted for repetitive myoclonus and rigidity in the lower limbs progressing since 10 years, associated with a fluctuating encephalopathy requiring stays in Intensive Care Unit. Multiple diagnostics and treatment were proposed, unsuccessfully, before the diagnosis of PERM syndrome was established. In association with the clinical presentation, a strong positive result for GAD (glutamic acid decarboxylase) antibodies lead to the diagnosis of PERM syndrome. CONCLUSIONS PERM syndrome is a rare disease and its diagnosis is not easy. Once the diagnosis is established, the correct treatment should follow and could be lifesaving, regardless of a delayed diagnosis. Maintenance of long-term oral corticotherapy is suggested to prevent relapses.
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Affiliation(s)
- Aurélie Degeneffe
- Department of Neurology, CHU Ambroise Paré Hospital, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
| | - Marie Dagonnier
- Department of Neurology, CHU Ambroise Paré Hospital, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
| | - Alain D’hondt
- Intensive Care Unit, CHU Ambroise Paré Hospital, Mons, Belgium
| | - Jose Antonio Elosegi
- Department of Neurology, CHU Ambroise Paré Hospital, Boulevard John Fitzgerald Kennedy 2, 7000 Mons, Belgium
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Swayne A, Tjoa L, Broadley S, Dionisio S, Gillis D, Jacobson L, Woodhall MR, McNabb A, Schweitzer D, Tsang B, Vincent A, Irani SR, Wong R, Waters P, Blum S. Antiglycine receptor antibody related disease: a case series and literature review. Eur J Neurol 2018; 25:1290-1298. [PMID: 29904974 PMCID: PMC6282944 DOI: 10.1111/ene.13721] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Antibodies to glycine receptors (GlyR-Abs) were first defined in progressive encephalopathy with rigidity and myoclonus (PERM) but were subsequently identified in other clinical presentations. Our aim was to assess the clinical associations of all patients identified with GlyR-Abs in Queensland, Australia, between April 2014 and May 2017 and to compare these to cases reported in the literature. METHODS A literature review identified the clinical features of all published GlyR-Ab-positive cases through online databases. A case series was undertaken via collection of clinical information from all patients diagnosed or known to immunology, pathology or neurological services in Queensland during the study period of 3 years. RESULTS In all, 187 GlyR-Ab-positive cases were identified in the literature. The majority (47.6%) had PERM, 22.4% had epilepsy, but the remaining 30% included mixed phenotypes consisting of cerebellar ataxia, movement disorders, demyelination and encephalitis/cognitive dysfunction. By contrast, in our series of 14 cases, eight had clinical presentations consistent with seizures and epilepsy and only three cases had classical features of PERM. There was one case each of global fatiguable weakness with sustained clonus, laryngeal dystonia and movement disorder with hemiballismus and tics. The rate of response to immune therapy was similar in all groups. CONCLUSION Antibodies to glycine receptors are linked to a spectrum of neurological disease. The results of the literature review and our case series suggest a greater relationship between GlyR-Abs and epilepsy than previously reported.
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Affiliation(s)
- A Swayne
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,School of Medicine, University of Queensland, Herston, QLD, Australia.,Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - L Tjoa
- Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - S Broadley
- Gold Coast University Hospital, Griffith University Medical School, Griffith University, QLD, Australia
| | - S Dionisio
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - D Gillis
- Pathology Queensland, Brisbane, QLD, Australia.,Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - L Jacobson
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M R Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A McNabb
- Cairns Base Hospital, Cairns, QLD, Australia
| | - D Schweitzer
- Mater Centre for Neuroscience, South Brisbane, QLD, Australia
| | - B Tsang
- Sunshine Coast University Hospital, Birtinya, QLD, Australia
| | - A Vincent
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - S R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - R Wong
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,Pathology Queensland, Brisbane, QLD, Australia
| | - P Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - S Blum
- Princess Alexandra Hospital Brisbane Australia, Wooloongabba, QLD, Australia.,School of Medicine, University of Queensland, Herston, QLD, Australia.,Mater Centre for Neuroscience, South Brisbane, QLD, Australia
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Hinson SR, Lopez-Chiriboga AS, Bower JH, Matsumoto JY, Hassan A, Basal E, Lennon VA, Pittock SJ, McKeon A. Glycine receptor modulating antibody predicting treatable stiff-person spectrum disorders. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e438. [PMID: 29464188 PMCID: PMC5813079 DOI: 10.1212/nxi.0000000000000438] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022]
Abstract
Background Glycine receptor alpha-1 subunit (GlyRα1)-immunoglobulin G (IgG) is diagnostic of stiff-person syndrome (SPS) spectrum but has been reported detectable in other neurologic diseases for which significance is less certain. Methods To assess GlyRα1-IgGs as biomarkers of SPS spectrum among patients and controls, specimens were tested using cell-based assays (binding [4°C] and modulating [antigen endocytosing, 37°C]). Medical records of seropositive patients were reviewed. Results GlyRα1-IgG (binding antibody) was detected in 21 of 247 patients with suspected SPS spectrum (8.5%) and in 8 of 190 healthy subject sera (4%) but not CSF. Among 21 seropositive patients, 20 had confirmed SPS spectrum clinically, but 1 was later determined to have a functional neurologic disorder. Sera from 9 patients with SPS spectrum , but not 7 controls, nor the functional patient, caused GlyRα1 modulation (100% specificity). SPS spectrum phenotypes included progressive encephalomyelitis with rigidity and myoclonus (PERM) (8), classic SPS (5), stiff limb (5), stiff trunk (1), and isolated exaggerated startle (hyperekplexia, 1). Neuropsychiatric symptoms present in 12 patients (60%) were anxiety (11), depression (6), and delirium (3). Anxiety was particularly severe in 3 patients with PERM. Objective improvements in SPS neurologic symptoms were recorded in 16 of 18 patients who received first-line immunotherapy (89%, 9/10 treated with corticosteroids, 8/10 treated with IVIg, 3/4 treated with plasma exchange, and 1 treated with rituximab). Treatment-sparing maintenance strategies were successful in 4 of 7 patients (rituximab [2/3], azathioprine [1/1], and mycophenolate [1/3]). Conclusions GlyRα1-modulating antibody improves diagnostic specificity for immunologically treatable SPS spectrum disorders. Classification of evidence This study provides Class IV evidence that GlyRα1-modulating antibody accurately identifies patients with treatable SPS spectrum disorders.
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Affiliation(s)
- Shannon R Hinson
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - James H Bower
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Joseph Y Matsumoto
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Anhar Hassan
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Eati Basal
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology (S.R.H., E.B., V.A.L., S.J.P., A.M.), Department of Neurology (A.S.L.-C., J.H.B., J.Y.M., A.H., V.A.L., S.J.P., A.M.), and Department of Immunology (V.A.L.), Mayo Clinic, Rochester, MN
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[Progressive encephalomyelitis with rigidity and myoclonus : Stiff tongue as initial symptom]. DER NERVENARZT 2017; 89:198-199. [PMID: 29038884 DOI: 10.1007/s00115-017-0429-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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