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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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Alghamdi RH, Alsowat D, Alyamani S, Alfaris H, Mokeem A. Co-existence of anti-glutamic acid decarboxylase-65 and anti-sry-like high-mobility group box receptor antibody-associated autoimmune encephalitis: A rare case report. Epilepsy Behav Rep 2024; 25:100648. [PMID: 38323090 PMCID: PMC10844659 DOI: 10.1016/j.ebr.2024.100648] [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: 11/09/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024] Open
Abstract
Autoimmune encephalitis (AE) has been increasingly recognized in children. An 11-year-old Saudi boy presented with prodromal symptoms of fever and headache followed by behavioral changes, cognitive impairment, and focal seizures. Cerebrospinal fluid (CSF) analysis showed pleocytosis. Brain magnetic resonance imaging showed T2/fluid-attenuated inversion recovery hyperintensities involving the temporal, parietal and frontal lobes. Electroencephalography revealed diffuse encephalopathy and electrographic seizures. AE was suspected; intravenous methylprednisolone and immunoglobulin were administered. Autoantibodies against glutamic acid decarboxylase-65 were detected in his serum and CSF and against Sry-like high- mobility group box 1 in his serum only. The patient was diagnosed with seropositive AE and favorably responded to intensive immunosuppressive therapy.
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Affiliation(s)
- Raneem H. Alghamdi
- Division of Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Daad Alsowat
- Division of Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Suad Alyamani
- Division of Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Haya Alfaris
- Division of Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Amal Mokeem
- Division of Pediatric Neurology, Department of Neurosciences, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
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Kuang Z, Baizabal-Carvallo JF, Mofatteh M, Xie S, Pan M, Ye J, Zhou L, Yang S, Wang Z, Chen Y, Li Y. Meningoencephalitis associated with GAD65 autoimmunity. Front Immunol 2023; 14:1120894. [PMID: 36969186 PMCID: PMC10035530 DOI: 10.3389/fimmu.2023.1120894] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
BackgroundEncephalitis has been recognized in patients with autoimmunity related to the 65-kDa isoform of glutamic acid decarboxylase (GAD65) antibodies; however, patients with meningoencephalitis associated with those antibodies have been rarely identified in the medical literature. We aimed to define the frequency, clinical features, response to therapy, and functional outcomes of patients with meningoencephalitis associated with GAD antibodies.MethodsWe retrospectively studied consecutive patients attending a tertiary care center for evaluation of an autoimmune neurological disorder from January 2018 to June 2022. The modified Rankin Scale (mRS) was used to assess the functional outcome at the last follow-up.ResultsWe evaluated 482 patients with confirmed autoimmune encephalitis during the study period. Four among the 25 patients with encephalitis related to GAD65 antibodies were identified. One patient was excluded owing to the coexistence of NMDAR antibodies. Three male patients aged 36, 24, and 16 years had an acute (n = 1) or subacute (n = 2) onset of confusion, psychosis, cognitive symptoms, seizures, or tremor. No patient had fever or clinical signs of meningeal irritation. Mild pleocytosis (<100 leukocytes/106) was identified in two patients, whereas one patient had normal CSF. Following immunotherapy with corticosteroids (n = 3) or intravenous immunoglobulin (n = 1), significant improvement was observed in all three cases, achieving a good outcome (mRS 1) in all cases.ConclusionMeningoencephalitis is an uncommon presentation of GAD65 autoimmunity. Patients present with signs of encephalitis but with meningeal enhancement and have good outcomes.
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Affiliation(s)
- Zuying Kuang
- Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, China
| | - José Fidel Baizabal-Carvallo
- Parkinson’s Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
- Department of Sciences and Engineering, University of Guanajuato, León, Mexico
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, United Kingdom
| | - Sifen Xie
- Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, China
| | - Mengqiu Pan
- Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, China
| | - Jinlong Ye
- Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, China
| | - Lihua Zhou
- Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, China
| | - Shuiquang Yang
- Department of Neurology, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
| | - Zhanhang Wang
- Department of Neurology, GuangDong 999 Brain Hospital, Guangzhou, China
- *Correspondence: Yimin Chen, ; Zhanhang Wang, ; Yaqin Li,
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People’s Hospital, Foshan, Guangdong, China
- *Correspondence: Yimin Chen, ; Zhanhang Wang, ; Yaqin Li,
| | - Yaqin Li
- Department of Neurology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, Guangdong, China
- *Correspondence: Yimin Chen, ; Zhanhang Wang, ; Yaqin Li,
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Wijnand A, Verhelst H. Anti-SOX1 Antibodies in a 3-Year-old Girl, Post-Varicella. Child Neurol Open 2023; 10:2329048X231200613. [PMID: 37745634 PMCID: PMC10517599 DOI: 10.1177/2329048x231200613] [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: 04/25/2023] [Revised: 08/04/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023] Open
Abstract
Anti-SRY-related HMG-box gene 1 (SOX1) antibodies were initially described in adults with paraneoplastic neurological disorders, where they are considered high-risk onconeural autoantibodies. Only two pediatric cases of anti-SOX1 antibodies have been reported: a 17-year-old adolescent presenting with paraneoplastic limbic encephalitis due to Hodgkin lymphoma and a 12-year-old girl presenting with non-paraneoplastic encephalitis. We present a unique case of anti-SOX1 antibodies in a 3-year-old girl, post-varicella infection. Initially, she presented with ataxia and dysmetria, with subsequent reports from parents of urinary incontinence and significant behavior changes. Additionally, reflexes in the lower limbs were absent. Anti-SOX1 antibodies tested positive in both serum and cerebrospinal fluid. Oncological screening at presentation and a seven-month follow-up showed no malignancies. The patient exhibited favorable clinical progress without requiring treatment. At the seven-month follow-up, serum antibodies tested negative. This case report broadens the known clinical spectrum, being the first description of post-varicella anti-SOX1 antibodies.
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Affiliation(s)
- Aline Wijnand
- Department of Child and Adolescent Psychiatry, Ghent University Hospital, Ghent, Belgium
| | - Helene Verhelst
- Department of Pediatrics, Division of Pediatric Neurology, Ghent University Hospital, Ghent, Belgium
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Shi X, Cai W, Zhang X, Pan H, Huang C, Wang S, Xu J. Early predictors of new-onset immune-related seizures: a preliminary study. BMC Neurol 2022; 22:503. [PMID: 36581882 PMCID: PMC9798624 DOI: 10.1186/s12883-022-03042-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Approximately 60% of patients with autoimmune encephalitis (AE) exhibit secondary acute symptomatic seizures and showed highly sensitive to immunotherapy. However, it is difficult for many patients to receive early immunotherapy since the early identification of the cause in AE is more complex. This study aimed to investigate the early predictors of initial immune-related seizures and to guide the evaluation of treatment and prognosis. METHODS One hundred and fifty-four patients with new-onset "unknown etiology" seizures with a course of disease less than 6 months were included. Serum and/or cerebrospinal fluid neuron-specific autoantibodies (NSAbs), including N-methyl-D-aspartate receptor (NMDAR), α-amino-3-hydroxy-5- Methyl-4-isoxazole propionic acid receptor 1 (AMPAR1), AMPAR2, anti-leucine rich glioma inactivated 1 antibody (LGI1), anti-gamma-aminobutyric acid type B receptor (GABABR), anti-contact protein-related protein-2 (CASPR2) were used to screen for immune etiology of the seizures. In addition, patients with epilepsy and encephalopathy were also examined via brain MRI, long-term video EEG, antibody prevalence in epilepsy and encephalopathy (APE2) score, and modified Rankin Scale (mRS). A logistic regression model was used to analyze the early predictors of immune etiology. RESULTS Thirty-four cases (22.1%) were positive for NSAbs. Among all 154 patients, 23 cases of autoimmune encephalitis (AE) (21 cases of NSAbs positive), 1 case of ganglionic glioma (NSAbs positive), 130 cases of epilepsy or seizures (12 cases of NSAbs positive) were recorded. Also, there were 17 patients (11.0%) with APE2 ≥ 4 points, and all of them met the clinical diagnosis of AE. The sensitivity and specificity of APE2 ≥ 4 points for predicting AE were 73.9% and 100%. The results of multivariate analysis showed that the NSAbs and APE2 scores independently influenced the early prediction of initial immune-related seizures (P < 0.05). CONCLUSION NSAbs and APE2 scores could act as early predictors of initial immune-related seizures.
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Affiliation(s)
- Xiangsong Shi
- Department of Neurology, Huai’an Third People’s Hospital, No. 272, Huaihai West Road, 223001 Huai’an, China
| | - Weiwei Cai
- Department of Neurology, Huai’an Third People’s Hospital, No. 272, Huaihai West Road, 223001 Huai’an, China
| | - Xiulin Zhang
- Department of Neurology, Huai’an Third People’s Hospital, No. 272, Huaihai West Road, 223001 Huai’an, China
| | - Heyue Pan
- Department of Neurology, Huai’an Third People’s Hospital, No. 272, Huaihai West Road, 223001 Huai’an, China
| | - Chengbing Huang
- Department of Psychiatry, Huai’an Third People’s Hospital, 223001 Huai’an, China
| | - Shouyong Wang
- Department of Neurology, Huai’an Third People’s Hospital, No. 272, Huaihai West Road, 223001 Huai’an, China
| | - Jianyang Xu
- Department of Neurology, Huai’an Third People’s Hospital, No. 272, Huaihai West Road, 223001 Huai’an, China
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Kim H, Yum MS, Kim MJ, Ko TS. A Rare Case of Anti-Ma2 Antibody-Mediated Autoimmune Encephalomyelitis in Childhood. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Lubarski K, Mania A, Michalak S, Osztynowicz K, Mazur-Melewska K, Figlerowicz M. The Clinical Spectrum of Autoimmune-Mediated Neurological Diseases in Paediatric Population. Brain Sci 2022; 12:brainsci12050584. [PMID: 35624969 PMCID: PMC9138824 DOI: 10.3390/brainsci12050584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/21/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022] Open
Abstract
Neurological autoimmune diseases have various origins and pathogeneses. Specific antibodies are associated with paraneoplastic syndromes, other infectious agents, or inherited disorders. We aim to evaluate the relation between the autoantibodies, the chosen symptoms, demographic characteristics, and infection history. We retrospectively analysed 508 children during neurological diagnostics. We investigated serum antineuronal, IgG, IgM anti-ganglioside, and anti-aquaporin-4 in both the serum and cerebrospinal fluid (CSF) anti-cell surface and anti-synaptic protein antibodies in 463, 99, 44, 343, and 119 patients, respectively. The CSF polymerase chain reaction detection of Herpesviridae, enterovirus, B19 parvovirus, adenovirus, and parechovirus involved 261 patients. We included available clinical information and electroencephalographic, radiologic, and microbiological results. The IgM anti-ganglioside antibodies increased the risk of tics and positive symptoms (p = 0.0345, p = 0.0263, respectively), the anti-glutamic acid decarboxylase particle of paresis (p = 0.0074), and anti-neuroendothelium of mutism (p = 0.0361). Anti-neuroendothelium, IgM anti-ganglioside, and CSF anti-N-methyl-D-aspartate antibodies were more often associated with consciousness loss (p = 0.0496, p = 0.0044, p = 0.0463, respectively). Anti-myelin antibodies co-occured with Herpes simplex virus (HSV)-2 IgG (p = 0.0415), anti-CV2 with HSV-1 IgM (p = 0.0394), whereas anti-glial fibrillary acidic protein was linked with past Epstein-Barr virus infection. The anti-ganglioside IgM and anti-myelin particles were bilaterally correlated (p = 0.0472). The clinical pictures may overlap, requiring specialistic diagnostics. We noticed the links between the infection aetiology and the specific autoantibody’s positivity.
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Affiliation(s)
- Karol Lubarski
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland; (K.L.); (A.M.); (K.M.-M.)
| | - Anna Mania
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland; (K.L.); (A.M.); (K.M.-M.)
| | - Sławomir Michalak
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland; (S.M.); (K.O.)
| | - Krystyna Osztynowicz
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego St., 60-355 Poznan, Poland; (S.M.); (K.O.)
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland; (K.L.); (A.M.); (K.M.-M.)
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, 27/33 Szpitalna St., 60-572 Poznan, Poland; (K.L.); (A.M.); (K.M.-M.)
- Correspondence: ; Tel.: +48-61-8491362
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Howlett WP. Rapidly progressive dementia: limitations in Africa. Pract Neurol 2022; 22:342-343. [DOI: 10.1136/practneurol-2022-003385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2022] [Indexed: 11/04/2022]
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