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Melzer N, Weber K, Räuber S, Rosenow F. [(Auto)immunity in focal epilepsy: mechanisms of (auto‑)immune-inflammatory epileptogenic neurodegeneration]. DER NERVENARZT 2024:10.1007/s00115-024-01695-5. [PMID: 38953922 DOI: 10.1007/s00115-024-01695-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
OBJECTIVE While the neuronal mechanisms of epileptic hyperexcitability (HE) have been studied in detail, recent findings suggest that extraneuronal, mainly immune-mediated inflammatory and vascular mechanisms play an important role in the development and progression of HE in epilepsy and the cognitive and behavioral comorbidities. MATERIAL AND METHODS Narrative review. RESULTS As in autoimmune (limbic) encephalitis (ALE/AIE) or Rasmussen's encephalitis (RE), the primary adaptive and innate immune responses and associated changes in the blood-brain barrier (BBB) and neurovascular unit (NVU) can cause acute cortical hyperexcitability (HE) and the development of hippocampal sclerosis (HS) and other structural cortical lesions with chronic HE. Cortical HE, which is associated with malformation of cortical development (MCD) and low-grade epilepsy-associated tumors (LEAT), for example, can be accompanied by secondary adaptive and innate immune responses and alterations in the BBB and NVU, potentially modulating the ictogenicity and epileptogenicity. These associations illustrate the influence of adaptive and innate immune mechanisms and associated changes in the BBB and NVU on cortical excitability and vice versa, suggesting a dynamic and complex interplay of these factors in the development and progression of epilepsy in general. DISCUSSION The described concept of a neuro-immune-vascular interaction in focal epilepsy opens up new possibilities for the pathogenetic understanding and thus also for the selective therapeutic intervention.
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Affiliation(s)
- Nico Melzer
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland.
| | - Katharina Weber
- Neurologisches Institut (Edinger Institut), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Frankfurt Cancer Institute (FCI), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
- Partnerstätte Frankfurt, Frankfurt am Main und Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutsches Konsortium für Translationale Krebsforschung (DKTK), Heidelberg, Deutschland
- Universitäres Centrum für Tumorerkrankungen Frankfurt (UCT), Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Saskia Räuber
- Klinik für Neurologie, Medizinische Fakultät und Universitätsklinikum, Heinrich-Heine-Universität Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - Felix Rosenow
- Epilepsiezentrum Frankfurt Rhein-Main, Klinik für Neurologie, Zentrum für Neurologie und Neurochirurgie, Universitätsklinikum Frankfurt, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
- LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland.
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Casagrande S, Sopetto GB, Bertalot G, Bortolotti R, Racanelli V, Caffo O, Giometto B, Berti A, Veccia A. Immune-Related Adverse Events Due to Cancer Immunotherapy: Immune Mechanisms and Clinical Manifestations. Cancers (Basel) 2024; 16:1440. [PMID: 38611115 PMCID: PMC11011060 DOI: 10.3390/cancers16071440] [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: 03/03/2024] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
The landscape of cancer treatment has undergone a significant transformation with the introduction of Immune Checkpoint Inhibitors (ICIs). Patients undergoing these treatments often report prolonged clinical and radiological responses, albeit with a potential risk of developing immune-related adverse events (irAEs). Here, we reviewed and discussed the mechanisms of action of ICIs and their pivotal role in regulating the immune system to enhance the anti-tumor immune response. We scrutinized the intricate pathogenic mechanisms responsible for irAEs, arising from the evasion of self-tolerance checkpoints due to drug-induced immune modulation. We also summarized the main clinical manifestations due to irAEs categorized by organ types, detailing their incidence and associated risk factors. The occurrence of irAEs is more frequent when ICIs are combined; with neurological, cardiovascular, hematological, and rheumatic irAEs more commonly linked to PD1/PD-L1 inhibitors and cutaneous and gastrointestinal irAEs more prevalent with CTLA4 inhibitors. Due to the often-nonspecific signs and symptoms, the diagnosis of irAEs (especially for those rare ones) can be challenging. The differential with primary autoimmune disorders becomes sometimes intricate, given the clinical and pathophysiological similarities. In conclusion, considering the escalating use of ICIs, this area of research necessitates additional clinical studies and practical insights, especially the development of biomarkers for predicting immune toxicities. In addition, there is a need for heightened education for both clinicians and patients to enhance understanding and awareness.
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Affiliation(s)
- Silvia Casagrande
- Unit of Neurology, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari-APSS, 38122 Trento, Italy; (S.C.); (B.G.)
| | - Giulia Boscato Sopetto
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
| | - Giovanni Bertalot
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Multizonal Unit of Pathology, APSS, 38122 Trento, Italy
| | - Roberto Bortolotti
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy;
| | - Vito Racanelli
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Unit of Internal Medicine, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy
| | - Orazio Caffo
- Unit of Oncology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy; (O.C.); (A.V.)
| | - Bruno Giometto
- Unit of Neurology, Rovereto Hospital, Azienda Provinciale per i Servizi Sanitari-APSS, 38122 Trento, Italy; (S.C.); (B.G.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Department of Psychology and Cognitive Sciences (DIPSCO), University of Trento, 38122 Trento, Italy
| | - Alvise Berti
- Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy; (G.B.S.); (G.B.); (V.R.)
- Center for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy
- Unit of Rheumatology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy;
| | - Antonello Veccia
- Unit of Oncology, Santa Chiara Regional Hospital, APSS, 38122 Trento, Italy; (O.C.); (A.V.)
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Mezni E, Corazza G, Mari R, Coze S, Charrier N, Chanez B, Chretien AS, Rochigneux P. Facial palsy after administration of immune checkpoint inhibitors: case report, literature review and clinical care management. Front Immunol 2024; 15:1375497. [PMID: 38585263 PMCID: PMC10995231 DOI: 10.3389/fimmu.2024.1375497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Neurological immune-related adverse events (irAEs) due to immune checkpoint inhibitors (ICI) are rare complications of immunotherapy, particularly dreadful for patients and clinical teams. Indeed, neurological irAEs are potentially severe and their diagnosis require prompt recognition and treatment. Additionally, the spectrum of neurological irAEs is broad, affecting either neuromuscular junction, peripheral or central nervous system. Here, we described the case of a 55-year man with metastatic melanoma, facing a brutal right peripheral cerebral palsy after his third ipilimumab/nivolumab infusion. After the case presentation, we reviewed the literature about this rare complication of immunotherapy, and described its diagnosis work-up and clinical management.
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Affiliation(s)
- Essia Mezni
- Medical Oncology Department, Paoli-Calmettes Institute, Marseille, France
| | - Giovanni Corazza
- Neurology Department, Assitance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
- Referral Centre for Neuromuscular Diseases and Amyotrophic Lateral Sclerosis (ALS), Hôpital La Timone, Marseille, France
| | - Roxane Mari
- Medical Oncology Department, Paoli-Calmettes Institute, Marseille, France
| | - Stephanie Coze
- Radiology Department, Assitance Publique Hôpitaux de Marseille, Aix-Marseille University, Marseille, France
| | - Nathalie Charrier
- Nuclear Medicine Department, Paoli-Calmettes Institut, Marseille, France
| | - Brice Chanez
- Medical Oncology Department, Paoli-Calmettes Institute, Marseille, France
| | - Anne Sophie Chretien
- Team Immunity and Cancer, Centre de Recherche en Canceírologie de Marseille (CRCM), Inserm, U1068, Centre national de la recherche scientifique (CNRS), Unité Mixte de Recherche 7258 (UMR7258), Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
| | - Philippe Rochigneux
- Medical Oncology Department, Paoli-Calmettes Institute, Marseille, France
- Team Immunity and Cancer, Centre de Recherche en Canceírologie de Marseille (CRCM), Inserm, U1068, Centre national de la recherche scientifique (CNRS), Unité Mixte de Recherche 7258 (UMR7258), Paoli-Calmettes Institute, Aix-Marseille University, Marseille, France
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Vogrig A, Tartaglia S, Dentoni M, Fabris M, Bax F, Belluzzo M, Verriello L, Bagatto D, Gastaldi M, Tocco P, Zoccarato M, Zuliani L, Pilotto A, Padovani A, Villagrán-García M, Davy V, Gigli GL, Honnorat J, Valente M. Central nervous system immune-related disorders after SARS-CoV-2 vaccination: a multicenter study. Front Immunol 2024; 15:1344184. [PMID: 38375477 PMCID: PMC10876052 DOI: 10.3389/fimmu.2024.1344184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/09/2024] [Indexed: 02/21/2024] Open
Abstract
Background COVID-19 vaccines have been approved due to their excellent safety and efficacy data and their use has also permitted to reduce neurological complications of SARS-CoV-2. However, clinical trials were underpowered to detect rare adverse events. Herein, the aim was to characterize the clinical spectrum and immunological features of central nervous system (CNS) immune-related events following SARS-CoV-2 vaccination. Methods Multicenter, retrospective, cohort study (December 1, 2020-April 30, 2022). Inclusion criteria were (1) de novo CNS disorders developing after SARS-CoV-2 vaccination (probable causal relationship as per 2021 Butler criteria) (2); evidence for an immune-mediated etiology, as per (i) 2016 Graus criteria for autoimmune encephalitis (AE); (ii) 2015 Wingerchuk criteria for neuromyelitis optica spectrum disorders; (iii) criteria for myelitis. Results Nineteen patients were included from 7 tertiary referral hospitals across Italy and France (one of them being a national referral center for AE), over almost 1 year and half of vaccination campaign. Vaccines administered were mRNA-based (63%) and adenovirus-vectored (37%). The median time between vaccination and symptoms onset was 14 days (range: 2-41 days). CSF was inflammatory in 74%; autoantibodies were detected in 5%. CSF cytokine analysis (n=3) revealed increased CXCL-10 (IP-10), suggesting robust T-cell activation. The patients had AE (58%), myelitis (21%), acute disseminated encephalomyelitis (ADEM) (16%), and brainstem encephalitis (5%). All patients but 2 received immunomodulatory treatment. At last follow-up (median 130 days; range: 32-540), only one patient (5%) had a mRS>2. Conclusion CNS adverse events of COVID-19 vaccination appear to be very rare even at reference centers and consist mostly of antibody-negative AE, myelitis, and ADEM developing approximately 2 weeks after vaccination. Most patients improve following immunomodulatory treatment.
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Affiliation(s)
- Alberto Vogrig
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Sara Tartaglia
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Marta Dentoni
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Martina Fabris
- Institute of Clinical Pathology, Department of Laboratory Medicine, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Francesco Bax
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Marco Belluzzo
- Neurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Lorenzo Verriello
- Neurology Unit, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Daniele Bagatto
- Department of Diagnostic Imaging, Unit of Neuroradiology, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierluigi Tocco
- Neurology and Stroke Unit, “Spirito Santo” Hospital of Pescara, Pescara, Italy
| | - Marco Zoccarato
- UOC Neurologia O.S.A. - Azienda Ospedale Università di Padova, Padua, Italy
| | - Luigi Zuliani
- Neurology Unit, AULSS8 Berica, San Bortolo Hospital, Vicenza, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Neurology Unit, Department of Continuity of Care and Frailty, ASST Spedali Civili Brescia University Hospital, Brescia, Italy
- Laboratory of Digital Neurology and Biosensors, University of Brescia, Brescia, Italy
| | - Macarena Villagrán-García
- French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Vincent Davy
- Department of Neurology, Hôpital Pitié Salpétrière, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Gian Luigi Gigli
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Jérôme Honnorat
- French Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Mariarosaria Valente
- Department of Medicine (DMED), University of Udine, Udine, Italy
- Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
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Khatib L, Do LD, Benaiteau M, Villagrán-García M, Scharf M, Meyer P, Haidar LA, Demeret S, Honnorat J. Autoimmune Cerebellar Ataxia Associated with Anti-Glutamate Receptor δ2 Antibodies: a Rare but Treatable Entity. CEREBELLUM (LONDON, ENGLAND) 2024; 23:260-266. [PMID: 36696031 DOI: 10.1007/s12311-023-01523-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/19/2023] [Indexed: 01/26/2023]
Abstract
We report two novel cases of autoimmune cerebellar ataxia (ACA) associated with anti-glutamate receptor δ2 antibodies (Gluδ2-Abs). The first case was confirmed by indirect immunofluorescence and cell-based assays: a 29-year-old woman presented after 5 days of headache and vomiting, a pancerebellar syndrome, downbeat nystagmus, decreased visual acuity linked to bilateral retrobulbar optic neuritis (RON), and lymphocytic pleocytosis in the cerebrospinal fluid (CSF) without any abnormality detected using cerebral magnetic resonance imaging (MRI). Second-line immunotherapy allowed progressive clinical improvement, with full recovery achieved after a 4-year follow-up. Thereafter, we retrospectively tested Gluδ2-Abs in 350 patients with a suspicion of autoimmune encephalitis without characterized autoantibody. We identified a second case, a 12-year-old boy who developed 10 days after a respiratory infection, a static cerebellar syndrome with lymphocytosis in the CSF, and right cerebellum hyperintensity in MRI. Five days of corticosteroid treatment allowed a quick clinical improvement. No tumor was identified in both cases, whereas laboratory analyses revealed autoimmune stigma. The present cases suggested that ACA associated with Gluδ2-Abs is an extremely rare but treatable disease. Therefore, testing for Gluδ2-Abs might be considered in the setting of suspected ACA and no initial antibody identification. The visual deficits and ocular motility abnormalities observed in the first reported case might be part of the clinical spectrum of Gluδ2-Abs ACA. Young age, infectious prodromes, lymphocytic pleocytosis, and autoimmune background usually appear together with this syndrome and should lead to discuss the initiation of immunotherapy (after ruling out differential diagnosis, especially infectious causes).
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Affiliation(s)
- Laura Khatib
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
| | - Le-Duy Do
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
- MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Marie Benaiteau
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
| | - Macarena Villagrán-García
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France
- MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Madeleine Scharf
- Institute of Experimental Immunology, affiliated to EURIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Pierre Meyer
- Pediatric Neurology Department, CHU de Montpellier, Montpellier, France
- Phymedexp, CNRS, INSERM, Université de Montpellier, Montpellier, France
| | - Lydia Abou Haidar
- Pediatric Neurology Department, CHU de Montpellier, Montpellier, France
| | - Sophie Demeret
- Neurology departement, CHU Pitie Salpetrière, Paris, France
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, Bron Cedex, 69677, Lyon, France.
- MeLiS-UCBL-CNRS UMR 5284-INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France.
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Farina A, Escalere M, Dion M, Moussy M, Pegat A, Villagrán-García M, Devic P, Lamiral A, Seyve A, Aure K, Wang A, Gorza L, Streichenberger N, Maisonobe T, Honnorat J, Birzu C, Psimaras D, Weisenburger-Lile D, Joubert B. Mononeuritis multiplex following immune checkpoint inhibitors in malignant pleural mesothelioma. Front Neurol 2024; 15:1338899. [PMID: 38333608 PMCID: PMC10850347 DOI: 10.3389/fneur.2024.1338899] [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: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction Mononeuritis multiplex is frequently related to vasculitic neuropathy and has been reported only sporadically as an adverse event of immune checkpoint inhibitors. Methods Case series of three patients with mononeuritis multiplex-all with mesothelioma-identified in the databases of two French clinical networks (French Reference Center for Paraneoplastic Neurological Syndromes, Lyon; OncoNeuroTox, Paris; January 2015-October 2022) set up to collect and investigate n-irAEs on a nationwide level. Results Three patients (male; median age 86 years; range 72-88 years) had pleural mesothelioma and received 10, 4, and 6 cycles, respectively, of first-line nivolumab plus ipilimumab combined therapy. In patient 1, the neurological symptoms involved the median nerves, and in the other two patients, there was a more diffuse distribution; the symptoms were severe (common terminology criteria for adverse events, CTCAE grade 3) in all patients. Nerve conduction studies indicated mononeuritis multiplex in all patients. Peripheral nerve biopsy demonstrated necrotizing vasculitis in patients 1 and 3 and marked IgA deposition without inflammatory lesions in patient 2. Immune checkpoint inhibitors were permanently withdrawn, and corticosteroids were administered to all patients, leading to complete symptom regression (CTCAE grade 0, patient 2) or partial improvement (CTCAE grade 2, patients 1 and 3). During steroid tapering, patient 1 experienced symptom recurrence and spreading to other nerve territories (CTCAE grade 3); he improved 3 months after rituximab and cyclophosphamide administration. Discussion We report the occurrence of mononeuritis multiplex, a very rare adverse event of immune checkpoint inhibitors, in the three patients with mesothelioma. Clinicians must be aware of this severe, yet treatable adverse event.
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Affiliation(s)
- Antonio Farina
- Centre de Référence Français des Syndromes Neurologiques Paranéoplasiques et des Encéphalites Auto-immunes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS—UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Manon Escalere
- Unité de Neurologie et de Neurovasculaire, Foch Hospital, Suresnes, France
| | - Matthias Dion
- Centre de Référence Français des Syndromes Neurologiques Paranéoplasiques et des Encéphalites Auto-immunes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
| | - Martin Moussy
- Service de Neurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Antoine Pegat
- Service ENMG et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Macarena Villagrán-García
- Centre de Référence Français des Syndromes Neurologiques Paranéoplasiques et des Encéphalites Auto-immunes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS—UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Perrine Devic
- Service de Neurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Anaïde Lamiral
- Service de Neurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Antoine Seyve
- Service de Neuro-Oncologie, Hôpital Neurologique, Hospices Civils de Lyon, Lyon, France
| | - Karine Aure
- Unité de Neurologie et de Neurovasculaire, Foch Hospital, Suresnes, France
| | - Adrien Wang
- Unité de Neurologie et de Neurovasculaire, Foch Hospital, Suresnes, France
| | - Lucas Gorza
- Unité de Neurologie et de Neurovasculaire, Foch Hospital, Suresnes, France
| | - Nathalie Streichenberger
- Service de Neuropathologie, Groupement Hospitalier Est, Hospices Civils de Lyon, Lyon, France
- Université Claude Bernard Lyon 1, Institut NeuroMyogène, CNRS UMR 5261—INSERM U1315, Lyon, France
| | - Thierry Maisonobe
- Département de Neurophysiologie Clinique, AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Jerome Honnorat
- Centre de Référence Français des Syndromes Neurologiques Paranéoplasiques et des Encéphalites Auto-immunes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS—UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Cristina Birzu
- Sorbonne Université, Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
- INSERM, CNRS, Assistance Publique-Hôpitaux de Paris, Institut du Cerveau Et de La Moelle Épinière, Sorbonne Université, Paris, France
| | - Dimitri Psimaras
- Sorbonne Université, Publique-Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière-Charles Foix, Paris, France
- INSERM, CNRS, Assistance Publique-Hôpitaux de Paris, Institut du Cerveau Et de La Moelle Épinière, Sorbonne Université, Paris, France
| | | | - Bastien Joubert
- Centre de Référence Français des Syndromes Neurologiques Paranéoplasiques et des Encéphalites Auto-immunes, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS—UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
- Service de Neurologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
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7
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Farina A, Villagrán-García M, Vogrig A, Zekeridou A, Muñiz-Castrillo S, Velasco R, Guidon AC, Joubert B, Honnorat J. Neurological adverse events of immune checkpoint inhibitors and the development of paraneoplastic neurological syndromes. Lancet Neurol 2024; 23:81-94. [PMID: 38101905 DOI: 10.1016/s1474-4422(23)00369-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 12/17/2023]
Abstract
Immune checkpoint inhibitors, a class of oncological treatments that enhance antitumour immunity, can trigger neurological adverse events closely resembling paraneoplastic neurological syndromes. Unlike other neurological adverse events caused by these drugs, post-immune checkpoint inhibitor paraneoplastic neurological syndromes predominantly affect the CNS and are associated with neural antibodies and cancer types commonly found also in spontaneous paraneoplastic neurological syndromes. Furthermore, post-immune checkpoint inhibitor paraneoplastic neurological syndromes have poorer neurological outcomes than other neurological adverse events of immune checkpoint inhibitors. Early diagnosis and initiation of immunosuppressive therapy are likely to be crucial in preventing the accumulation of neurological disability. Importantly, the neural antibodies found in patients with post-immune checkpoint inhibitor paraneoplastic neurological syndromes are sometimes detected before treatment, indicating that these antibodies might help to predict the development of neurological adverse events. Experimental and clinical evidence suggests that post-immune checkpoint inhibitor paraneoplastic neurological syndromes probably share immunological features with spontaneous paraneoplastic syndromes. Hence, the study of post-immune checkpoint inhibitor paraneoplastic neurological syndromes can help in deciphering the immunopathogenesis of paraneoplastic neurological syndromes and in identifying novel therapeutic targets.
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Affiliation(s)
- Antonio Farina
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France; Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Macarena Villagrán-García
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy; Department of Medicine (DAME), University of Udine Medical School, Udine, Italy
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sergio Muñiz-Castrillo
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France; Stanford Center for Sleep Sciences and Medicine, Palo Alto, CA, USA
| | - Roser Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-Institut Català d Oncologia L'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain; Institute of Neurosciences and Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Amanda C Guidon
- Harvard Medical School, Boston, MA, USA; Division of Neuromuscular Medicine, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Bastien Joubert
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France; Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - Jérôme Honnorat
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron, France; MeLiS, UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France.
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Brigo F, Zelano J, Abraira L, Bentes C, Ekdahl CT, Lattanzi S, Ingvar Lossius M, Redfors P, Rouhl RPW, Russo E, Sander JW, Vogrig A, Wickström R. Proceedings of the "International Congress on Structural Epilepsy & Symptomatic Seizures" (STESS, Gothenburg, Sweden, 29-31 March 2023). Epilepsy Behav 2024; 150:109538. [PMID: 38039602 DOI: 10.1016/j.yebeh.2023.109538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carla Bentes
- Neurophysiological Monitoring Unit - EEG/Sleep Laboratory, Refractory Epilepsy Reference Centre (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Christine T Ekdahl
- Division of Clinical Neurophysiology and Department of Clinical Sciences, Lund University, Sweden; Lund Epilepsy Center, Department of Clinical Sciences, Lund University, Sweden
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petra Redfors
- Department of Neurology, Member of the ERN EpiCARE, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Academic Centre for Epileptology Kempenhaeghe/MUMC+ Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Italy
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK; Centre for Epilepsy, Chalfont St Peter, Bucks., SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 610041, China
| | - Alberto Vogrig
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Ronny Wickström
- Neuropediatric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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9
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Brigo F, Vogrig A. Back to the future: encephalitis lethargica as an autoimmune disorder? Neurol Sci 2024; 45:93-99. [PMID: 37688743 DOI: 10.1007/s10072-023-07053-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
More than 100 years after its emergence, the exact pathophysiological mechanisms underlying encephalitis lethargica (EL) are still elusive and awaiting convincing and complete elucidation. This article summarizes arguments proposed over time to support or refute the hypothesis of EL as an autoimmune neuropsychiatric disorder triggered by an infectious process. It also provides a critical evaluation of modern cases labeled as EL and a comprehensive differential diagnosis of autoimmune neurological conditions that could mimic EL. The evidence supporting the autoimmune nature of historical EL is sparse and not entirely convincing. It is possible that autoimmune mechanisms were involved in the pathogenesis of this disease as an idiosyncratic response to a yet unidentified infectious agent in genetically predisposed individuals. Although there has been an increase in the incidence of presumed autoimmune encephalomyelitis since the peak of EL pandemics, most evidence does not support an underlying autoimmune mechanism. There are significant differences between historical and recent EL cases in terms of clinical symptomatology, epidemiology, and neuropathological features, suggesting that they are different entities with only superficial similarity. The term "encephalitis lethargica," still frequently used in the medical literature, should not be used for cases occurring at present in the sporadic form. Historical EL should be kept apart from recent EL, as they differ in important aspects.
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Affiliation(s)
- Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy.
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria.
| | - Alberto Vogrig
- Clinical Neurology, Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
- Department of Medicine (DAME), University of Udine, Udine, Italy
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10
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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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11
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Montalvo M, Flanagan EP. Paraneoplastic/autoimmune myelopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:193-201. [PMID: 38494277 DOI: 10.1016/b978-0-12-823912-4.00017-7] [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 myelopathies are a rare but important category of myelopathy. They usually present with an insidious or subacute progressive neurologic syndrome. Risk factors include tobacco use and family history of cancer. Cerebrospinal fluid analysis usually shows lymphocytic pleocytosis with elevated protein. MRI findings suggest that paraneoplastic myelopathies include longitudinally extensive T2 hyperintensities that are tract-specific and accompanied by enhancement, but spinal MRIs can also be normal. The most commonly associated neural antibodies include amphiphysin and collapsin-response-mediator-protein-5 (CRMP5/anti-CV2) antibodies with lung and breast cancers being the most frequent oncologic accompaniments. The differential diagnosis of paraneoplastic myelopathies includes nutritional deficiency myelopathy (B12, copper) as well as autoimmune/inflammatory conditions such as primary progressive multiple sclerosis or spinal cord sarcoidosis. Patients treated with immune checkpoint inhibitors for cancer may develop myelitis, that can be considered along the spectrum of paraneoplastic myelopathies. Management of paraneoplastic myelopathy includes oncologic treatment and immunotherapy. Despite these treatments, the prognosis is poor and the majority of patients eventually become wheelchair-dependent.
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Affiliation(s)
- Mayra Montalvo
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - 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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12
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Agapie ML, Borjog FT, Dumitraşcu CO, Prăjescu R, Popescu M, Orban C. Autoimmune encephalitis and paraneoplastic encephalitis: difficulties in diagnosis and management in the ICU. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY = REVUE ROUMAINE DE MORPHOLOGIE ET EMBRYOLOGIE 2023; 64:475-482. [PMID: 38184827 PMCID: PMC10863685 DOI: 10.47162/rjme.64.4.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
Autoimmune encephalitis (AIE) represents a category of relatively newly described neurological disorders associated with an increasing prevalence, a significant impact on the healthcare system, and a high rate of intensive care unit (ICU) admission. This category of diseases often requires prompt treatment, even before a definitive diagnosis is established. In the ICU, patients present with nonspecific signs and symptoms for AIE, which pose challenges in both management and diagnosis. Patients frequently exhibit dysautonomia, severe physical and psychic agitation, as well as tremors and dyskinesia, all of which complicate the diagnosis. They are prone to developing infections, including ventilator-associated pneumonia, and issues related to difficult venous access and pressure ulcers. Early initiation of immunosuppressive treatment is necessary to improve patients' outcome. Through this article, we aimed to summarize current knowledge in terms of the difficulties in diagnosing and management of this pathology in the ICU, as well as the implications for the healthcare system in terms of human and financial resources.
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Affiliation(s)
- Mihaela Livia Agapie
- Department of Anesthesiology and Intensive Care, Emergency University Hospital Bucharest, Romania;
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13
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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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14
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Vaišvilas M, Ciano-Petersen NL, Macarena Villagrán-García MD, Muñiz-Castrillo S, Vogrig A, Honnorat J. Paraneoplastic encephalitis: clinically based approach on diagnosis and management. Postgrad Med J 2023; 99:669-678. [PMID: 37389581 DOI: 10.1136/postgradmedj-2022-141766] [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: 03/23/2022] [Accepted: 04/25/2022] [Indexed: 11/04/2022]
Abstract
Paraneoplastic neurological syndromes (PNSs) comprise a subset of immune-mediated nervous system diseases triggered by an underlying malignancy. Each syndrome usually shows a distinct clinical presentation and outcome according to the associated neural antibodies. PNSs generally have a subacute onset with rapid progression and severe neurological disability. However, some patients may have hyperacute onset or even show chronic progression mimicking neurodegenerative diseases. Updated diagnostic criteria for PNS have been recently established in order to increase diagnostic specificity and to encourage standardisation of research initiatives related to PNS. Treatment for PNS includes oncological therapy and immunomodulation to halt neurological deterioration although current treatment options are seldom effective in reversing disability. Nevertheless, growing knowledge and better understanding of PNS pathogenesis promise better recognition, earlier diagnosis and novel treatment strategies. Considering that PNSs provide a model of effective anticancer immunity, the impact of these studies will extend far beyond the field of neurology.
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Affiliation(s)
- Mantas Vaišvilas
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Nicolás Lundahl Ciano-Petersen
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - M D Macarena Villagrán-García
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Sergio Muñiz-Castrillo
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Alberto Vogrig
- Department of Neuro-oncology Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
| | - Jérôme Honnorat
- Department of Neuro-oncology, Université Claude Bernard Lyon 1 Villeurbanne, Lyon, France
- Department of Neuro-oncology, Hospices Civils de Lyon, Bron, France
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15
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Farina A, Birzu C, Elsensohn MH, Picca A, Muñiz-Castrillo S, Vogrig A, Villagrán-García M, Ciano-Petersen NL, Massacesi L, Hervier B, Guégan S, Kramkimel N, Vano Y, Salem JE, Allenbach Y, Maisonobe T, Assaad S, Maureille A, Devic P, Weiss N, Pegat A, Maucort-Boulch D, Ricard D, Honnorat J, Psimaras D, Joubert B. Neurological outcomes in immune checkpoint inhibitor-related neurotoxicity. Brain Commun 2023; 5:fcad169. [PMID: 37389303 PMCID: PMC10306160 DOI: 10.1093/braincomms/fcad169] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 04/03/2023] [Accepted: 05/25/2023] [Indexed: 07/01/2023] Open
Abstract
While the spectrum of neurological immune checkpoint inhibitor-related adverse events is expanding, patients' outcomes are not well documented. This study aimed to assess outcomes of neurological immune-related adverse events and to identify prognostic factors. All patients experiencing grade ≥2 neurological immune-related adverse events identified at two clinical networks (French Reference Center for Paraneoplastic Neurological Syndromes, Lyon; and OncoNeuroTox, Paris) over five years were included. Modified Rankin scores were assessed at onset, 6, 12, 18 months, and last visit. A multi-state Markov model was used to estimate the transition rates between minor disability (mRS <3), severe disability (mRS 3-5), and death (mRS 6), over the study period. The state-to-state transition rates were estimated using maximum likelihood and variables were introduced into the different transitions to study their effects. A total of 147 patients were included out of 205 patients with a suspicion of neurological immune-related adverse events. The median age was 65 years (range 20-87) and 87/147 patients (59.2%) were male. Neurological immune-related adverse events involved the peripheral nervous system in 87/147 patients (59.2%), the central nervous system in 51/147 (34.7%), and both systems in 9/147 (6.1%). Paraneoplastic-like syndromes were observed in 30/147 patients (20.4%). Cancers included lung cancers (36.1%), melanoma (30.6%), urological cancers (15.6%), and others (17.8%). Patients were treated with programmed cell death protein (ligan) 1 (PD(L)1) inhibitors (70.1%), CTLA4 inhibitors (3.4%) or both (25.9%). Severe disability was reported in 108/144 patients (75.0%) at onset and in 33/146 patients (22.6%) at last visit (median follow-up duration: 12 months, range 0.5-50); 48/147 (32.7%) patients died, from cancer progression (17/48, 35.4%), neurological toxicity (15/48, 31.2%), other causes (10/48, 20.8%) or unknown causes (6/48, 12.5%). The rate of transition from severe to minor disability independently increased with melanoma [compared to lung cancer, hazard ratio = 3.26, 95%CI (1.27; 8.41)] and myositis/neuromuscular junction disorders [hazard ratio = 8.26, 95%CI (2.90; 23.58)], and decreased with older age [hazard ratio = 0.68, 95%CI (0.47; 0.99)] and paraneoplastic-like syndromes [hazard ratio = 0.29, 95%CI (0.09; 0.98)]. In patients with neurological immune-related adverse events, myositis/neuromuscular junction disorders and melanoma increase the transition rate from severe to minor disability, while older age and paraneoplastic-like syndromes result in poorer neurological outcomes; future studies are needed to optimize the management of such patients.
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Affiliation(s)
- Antonio Farina
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence 50139, Italy
| | - Cristina Birzu
- Department of Neurology 2 Mazarin, Sorbonne University, Brain Institute, INSERM UMR 1127, Groupe Hospitalier Pitié-Salpêtrière, Paris 75013, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
| | | | | | - Sergio Muñiz-Castrillo
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Alberto Vogrig
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Macarena Villagrán-García
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Nicolás Lundahl Ciano-Petersen
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
| | - Luca Massacesi
- Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence 50139, Italy
| | - Baptiste Hervier
- Department of Internal Medicine, AP-HP, Hôpital St Louis, Paris 75010, France
| | - Sarah Guégan
- Department of Dermatology, AP-HP, Hôpital Cochin, Paris 75014, France
- Department of Dermatology, Université de Paris Cité, Paris 75006, France
| | - Nora Kramkimel
- Department of Dermatology, AP-HP, Hôpital Cochin, Paris 75014, France
| | - Yann Vano
- Department of Medical Oncology, AP-HP, Centre Hôpital Européen Georges-Pompidou, Paris 75015, France
| | - Joe Elie Salem
- Department of Pharmacology, Sorbonne University, INSERM, UNICO-GRECO Cardio-oncology Program, CIC-1901, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Yves Allenbach
- APHP, Department of Internal Medicine, Sorbonne University, Sorbonne University, INSERM Groupe Hospitalier Pitié-Salpêtrière, Paris 75651, France
| | - Thierry Maisonobe
- APHP, Department of Clinical Neurophysiology, Sorbonne University, Paris 75013, France
| | - Souad Assaad
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon 69008, France
| | - Aurélien Maureille
- Department of Medical Oncology, Léon Bérard Cancer Center, Lyon 69008, France
| | - Perrine Devic
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, 69002 Lyon, France
- Department of Neurology, Hôpital Lyon Sud, Hospices Civils de Lyon, Lyon 69495, France
| | - Nicolas Weiss
- Department of Neurology, Sorbonne University, Hôpital de la Pitié-Salpêtrière, unité de Médecine Intensive Réanimation à orientation neurologique, Paris 75013, France
- Brain Liver Pitié-Salpêtrière (BLIPS) Study Group, INSERM UMR_S 938, Centre de recherche Saint-Antoine, Metabolic, Biliary and Fibro-Inflammatory Diseases of the Liver, Institute of Cardiometabolism and Nutrition (ICAN), Paris 75012, France
| | - Antoine Pegat
- Department of Neurological Functional Explorations, Hospices Civils de Lyon, Neurological Hospital, Bron 69500, France
| | - Delphine Maucort-Boulch
- Biostatistics—Bioinformatics Department, Public Health Unit. Hospices Civils de Lyon, Lyon 69003, France
- Laboratory of Biometry and Evolutionary Biology, University Claude Bernard Lyon 1, Villeurbanne 69622, France
- CNRS, UMR5558, Laboratory of Biometry and Evolutionary Biology, Biostatistics-Health Team, Villeurbanne 69622, France
| | - Damien Ricard
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
- Neurology Department, Hôpital d’Instruction des Armées Percy, Service de Santé des Armées, Clamart 92140, France
| | - Jérôme Honnorat
- Reference Centre for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Neurological Hospital, Bron 69677, France
- MeLiS - UCBL-CNRS UMR 5284—INSERM U1314, Université Claude Bernard Lyon 1, Lyon 69008, France
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, 69002 Lyon, France
| | - Dimitri Psimaras
- Department of Neurology 2 Mazarin, Sorbonne University, Brain Institute, INSERM UMR 1127, Groupe Hospitalier Pitié-Salpêtrière, Paris 75013, France
- OncoNeuroTox Group, Center for Patients with Neurological Complications of Oncologic Treatments Groupe Hospitalier Pitié-Salpêtrière et Hôpital Percy, Paris 75561, France
| | - Bastien Joubert
- Correspondence to: Bastien Joubert, MD, PhD French Reference Centre for Paraneoplastic Neurological Syndromes, Neurological Hospital 59 Boulevard Pinel, 69677 Bron Cedex, France E-mail:
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Marsili L, Marcucci S, LaPorta J, Chirra M, Espay AJ, Colosimo C. Paraneoplastic Neurological Syndromes of the Central Nervous System: Pathophysiology, Diagnosis, and Treatment. Biomedicines 2023; 11:biomedicines11051406. [PMID: 37239077 DOI: 10.3390/biomedicines11051406] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/04/2023] [Accepted: 05/06/2023] [Indexed: 05/28/2023] Open
Abstract
Paraneoplastic neurological syndromes (PNS) include any symptomatic and non-metastatic neurological manifestations associated with a neoplasm. PNS associated with antibodies against intracellular antigens, known as "high-risk" antibodies, show frequent association with underlying cancer. PNS associated with antibodies against neural surface antigens, known as "intermediate- or low-risk" antibodies, are less frequently associated with cancer. In this narrative review, we will focus on PNS of the central nervous system (CNS). Clinicians should have a high index of suspicion with acute/subacute encephalopathies to achieve a prompt diagnosis and treatment. PNS of the CNS exhibit a range of overlapping "high-risk" clinical syndromes, including but not limited to latent and overt rapidly progressive cerebellar syndrome, opsoclonus-myoclonus-ataxia syndrome, paraneoplastic (and limbic) encephalitis/encephalomyelitis, and stiff-person spectrum disorders. Some of these phenotypes may also arise from recent anti-cancer treatments, namely immune-checkpoint inhibitors and CAR T-cell therapies, as a consequence of boosting of the immune system against cancer cells. Here, we highlight the clinical features of PNS of the CNS, their associated tumors and antibodies, and the diagnostic and therapeutic strategies. The potential and the advance of this review consists on a broad description on how the field of PNS of the CNS is constantly expanding with newly discovered antibodies and syndromes. Standardized diagnostic criteria and disease biomarkers are fundamental to quickly recognize PNS to allow prompt treatment initiation, thus improving the long-term outcome of these conditions.
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Affiliation(s)
- Luca Marsili
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Samuel Marcucci
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Joseph LaPorta
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Martina Chirra
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Alberto J Espay
- Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Carlo Colosimo
- Department of Neurology, Santa Maria University Hospital, 05100 Terni, Italy
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Deng Y, Zhang X, Wang L, Lu X, Gao Y, Wu Z, Zhong Z. Anti-SOX1 antibodies-positive paraneoplastic neurological syndromes caused by thyroid carcinoma: A case report. Medicine (Baltimore) 2023; 102:e33499. [PMID: 37083806 PMCID: PMC10118322 DOI: 10.1097/md.0000000000033499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Paraneoplastic neurological syndromes (PNSs) are a group of neurological diseases caused by distant immune effects of malignant tumors, which often occur in patients with small cell lung cancer but are not prone to occur in patients with thyroid cancer. Anti-Sry-like high mobility group box (SOX)1 antibodies (abs)-associated PNSs caused by thyroid cancer are clinically rarer. PATIENT CONCERNS A 57-year-old Chinese male patient presented with autonomic neuropathy. A thyroid biopsy revealed the diagnosis of papillary thyroid microcarcinoma. The serum anti-SOX1 abs confirmed positive. DIAGNOSES A diagnosis of anti-SOX1 antibodies-positive PNS was made. INTERVENTIONS The patient received total thyroidectomy. OUTCOMES After total thyroidectomy, the patient's symptoms resolved quickly, and the serum anti-SOX1 abs test results was negative on re-examination. LESSONS Thyroid cancer can cause anti-SOX1 abs-associated PNS with only autonomic neuropathy.
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Affiliation(s)
- Yazhi Deng
- Medical College of Hunan Normal University, Changsha, Hunan Province, China
| | - Xiaobo Zhang
- First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Lei Wang
- First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Xuelin Lu
- First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Yunchun Gao
- First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Zhenkai Wu
- First People’s Hospital of Changde City, Changde, Hunan Province, China
| | - Zhenzhen Zhong
- First People’s Hospital of Changde City, Changde, Hunan Province, China
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Chiko Y, Sugisaki Y, Miyoshi K, Morichika D, Beika Y, Taniguchi A, Ichihara E, Okada T. Anti-SOX1 Antibody-positive Small-cell Lung Cancer That Triggered Opsoclonus. Intern Med 2023; 62:881-884. [PMID: 35989271 PMCID: PMC10076147 DOI: 10.2169/internalmedicine.0168-22] [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] [Indexed: 11/06/2022] Open
Abstract
A 72-year-old woman with opsoclonus visited our hospital and was diagnosed with small-cell lung cancer. Blood tests revealed anti-SOX1 antibodies, so the patient was diagnosed with paraneoplastic opsoclonus-myoclonus syndrome. After steroid pulse therapy was started, chemotherapy of treatment, the opsoclonus showed an improving trend. Anti-Ri and anti-Hu antibodies have been reported as autoantibodies associated with neoplastic opsoclonus-myoclonus syndrome; however, there are no such reports concerning anti-SOX1 antibody. Therefore, this is a valuable case.
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Affiliation(s)
- Yuki Chiko
- Department of Internal Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
| | - Yuka Sugisaki
- Department of Internal Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
| | - Keiji Miyoshi
- Department of Respiratory Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
| | - Daisuke Morichika
- Department of Respiratory Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
| | - Yuka Beika
- Department of Respiratory Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
| | - Akihiko Taniguchi
- Department of Respiratory Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
| | - Eiki Ichihara
- Department of Allergy and Respiratory Medicine, Okayama University Hospital, Japan
| | - Toshiaki Okada
- Department of Respiratory Medicine, Independent Administrative Agency, National Hospital Organization, Fukuyama Medical Center, Japan
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19
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Evaluation and management of acute high-grade immunotherapy-related neurotoxicity. Heliyon 2023; 9:e13725. [PMID: 36851967 PMCID: PMC9958505 DOI: 10.1016/j.heliyon.2023.e13725] [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: 06/30/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Immune checkpoint inhibitor monoclonal antibodies allow the host's immune system to attack tumors, which has revolutionized cancer care over the last decade. As the use of immune checkpoint inhibitors has expanded, so have autoimmune-like complications known as immune-related adverse events. These include the infrequent but increasingly more common, potentially deadly neurological immune related adverse events. When feeling acutely ill, patients will often seek care not from their oncologist but from their family physician, clinics, emergency, and urgent care sites, or other available providers. Thus, while assessing acutely ill cancer patients who are experiencing neurological symptoms, non-oncologists should be prepared to recognize, diagnose, and treat neurological immune related adverse events in addition to more familiar conditions. This narrative review is designed to update acute care clinicians on current knowledge and to present a symptom-based framework for evaluating and treating neurological immune related adverse events based on the leading immunotoxicity organizations' latest recommendations.
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20
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Abstract
PURPOSE OF REVIEW To provide an overview and highlight recent updates in the field of paraneoplastic neurologic disorders. RECENT FINDINGS The prevalence of paraneoplastic neurologic disorders is greater than previously reported and the incidence has been rising over time, due to improved recognition in the era of antibody biomarkers. Updated diagnostic criteria that are broadly inclusive and also contain diagnostic risk for clinical presentations (high and intermediate) and diagnostic antibodies (high, intermediate, and low) have replaced the original 2004 criteria. Antibody biomarkers continue to be characterized (e.g., KLHL-11 associated with seminoma in men with brainstem encephalitis). Some paraneoplastic antibodies also provide insight into likely immunotherapy response and prognosis. The rise of immune checkpoint inhibitors as cancer therapeutics has been associated with newly observed immune-mediated adverse effects including paraneoplastic neurological disorders. The therapeutic approach to paraneoplastic neurologic disorders is centered around cancer care and trials of immune therapy. The field of paraneoplastic neurologic disorders continues to be advanced by the identification of novel antibody biomarkers which have diagnostic utility, and give insight into likely treatment responses and outcomes.
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Affiliation(s)
- Michael Gilligan
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | | | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, College of Medicine, Mayo Clinic, Rochester, MN, USA.
- Department of Neurology, College of Medicine, Mayo Clinic, 200 1st ST SW, Rochester, MN, 55905, USA.
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21
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Zhang L, Zhang L, Li F, Liu W, Tai Z, Yang J, Zhang H, Tuo J, Yu C, Xu Z. When herpes simplex virus encephalitis meets antiviral innate immunity. Front Immunol 2023; 14:1118236. [PMID: 36742325 PMCID: PMC9896518 DOI: 10.3389/fimmu.2023.1118236] [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: 12/07/2022] [Accepted: 01/06/2023] [Indexed: 01/21/2023] Open
Abstract
Herpes simplex virus (HSV) is the most common pathogen of infectious encephalitis, accounting for nearly half of the confirmed cases of encephalitis. Its clinical symptoms are often atypical. HSV PCR in cerebrospinal fluid is helpful for diagnosis, and the prognosis is usually satisfactory after regular antiviral treatment. Interestingly, some patients with recurrent encephalitis have little antiviral effect. HSV PCR in cerebrospinal fluid is negative, but glucocorticoid has a significant effect after treatment. Specific antibodies, such as the NMDA receptor antibody, the GABA receptor antibody, and even some unknown antibodies, can be isolated from cerebrospinal fluid, proving that the immune system contributes to recurrent encephalitis, but the specific mechanism is still unclear. Based on recent studies, we attempt to summarize the relationship between herpes simplex encephalitis and innate immunity, providing more clues for researchers to explore this field further.
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Affiliation(s)
- Linhai Zhang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, China
| | - Lijia Zhang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Fangjing Li
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wanyu Liu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhenzhen Tai
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Juan Yang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Haiqing Zhang
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jinmei Tuo
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, China,*Correspondence: Jinmei Tuo, ; Changyin Yu, ; Zucai Xu,
| | - Changyin Yu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, China,*Correspondence: Jinmei Tuo, ; Changyin Yu, ; Zucai Xu,
| | - Zucai Xu
- Department of Neurology, Affiliated Hospital of Zunyi Medical University, Zunyi, China,The Collaborative Innovation Center of Tissue Damage Repair and Regeneration Medicine of Zunyi Medical University, Zunyi, China,*Correspondence: Jinmei Tuo, ; Changyin Yu, ; Zucai Xu,
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22
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Dorcet G, Benaiteau M, Pariente J, Ory‐Magne F, Cheuret E, Rafiq M, Brooks W, Puissant‐Lubrano B, Fortenfant F, Renaudineau Y, Bost C. Cerebrospinal fluid YKL-40 level evolution is associated with autoimmune encephalitis remission. Clin Transl Immunology 2023; 12:e1439. [PMID: 36938371 PMCID: PMC10015376 DOI: 10.1002/cti2.1439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/06/2022] [Accepted: 02/04/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Because of its heterogeneity in clinical presentation and course, predicting autoimmune encephalitis (AIE) evolution remains challenging. Hence, our aim was to explore the correlation of several biomarkers with the clinical course of disease. Methods Thirty-seven cases of AIE were selected retrospectively and divided into active (N = 9), improved (N = 12) and remission (N = 16) AIE according to their disease evolution. Nine proteins were tested in both serum and cerebrospinal fluid (CSF) at diagnosis (T0) and during the follow-up (T1), in particular activated MMP-9 (MMP-9A) and YKL-40 (or chitinase 3-like 1). Results From diagnosis to revaluation, AIE remission was associated with decreased YKL-40 and MMP-9A levels in the CSF, and with decreased NfL and NfH levels in the serum. The changes in YKL-40 concentrations in the CSF were associated with (1) still active AIE when increasing >10% (P-value = 0.0093); (2) partial improvement or remission when the changes were between +9% and -20% (P-value = 0.0173); and remission with a reduction > -20% (P-value = 0.0072; overall difference between the three groups: P-value = 0.0088). At T1, the CSF YKL-40 levels were significantly decreased between active and improved as well as improved and remission AIE groups but with no calculable threshold because of patient heterogeneity. Conclusion The concentration of YKL-40, a cytokine-like proinflammatory protein produced by glial cells, is correlated in the CSF with the clinical course of AIE. Its introduction as a biomarker may assist in following disease activity and in evaluating therapeutic response.
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Affiliation(s)
- Guillaume Dorcet
- Département de NeurologieHôpital Pierre Paul Riquet, CHU de ToulouseToulouseFrance
- Laboratoire d'ImmunologieInstitut Fédératif de Biologie, CHU de ToulouseToulouseFrance
- INSERM, INFINITyToulouseFrance
| | - Marie Benaiteau
- Département de NeurologieHôpital Pierre Paul Riquet, CHU de ToulouseToulouseFrance
| | - Jérémie Pariente
- Département de NeurologieHôpital Pierre Paul Riquet, CHU de ToulouseToulouseFrance
- INSERM, ToNICToulouseFrance
| | - Fabienne Ory‐Magne
- Département de NeurologieHôpital Pierre Paul Riquet, CHU de ToulouseToulouseFrance
| | - Emmanuel Cheuret
- Unité Pédiatrique Neuro‐céphaliqueHôpital des Enfants, CHU de ToulouseToulouseFrance
| | - Marie Rafiq
- Département de NeurologieHôpital Pierre Paul Riquet, CHU de ToulouseToulouseFrance
- INSERM, ToNICToulouseFrance
| | - Wesley Brooks
- Department of ChemistryUniversity of South FloridaTampaFLUSA
| | - Bénédicte Puissant‐Lubrano
- Laboratoire d'ImmunologieInstitut Fédératif de Biologie, CHU de ToulouseToulouseFrance
- INSERM, INFINITyToulouseFrance
| | - Françoise Fortenfant
- Laboratoire d'ImmunologieInstitut Fédératif de Biologie, CHU de ToulouseToulouseFrance
| | - Yves Renaudineau
- Laboratoire d'ImmunologieInstitut Fédératif de Biologie, CHU de ToulouseToulouseFrance
- INSERM, INFINITyToulouseFrance
| | - Chloé Bost
- Laboratoire d'ImmunologieInstitut Fédératif de Biologie, CHU de ToulouseToulouseFrance
- INSERM, INFINITyToulouseFrance
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23
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Chekanova EO, Shabalina AA, Zakharova MN. [Clinical characteristics and short-term outcomes of autoimmune encephalitis in adults]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:103-115. [PMID: 37560842 DOI: 10.17116/jnevro2023123072103] [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] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To characterize clinical, paraclinical features and short-term outcomes in different types of autoimmune encephalitis (AE) in a one-center cohort of Russian patients, as well as to evaluate the frequency and significance of the joint expression of antineuronal and anti-glial antibodies (Abs) in AE. MATERIAL AND METHODS Forty-one patients were diagnosed with AE at the Research Center of Neurology from November 2020 to December 2022. Demographic, clinical characteristics, results of laboratory tests, MRI of brain, treatment and outcomes of disease were analyzed. The analysis of Abs to glial antigens (myelin-oligodendrocyte glycoprotein - MOG, glial fibrillar acidic protein - GFAP, aquaporin 4 - AQP-4) was performed by indirect immunofluorescence assay (Euroimmun, Germany). RESULTS In 24 (58.5%) patients was established definite AE, confirmed by specific Abs detection; in 2 (4.9%) - definite limbic encephalitis, in 15 (36.6%) - seronegative probable AE (including 3 cases of Hashimoto's encephalitis). GFAP-Abs in cerebrospinal fluid (CSF) were detected only in two patients - with clinical and MRI-picture of autoimmune GFAP-astrocytopathy (A-GFAP-A). GFAP- and MOG-Abs in the blood were detected in 25.7% and 6%, respectively, AQP-4-Abs were not detected. There were no correlations between co-expression with glial Abs and clinical characteristics. Systemic and antithyroid Abs were present in 15% and 31%, respectively. Paraneoplastic AE accounted for 22%. For the first time in the Russian population, 2 cases of A-GFAP-A, 6 cases of AE associated with COVID-19 were described. The most common first syndrome were epileptic seizure (34%), psychiatric (29%) and cognitive (14%) disorders. Relapses of AE was observed in 22%. Inflammatory changes in CSF were detected in 41%, focal changes on MRI in 68%. First-line immune therapy was performed in all patients, 85% of cases received pulse therapy with methylprednisolone. Second-line immune therapy (rituximab or cyclophosphamide intravenously) was performed in 19.5%, 78% of patients achieved significant improvement during treatment (scores ≤2 on the modified Rankin scale). CONCLUSIONS The results allow us to consider COVID-19 as a trigger of AE. The absence of detection of GFAP-Abs in CSF in patients with other types of AE contributes to the confirmation of the specificity of GFAP-seropositivity of CSF for the diagnosis of A-GFAP-A. The expression of GFAP- and MOG-Abs in AE can serve as confirmation of the immuno-mediated etiology of the disease, which is especially important for the AE diagnosis in the absence of antineuronal Abs.
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Seizures, Epilepsy, and NORSE Secondary to Autoimmune Encephalitis: A Practical Guide for Clinicians. Biomedicines 2022; 11:biomedicines11010044. [PMID: 36672553 PMCID: PMC9855825 DOI: 10.3390/biomedicines11010044] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/08/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022] Open
Abstract
The most recent International League Against Epilepsy (ILAE) classification has included "immune etiology" along with other well-known causes of epilepsy. This was possible thanks to the progress in detection of pathogenic neural antibodies (Abs) in a subset of patients, and resulted in an increased interest in identifying potentially treatable causes of otherwise refractory seizures. Most autoimmune encephalitides (AE) present with seizures, but only a minority of cases evolve to long-term epilepsy. The risk of epilepsy is higher for patients harboring Abs targeting intracellular antigens (T cell-mediated and mostly paraneoplastic, such as Hu, CV2/CRMP5, Ma2, GAD65 Abs), compared with patients with neuronal surface Abs (antibody-mediated and less frequently paraneoplastic, such as NMDAR, GABAbR, LGI1, CASPR2 Abs). To consider these aspects, conceptual definitions for two entities were provided: acute symptomatic seizures secondary to AE, and autoimmune-associated epilepsy, which reflect the different pathophysiology and prognoses. Through this manuscript, we provide an up-to-date review on the current state of knowledge concerning diagnosis and management of patients with Ab-mediated encephalitis and associated epilepsy. Special emphasis is placed on clinical aspects, such as brain magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) specificities, electroencephalographic (EEG) findings, cancer screening and suggestions for a rational therapeutic approach.
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Farina A, Villagrán-García M, Ciano-Petersen NL, Vogrig A, Muñiz-Castrillo S, Taillandier L, Michaud M, Lefilliatre M, Wang A, Lepine Z, Picard G, Wucher V, Dhairi M, Fabien N, Goncalves D, Rogemond V, Joubert B, Honnorat J. Anti-Hu Antibodies in Patients With Neurologic Side Effects of Immune Checkpoint Inhibitors. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200058. [PMID: 36446613 PMCID: PMC9709718 DOI: 10.1212/nxi.0000000000200058] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND OBJECTIVES To clinically characterize post-immune checkpoint inhibitor (ICI) Hu antibody (Ab) neurologic disorders, we analyzed Hu-Ab-positive patients with neurologic immune-related adverse events (n-irAEs) and compared them with patients with other n-irAEs, ICI-naive patients with Hu-Ab paraneoplastic neurologic syndromes (PNSs) identified in the same study center, and those with Hu-Ab n-irAEs reported elsewhere. METHODS Patients whose samples were sent to the French reference center for a suspicion of n-irAE (2015-2021) were identified; those with a final diagnosis of n-irAE and Hu-Ab were included. Control groups included patients with a final diagnosis of n-irAE occurring during the same period as the patients included (2018-2021) but without Hu-Ab, and ICI-naive patients with Hu-Ab PNS diagnosed during the same period; a systematic review was performed to identify previous reports. RESULTS Eleven patients with Hu-Ab and n-irAEs were included (median age, 66 years, range 44-76 years; 73% men). Ten patients had small cell lung cancer, and 1 had lung adenocarcinoma. The median follow-up from onset was 3 months (range 0.5-18 months). Compared with those with other n-irAEs (n = 63), Hu-Ab-positive patients had more frequently co-occurring involvement of both central and peripheral nervous systems (36% vs 8%, p = 0.02) and limbic (54% vs 14%, p < 0.01), brainstem (27% vs 5%, p = 0.02), and dorsal root ganglia (45% vs 5%, p < 0.01) involvement. The proportion of patients with severe disability (modified Rankin Scale score >3) at diagnosis was higher among Hu-Ab n-irAEs (91% vs 52%, p = 0.02). Patients with Hu-Ab had also poorer outcome (100% vs 28%, p < 0.01) and higher mortality (91% vs 46%, p < 0.01). There was no significant difference in terms of clinical features between Hu-Ab n-irAEs and ICI-naive Hu-Ab PNS (n = 92), but there was a poorer outcome (56/78, 71%, p < 0.01) and higher mortality (26%, p < 0.01) among the former. No significant difference was found between the patients reported herein and those in the literature. DISCUSSION The presence of Hu-Ab identifies a subgroup of n-irAEs that consistently reproduce the phenotypes of Hu-Ab-related PNS, supporting the hypothesis of ICI triggering or unmasking PNS. As these patients show high disability and mortality, further studies are required to investigate the underlying immunopathogenic mechanisms and to improve the outcome of Hu-Ab n-irAEs.
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Affiliation(s)
- Antonio Farina
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Macarena Villagrán-García
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Nicolás Lundahl Ciano-Petersen
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Alberto Vogrig
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Sergio Muñiz-Castrillo
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Luc Taillandier
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Maud Michaud
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Mathilde Lefilliatre
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Adrien Wang
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Zoe Lepine
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Géraldine Picard
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Valentin Wucher
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Maroua Dhairi
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Nicole Fabien
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - David Goncalves
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Véronique Rogemond
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Bastien Joubert
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France
| | - Jèrôme Honnorat
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Hospices Civils de Lyon, France; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (A.F., M.V.G., N.L.C.-P., A.V., S.M.-C., G.P., V.W., M.D., V.R., B.J., J.H.), Université Claude Bernard Lyon 1, France; Dipartimento di Neuroscienze (A.F.), Psicologia, Area del Farmaco e Salute del Bambino, Università di Firenze, Italia; Unité de Neuro Oncologie (L.T.), Département de Neurologie, Hôpital Central, Nancy Cedex, France; Unité mixte de Recherche 7039 CRAN BioSiS CNRS (L.T.), Faculté de Médecine, Vandoeuvre les Nancy, France; Centre de Référence des Pathologies Neuromusculaires de l'Adulte (Nord-Est-Ile de France) (M.M.), Service de Neurologie, CHU Central Nancy, France; Service de Neurologie (M.L.), CHU Central Caen, France; Service de Neurologie (A.W.), Hôpital Foch, Suresnes, France; Service de Neurologie (Z.L.), Centre Hospitalier de Pau, France; Service d'Immunologie (N.F., D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon Pierre-Bénite, France; and ImmuCare (Immunology Cancer Research) (B.J., J.H.), Institut de Cancérologie, Hospices Civils de Lyon, France.
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Muñiz-Castrillo S, Vogrig A, Ciano-Petersen NL, Villagrán-García M, Joubert B, Honnorat J. Novelties in Autoimmune and Paraneoplastic Cerebellar Ataxias: Twenty Years of Progresses. CEREBELLUM (LONDON, ENGLAND) 2022; 21:573-591. [PMID: 35020135 DOI: 10.1007/s12311-021-01363-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Abstract
Major advances in our knowledge concerning autoimmune and paraneoplastic cerebellar ataxias have occurred in the last 20 years. The discovery of several neural antibodies represents an undeniable contribution to this field, especially those serving as good biomarkers of paraneoplastic neurological syndromes and those showing direct pathogenic effects. Yet, many patients still lack detectable or known antibodies, and also many antibodies have only been reported in few patients, which makes it difficult to define in detail their clinical value. Nevertheless, a notable progress has additionally been made in the clinical characterization of patients with the main neural antibodies, which, although typically present with a subacute pancerebellar syndrome, may also show either hyperacute or chronic onsets that complicate the differential diagnoses. However, prodromal and transient features could be useful clues for an early recognition, and extracerebellar involvement may also be highly indicative of the associated antibody. Moreover, important advances in our understanding of the pathogenesis of cerebellar ataxias include the description of antibody effects, especially those targeting cell-surface antigens, and first attempts to isolate antigen-specific T-cells. Furthermore, genetic predisposition seems relevant, although differently involved according to cancer association, with particular HLA observed in non-paraneoplastic cases and genetic abnormalities in the tumor cells in paraneoplastic ones. Finally, immune checkpoint inhibitors used as cancer immunotherapy may rarely induce cerebellar ataxias, but even this undesirable effect may in turn serve to shed some light on their physiopathology. Herein, we review the principal novelties of the last 20 years regarding autoimmune and paraneoplastic cerebellar ataxias.
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Affiliation(s)
- Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Alberto Vogrig
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Nicolás Lundahl Ciano-Petersen
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Macarena Villagrán-García
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Bastien Joubert
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677, Bron Cedex, France.
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217, CNRS, UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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Gozubatik-Celik RG, Gul ZB, Bilgin EB, Yildiz MU, Yenidunya O, Misirli H, Celik HT, Kurtulus F, Yaman A, Domac F, Karaci R, Cokar O, Culha Oktar A, Emre Toprak U, Yavuz N, Dalgıc E, Ozen Barut B, Dogan Ak P, Ozgenc CI, Bulbul NG, Atmaca MM, Gokyigit FM, Gürkan ZM, Pazarci N, Surmeli R, Kale N, Yildirim Z, Yayla V, Sozer N, Cabalar M, Delen F, Ucler S, Unal E, Sungur MA, Sen A, Atakli D, Soysal A. Autoimmune encephalitis and paraneoplastic syndromes in Turkey: a multi-centre study. Neurol Sci 2022; 43:4393-4403. [DOI: 10.1007/s10072-022-05955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 02/16/2022] [Indexed: 10/19/2022]
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28
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Wang B, Wang C, Feng J, Hao M, Guo S. Clinical Features, Treatment, and Prognostic Factors in Neuronal Surface Antibody-Mediated Severe Autoimmune Encephalitis. Front Immunol 2022; 13:890656. [PMID: 35720290 PMCID: PMC9205246 DOI: 10.3389/fimmu.2022.890656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to determine the clinical characteristics and evaluate the efficacy of immunotherapy and the long-term prognosis of severe autoimmune encephalitis (AE) in China. Methods Clinical features, laboratory or radiological findings, and treatment outcomes of 60 severe patients with AE from January 1, 2014, to December 31, 2020, were collected. Continuous variables were compared using the t-test and the nonparametric Mann–Whitney U test, as appropriate. Univariate and multivariable logistic regression analyses were performed to assess the correlations between factors, treatment responses, and prognosis of severe AE. Results The median age of symptom onset was 35 years. Tumors were identified in 23.3% of patients, and 36/60 (60%) patients responded to first-line immunotherapy. Second-line immunotherapy was implemented in 26/60 (43.3%) patients. A significant clinical benefit was observed in 19/26 (73.1%) patients treated with lower dosage rituximab; seven patients were still refractory and received bortezomib as an add-on therapy. During the last follow-up, 48/60 (80%) patients achieved good outcomes (mRS, 0–2), and 10 died. Seventeen patients experienced relapses. A high CD19+ B-cell count (OR, 1.197; 95% CI [1.043–1.496]; p = 0.041) and a lower neutrophil-to-lymphocyte ratio (NLR; OR, 0.686; 95% CI [0.472–0.884]; p = 0.015) predict the response to first-line treatment and good prognosis, respectively. Conclusions Patients with severe AE were in critical condition at baseline but could be salvaged after effective rescue immunotherapy. A lower dosage of rituximab could be an optimal option for severe AE. CD19+ B-cell count and NLR may provide prognostic information for predicting treatment response and outcome of severe AE.
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Affiliation(s)
- Baojie Wang
- Department of Neurology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.,Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
| | - Chunjuan Wang
- Department of Neurology, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Jianli Feng
- Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
| | - Maolin Hao
- Department of Neurology, Shandong Second Provincial General Hospital, Jinan, China
| | - Shougang Guo
- Department of Neurology, Shandong Provincial Hospital, Shandong University, Jinan, China
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29
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Alberto T, Honnorat J, Joubert B. Sindromi neurologiche paraneoplastiche. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46429-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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30
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Wada S, Iwamoto K, Ozaki N. Atezolizumab, an immune checkpoint inhibitor, caused precedent depressive symptoms related to limbic encephalitis. Psychiatry Clin Neurosci 2022; 76:125-126. [PMID: 34967076 DOI: 10.1111/pcn.13325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 12/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Shuhei Wada
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kunihiro Iwamoto
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
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31
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Albarrán V, Chamorro J, Rosero DI, Saavedra C, Soria A, Carrato A, Gajate P. Neurologic Toxicity of Immune Checkpoint Inhibitors: A Review of Literature. Front Pharmacol 2022; 13:774170. [PMID: 35237154 PMCID: PMC8882914 DOI: 10.3389/fphar.2022.774170] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Immune checkpoint inhibitors have entailed a change of paradigm in the management of multiple malignant diseases and are acquiring a key role in an increasing number of clinical sceneries. However, since their mechanism of action is not limited to the tumor microenvironment, their systemic activity may lead to a wide spectrum of immune-related side effects. Although neurological adverse events are much less frequent than gastrointestinal, hepatic, or lung toxicity, with an incidence of <5%, their potential severity and consequent interruptions to cancer treatment make them of particular importance. Despite them mainly implying peripheral neuropathies, immunotherapy has also been associated with an increased risk of encephalitis and paraneoplastic disorders affecting the central nervous system, often appearing in a clinical context where the appropriate diagnosis and early management of neuropsychiatric symptoms can be challenging. Although the pathogenesis of these complications is not fully understood yet, the blockade of tumoral inhibitory signals, and therefore the elicitation of cytotoxic T-cell-mediated response, seems to play a decisive role. The aim of this review was to summarize the current knowledge about the pathogenic mechanisms, clinical manifestations, and therapeutic recommendations regarding the main forms of neurotoxicity related to checkpoint inhibitors.
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32
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Elkoshi Z. Cancer and Autoimmune Diseases: A Tale of Two Immunological Opposites? Front Immunol 2022; 13:821598. [PMID: 35145524 PMCID: PMC8822211 DOI: 10.3389/fimmu.2022.821598] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/06/2022] [Indexed: 01/21/2023] Open
Abstract
The present article compares, side-by-side, cancer and autoimmune diseases in terms of innate and adaptive immune cells involvement, MHC Class I and Class II expression, TGFβ effect, immune modulating drugs effect and the effect of reactive oxygen species. The change in the inflammatory immune reaction during the progress of cancer and the effect of this change on the comorbidity of autoimmune diseases and cancer are discussed. The similar inflammatory properties of autoimmune diseases and early cancer, and the contrasting inflammatory properties of autoimmune diseases and advanced cancer elucidate the increased incidence of many types of cancer in patients with pre-existing autoimmune diseases and the decreased cancer-specific mortality of these patients. Stage-dependent effects of reactive oxygen-species on tumor proliferation are an additional probable cause for these epidemiological observations. The relationship: {standardized incidence ratio (SIR)} > {cancer-specific hazard ratio (HR)} for cancer patients with a history of autoimmune diseases is substantiated and rationalized.
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Ciano-Petersen NL, Muñiz-Castrillo S, Vogrig A, Joubert B, Honnorat J. Immunomodulation in the acute phase of autoimmune encephalitis. Rev Neurol (Paris) 2022; 178:34-47. [PMID: 35000790 DOI: 10.1016/j.neurol.2021.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 12/06/2021] [Accepted: 12/13/2021] [Indexed: 12/14/2022]
Abstract
Autoimmune encephalitides constitute an emerging group of diseases for which the diagnosis and management may be challenging, and are usually associated with antibodies against neuroglial antigens used as biomarkers. In this review, we aimed to clarify the diagnostic approach to patients with encephalitis of suspected autoimmune origin in order to initiate early immunotherapy, and to summarize the evidence of current immunotherapies and alternative options assessed for refractory cases. Currently, the general therapeutic approach consists of steroids, IVIG, and/or plasma exchange as first-line medications, which should be prescribed once a diagnosis of possible autoimmune encephalitis is established. For patients not responding to these treatments, rituximab and cyclophosphamide are used as second-line immunotherapy. Additionally, alternative therapies, chiefly tocilizumab and bortezomib, have been reported to be useful in particularly refractory cases. Although the aforementioned approach with first and second-line immunotherapy is widely accepted, the best therapeutic strategy is still unclear since most available evidence is gathered from retrospective non-controlled studies. Moreover, several predictors of good long-term prognosis have been proposed such as response to first-line therapies, modified Rankin score lesser than 4 at the worst neurologic status, no need for admission in intensive care unit, and early escalation to second-line immunotherapy. Thus, the lack of solid evidence underlines the necessity of future well-conducted trials addressing both the best therapeutic regimen and the outcome predictors, but since autoimmune encephalitides have a relatively low incidence, international collaborations seem imperative to reach a reasonable study population size.
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Affiliation(s)
- N L Ciano-Petersen
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Inserm U1217/CNRS UMR 5310, SynatAc Team, Institute NeuroMyoGène, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Biomedical Research Institute of Málaga-IBIMA, Málaga, Spain; Neurology Department, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - S Muñiz-Castrillo
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Inserm U1217/CNRS UMR 5310, SynatAc Team, Institute NeuroMyoGène, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - A Vogrig
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Inserm U1217/CNRS UMR 5310, SynatAc Team, Institute NeuroMyoGène, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - B Joubert
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Inserm U1217/CNRS UMR 5310, SynatAc Team, Institute NeuroMyoGène, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - J Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Inserm U1217/CNRS UMR 5310, SynatAc Team, Institute NeuroMyoGène, Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France.
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34
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Hébert J, Muccilli A, Wennberg RA, Tang-Wai DF. Autoimmune Encephalitis and Autoantibodies: A Review of Clinical Implications. J Appl Lab Med 2022; 7:81-98. [PMID: 34996085 DOI: 10.1093/jalm/jfab102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Autoimmune encephalitis (AE) is a common cause of encephalitis. We review the most recent evidence on this neuroimmune condition and autoantibody testing currently available. CONTENT Clinical criteria, neuroimaging and electroencephalography can facilitate the diagnosis of AE prior to obtaining autoantibody testing results, and lead to a diagnosis of AE even in the absence of a recognized antibody. Early treatment of AE has been found to correlate with improved long-term functional and cognitive outcomes. We suggest a clinical approach to diagnosis based on the predominant area of nervous system involvement and the results of ancillary testing that are widely available. We also propose a 2-tiered approach to the acute management of probable or definite AE. We, finally, provide guidance on the long-term management of AE-a challenging and understudied area. SUMMARY Much work remains to be done to improve the care of patients with AE. As understanding of the pathophysiology and predisposing factors underlying this condition steadily increases, a more evidence-based, targeted approach to the treatment of AE is still desired. Nonetheless, looking at the progress made over the past 2 decades, since the discovery of the first autoantibodies associated with AE, one cannot help but feel optimistic about the road ahead.
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Affiliation(s)
- Julien Hébert
- Department of Medicine, Division of Neurology, Division of Neurology, University of Toronto, Toronto, ON, Canada
| | - Alexandra Muccilli
- Department of Medicine, Division of Neurology, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, Multiple Sclerosis Clinic, St. Michael's Hospital, Toronto, ON, Canada
| | - Richard A Wennberg
- Department of Medicine, Division of Neurology, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, Epilepsy Clinic and Neurophysiology Lab, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - David F Tang-Wai
- Department of Medicine, Division of Neurology, Division of Neurology, University of Toronto, Toronto, ON, Canada.,Department of Medicine, Division of Neurology, Memory Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
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35
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Poore B, Hamilton R, Kelliher MT, Mahmood S, Mindiola-Romero AE, Richards R, Motanagh S, Cervinski MA, Nerenz RD. Retrospective Evaluation of the Antibody Prevalence in Epilepsy and Encephalopathy (APE2) Score. J Appl Lab Med 2022; 7:36-45. [PMID: 34996088 DOI: 10.1093/jalm/jfab106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 08/16/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Autoimmune encephalitis (AE) is a rare collection of disorders that present with a diverse and often nebulous set of clinical symptoms. Indiscriminate use of multi-antibody panels decreases their overall utility and predictive value. Application of a standardized scoring system may help reduce the number of specimens that generate misleading or uninformative results. METHODS The results of autoimmune encephalopathy, epilepsy, or dementia autoantibody panels performed on serum (n = 251) or cerebrospinal fluid (CSF) (n = 235) specimens from October 9th, 2016 to October 11th, 2019 were collected. Retrospective chart review was performed to calculate the Antibody Prevalence in Epilepsy and Encephalopathy (APE2) score for patients with an antibody above the assay-specific reference interval and to classify results as true or false positive. RESULTS Of the 486 specimens, 60 (12.3%) generated positive results for any AE antibody (6 CSF and 54 serum). After removing 2 duplicate specimens collected from a single patient, 10 of the remaining 58 were determined to be true positives and 8 contained neural-specific antibodies. Application of the APE2 score revealed that 89% of all true positives and 86% of specimens with neural-specific antibodies had a score ≥4. In contrast, 76% of false positives, 74% of clinically nonspecific antibodies, and 85% of the negative specimens had an APE2 score <4. CONCLUSION The APE2 score can improve the diagnostic utility of autoimmune encephalopathy evaluation panels.
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Affiliation(s)
- Brad Poore
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert Hamilton
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Michael T Kelliher
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Sundis Mahmood
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Andres E Mindiola-Romero
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Ryland Richards
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Samaneh Motanagh
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Mark A Cervinski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Geisel School of Medicine at Dartmouth, Hanover, NH, USA
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Luo Y, Li J, Jiang F, Tan A, Qin X, Xiao X, Wang Z, Wang P, Yi Y, Li J, Yuan S, Liu L, Xiao J. Autoimmune Encephalitis With Psychotic Manifestations and Cognitive Impairment Presenting as Schizophrenia: Case Report and Literature Review. Front Psychiatry 2022; 13:827138. [PMID: 35237195 PMCID: PMC8882583 DOI: 10.3389/fpsyt.2022.827138] [Citation(s) in RCA: 6] [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: 12/01/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Autoimmune encephalitis is characterized by mental and behavioral symptoms, seizures, and cognitive impairment. The presence of schizophrenia needs to be distinguished from that of autoimmune encephalitis. Herein, we describe the case of a woman who exhibited abnormal mental behavior and cognitive impairment. The patient had experienced similar symptoms more than 20 years previously and had been diagnosed with schizophrenia. The patient's psychotic symptoms improved after treatment with antipsychotic drugs; however, cognitive impairment persisted. She was diagnosed with anti-N-methyl-D-aspartate (NMDA)-receptor concurrent with anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA)-receptor encephalitis. She showed improvement after treatment with steroids and intravenous immunoglobulins (IVIgs). Furthermore, we reviewed the literature and found that, including the present case, 10 patients have been diagnosed with anti-NMDA concurrent with anti-AMPA-receptor encephalitis. Three of these patients were men and seven were women, and their ages ranged from 21 to 71 years. Moreover, seven (70%) patients had a history of tumors. Symptoms of these patients included psychotic symptoms, varying degrees of consciousness disturbance, seizures, dyskinesia, dystonia, autonomic dysfunction, agitation, and verbal reduction. Brain magnetic resonance imaging findings showed scattered fluid-attenuated inversion recovery hyperintensity in subcortical white matter and/or medial temporal lobe in seven (70%) patients. After combination treatment, including tumor removal and administration of steroids, IVIg, plasma exchange, or immunity inhibitors, the symptoms improved in part of the patients. It is necessary to exclude autoimmune encephalitis for patients with psychiatric manifestations and cognitive impairment. Timely combination therapy is important in anti-NMDA-receptor concurrent with anti-AMPA-receptor encephalitis.
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Affiliation(s)
- Yuanyuan Luo
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Jieying Li
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Fugui Jiang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Arui Tan
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xiaohong Qin
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xiaoqiang Xiao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Zuxing Wang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Peijia Wang
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yang Yi
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Juan Li
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shuai Yuan
- The Fourth People's Hospital of Chengdu, Chengdu, China
| | - Lei Liu
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jun Xiao
- Sichuan Provincial Center for Mental Health, Sichuan Academy of Medical Science & Sichuan Provincial People's Hospital, Chengdu, China.,Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu, China
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Arai H, Utsu Y, Horio J, Furukawa S, Kikkawa Y. Paraneoplastic Opsoclonus-myoclonus Syndrome with Anti-Hu and Anti-SOX-1 Antibodies after Immune-checkpoint Inhibitor Treatment Combined with Chemotherapy in a Patient with Small-cell Lung Cancer. Intern Med 2022; 61:71-74. [PMID: 34980760 PMCID: PMC8810250 DOI: 10.2169/internalmedicine.7167-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 69-year-old man with advanced small-cell lung cancer achieved partial remission after 3 courses of immunochemotherapy that included atezolizumab. Ten days after the last treatment, he developed paraneoplastic opsoclonus-myoclonus syndrome and required mechanical ventilation. Serology testing detected anti-Hu and anti-SOX-1 antibodies. Despite steroid pulse therapy, various anticonvulsants, continuous intravenous sedation, and a fourth course of chemotherapy without atezolizumab, his condition failed to improve. Paraneoplastic opsoclonus-myoclonus syndrome with autoantibodies after immune-checkpoint inhibitor treatment has not been reported previously. Although a causal relationship between immune-checkpoint inhibitors and paraneoplastic syndromes has been suggested, the mechanism remains unknown.
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Affiliation(s)
- Hironori Arai
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Yoshikazu Utsu
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Joji Horio
- Department of Hematology and Oncology, Japanese Red Cross Narita Hospital, Japan
| | - Shogo Furukawa
- Department of Neurology, Japanese Red Cross Narita Hospital, Japan
| | - Yuriko Kikkawa
- Department of Neurology, Japanese Red Cross Narita Hospital, Japan
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Movement Disorders in Oncology: From Clinical Features to Biomarkers. Biomedicines 2021; 10:biomedicines10010026. [PMID: 35052708 PMCID: PMC8772745 DOI: 10.3390/biomedicines10010026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/17/2022] Open
Abstract
Background: the study of movement disorders associated with oncological diseases and anticancer treatments highlights the wide range of differential diagnoses that need to be considered. In this context, the role of immune-mediated conditions is increasingly recognized and relevant, as they represent treatable disorders. Methods: we reappraise the phenomenology, pathophysiology, diagnostic testing, and treatment of movement disorders observed in the context of brain tumors, paraneoplastic conditions, and cancer immunotherapy, such as immune-checkpoint inhibitors (ICIs). Results: movement disorders secondary to brain tumors are rare and may manifest with both hyper-/hypokinetic conditions. Paraneoplastic movement disorders are caused by antineuronal antibodies targeting intracellular or neuronal surface antigens, with variable prognosis and response to treatment. ICIs promote antitumor response by the inhibition of the immune checkpoints. They are effective treatments for several malignancies, but they may cause movement disorders through an unchecked immune response. Conclusions: movement disorders due to focal neoplastic brain lesions are rare but should not be missed. Paraneoplastic movement disorders are even rarer, and their clinical-laboratory findings require focused expertise. In addition to their desired effects in cancer treatment, ICIs can induce specific neurological adverse events, sometimes manifesting with movement disorders, which often require a case-by-case, multidisciplinary, approach.
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Ciano-Petersen NL, Cabezudo-García P, Muñiz-Castrillo S, Honnorat J, Serrano-Castro PJ, Oliver-Martos B. Current Status of Biomarkers in Anti-N-Methyl-D-Aspartate Receptor Encephalitis. Int J Mol Sci 2021; 22:13127. [PMID: 34884930 PMCID: PMC8658717 DOI: 10.3390/ijms222313127] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/29/2021] [Accepted: 12/01/2021] [Indexed: 02/05/2023] Open
Abstract
The discovery of biomarkers in rare diseases is of paramount importance to allow a better diagnosis, improve predictions of outcomes, and prompt the development of new treatments. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare autoimmune disorder associated with the presence of antibodies targeting the GluN1 subunit of the NMDAR. Since it was discovered in 2007, large efforts have been made towards the identification of clinical, paraclinical, and molecular biomarkers to better understand the immune mechanisms that govern the course of the disease as well as to define predictors of treatment response and long-term outcomes. However, most of these biomarkers are still in an exploratory phase, with only a few candidates reaching the final phases of the always-complex process of biomarker development, mainly due to the low incidence of the disease and its recent description. Clinical and paraclinical markers are probably the most widely explored in anti-NMDAR encephalitis, five of them combined in a clinical score to predict 1 year outcome. On the contrary, soluble molecules, such as persistent antibody positivity, antibody titers, cytokines, and other inflammatory mediators, have been proposed as biomarkers of clinical activity, inflammation, prognosis, and treatment response, but further studies are required for their clinical validation including larger and more homogenous cohorts of patients. Similarly, genetic susceptibility biomarkers are still in the exploratory phase and, therefore, weak conclusions can for now only be achieved. Thus, further studies are warranted to define biomarkers and unravel the underlying mechanisms driving rare diseases such as anti-NMDAR encephalitis. Future international collaborative studies with prospective designs that enable the enrollment of large cohorts will allow for the identification and validation of novel biomarkers for clinical decision-making.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Pablo Cabezudo-García
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
| | - Sergio Muñiz-Castrillo
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Jérôme Honnorat
- French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France; (S.M.-C.); (J.H.)
- SynatAc Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Université de Lyon, Université Claude Bernard Lyon 1, 69372 Lyon, France
| | - Pedro Jesús Serrano-Castro
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
| | - Begoña Oliver-Martos
- Neuroimmunology and Neuroinflammation Group, Biomedical Research Institute of Málaga (IBIMA), 29007 Málaga, Spain; (N.L.C.-P.); (P.C.-G.)
- Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-RECA), 29010 Málaga, Spain
- Department of Cell Biology, Genetics and Physiology, Physiology Area, University of Malaga, 29010 Málaga, Spain
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Doruyter AGG, Parkes J, Carr J, Warwick JM. PET-CT in brain disorders: The South African context. SA J Radiol 2021; 25:2201. [PMID: 34858659 PMCID: PMC8603194 DOI: 10.4102/sajr.v25i1.2201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022] Open
Abstract
Positron emission tomography combined with X-ray computed tomography (PET-CT) has an established role in the management of brain disorders, but may be underutilised in South Africa. Possible barriers to access include the limited number of PET-CT facilities and the lack of contemporary guidelines for the use of brain PET-CT in South Africa. The current review aims to highlight the evidence-based usage of brain Positron emission tomography (PET) in dementia, movement disorders, brain tumours, epilepsy, neuropsychiatric lupus, immune-mediated encephalitides, and brain infections. While being areas of research, there is currently no clinical role for the use of PET-CT in traumatic brain injury or in psychiatric or neurodevelopmental disorders. Strategies to expand the appropriate use of PET-CT in brain disorders are discussed in this article.
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Affiliation(s)
- Alexander G G Doruyter
- NuMeRI Node for Infection Imaging, Central Analytical Facilities, Stellenbosch University, Cape Town, South Africa.,Division of Nuclear Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jeannette Parkes
- Division of Radiation Oncology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jonathan Carr
- Division of Neurology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - James M Warwick
- Division of Nuclear Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Ciano-Petersen NL, Hamad-Cueto O, Drissi-Reyes H, Doña-Díaz Á, García-Martín G. Case Report: Autoimmune Psychosis in Chromosome 22q11.2 Deletion Syndrome. Front Immunol 2021; 12:708625. [PMID: 34721378 PMCID: PMC8551914 DOI: 10.3389/fimmu.2021.708625] [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: 05/12/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Chromosome 22q11.2 deletion syndrome (22q11DS) is characterized by congenital cardiac abnormalities, hypoplastic thymus, palatal abnormalities, and hypocalcemia, although other clinical features are frequent such as autoimmune and psychiatric disorders. One-third of the patients have psychotic disorders, frequently followed by developmental regression and long-term cognitive disturbances. Despite humoral and cellular immunodeficiency are common in 22q11DS, it is associated with an increased prevalence of autoimmune disorders such as idiopathic thrombocytopenic purpura and juvenile idiopathic arthritis, likely due to immune dysregulations associated with thymic abnormalities, which plays a major role in self-tolerance. We report an unique case of a 14-year-old girl with 22q11DS that presented with subacute psychotic symptoms, intolerance to antipsychotics, CSF pleocytosis, and EEG abnormalities, that was successfully treated with empiric immunotherapy after fulfilling criteria for probable seronegative autoimmune encephalitis and probable autoimmune psychosis. The autoimmune etiology of these clinical features of 22q11DS has never been postulated despite the predisposition of this syndrome to present autoimmune disorders. We suggest the systematic evaluation with serum and CSF neuronal antibodies, MRI, and EEG of patients with 22q11DS that develop subacute psychotic symptoms or rapidly progressive cognitive decline. Early immunomodulatory therapies should be carefully considered if criteria of probable autoimmune psychosis or possible autoimmune encephalitis are fulfilled, as it may prevent long-term disabilities. Further studies are required to assess the autoimmune origin of psychosis and cognitive impairment associated with 22q11DS.
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Affiliation(s)
- Nicolás Lundahl Ciano-Petersen
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, Spain.,Andalucía Tech, Facultad de Medicina, Universidad de Málaga, Málaga, Spain.,Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
| | - Omar Hamad-Cueto
- Servicio de Neurología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | - Álvaro Doña-Díaz
- UGC Salud Mental, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Guillermina García-Martín
- Neuroimmunology and Neuroinflammation Group, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.,Servicio de Neurología, Hospital Regional Universitario de Málaga, Málaga, Spain.,Red Andaluza de Investigación Clínica y Traslacional en Neurología (Neuro-Reca), Málaga, Spain
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42
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How to diagnose and manage neurological toxicities of immune checkpoint inhibitors: an update. J Neurol 2021; 269:1701-1714. [PMID: 34708250 DOI: 10.1007/s00415-021-10870-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 10/18/2021] [Accepted: 10/20/2021] [Indexed: 12/19/2022]
Abstract
As the use of cancer immunotherapy with immune checkpoint inhibitors (ICIs) is expanding rapidly for the treatment of many tumor types, it is crucial that both neurologists and oncologists become familiar with the diagnosis and treatment of neurological immune-related adverse events (n-irAEs). These are rare complications, developing in their severe forms in only 1-3% of the patients, but are highly relevant due to their mortality and morbidity burden. The diagnosis of n-irAEs is-however-challenging, as many alternative diagnoses need to be considered in the complex scenario of a patient with advanced cancer developing neurological problems. A tailored diagnostic approach is advisable according to the presentation, clinical history, and known specificities of n-irAEs. Several patterns characterized by distinct clinical, immunological, and prognostic characteristics are beginning to emerge. For example, myasthenia gravis is more likely to develop after anti-programmed cell death protein 1 (PD-1) or anti-programmed cell death ligand 1 (PD-L1) treatment, while meningitis appears more frequently after anti-cytotoxic T lymphocyte antigen-4 (CTLA-4) therapy. Also, peripheral neuropathy and Guillain-Barré syndrome seem to be more common in patients with an underlying melanoma. Central nervous system disorders (CNS) are less frequent and are more often associated with lung cancer, and some of them (especially those with limbic encephalitis and positive onconeural antibodies) have a poor prognosis. Herein, we provide an update of the recent advances in the diagnosis and treatment of neurological toxicities related to ICI use, focusing on the exclusion of alternative diagnoses, diagnostic specificities, and treatment of n-irAEs.
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Fels E, Muñiz-Castrillo S, Vogrig A, Joubert B, Honnorat J, Pascual O. Role of LGI1 protein in synaptic transmission: From physiology to pathology. Neurobiol Dis 2021; 160:105537. [PMID: 34695575 DOI: 10.1016/j.nbd.2021.105537] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 01/17/2023] Open
Abstract
Leucine-Rich Glioma Inactivated protein 1 (LGI1) is a secreted neuronal protein highly expressed in the central nervous system and high amount are found in the hippocampus. An alteration of its function has been described in few families of patients with autosomal dominant temporal lobe epilepsy (ADLTE) or with autoimmune limbic encephalitis (LE), both characterized by epileptic seizures. Studies have shown that LGI1 plays an essential role during development, but also in neuronal excitability through an action on voltage-gated potassium Kv1.1 channels, and in synaptic transmission by regulating the surface expression of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPA-R). Over the last decade, a growing number of studies investigating LGI1 functions have been published. They aimed to improve the understanding of LGI1 function in the regulation of neuronal networks using different animal and cellular models. LGI1 appears to be a major actor of synaptic regulation by modulating trans-synaptically pre- and post-synaptic proteins. In this review, we will focus on LGI1 binding partners, "A Disintegrin And Metalloprotease (ADAM) 22 and 23", the complex they form at the synapse, and will discuss the effects of LGI1 on neuronal excitability and synaptic transmission in physiological and pathological conditions. Finally, we will highlight new insights regarding N-terminal Leucine-Rich Repeat (LRR) domain and C-terminal Epitempin repeat (EPTP) domain and their potentially distinct role in LGI1 function.
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Affiliation(s)
- Elodie Fels
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France
| | - Sergio Muñiz-Castrillo
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Alberto Vogrig
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Bastien Joubert
- Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France
| | - Jérôme Honnorat
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France; French Reference Center on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 59 Boulevard Pinel, 69677 Bron Cedex, France.
| | - Olivier Pascual
- Synaptopathies and Auto-antibodies (SynatAc) Team, Institut NeuroMyoGène, INSERM U1217/CNRS UMR 5310, Universités de Lyon, Université Claude Bernard Lyon 1, Lyon, France; Université Claude Bernard Lyon 1, Universités de Lyon, Lyon, France.
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Vogrig A, Péricart S, Pinto AL, Rogemond V, Muñiz-Castrillo S, Picard G, Selton M, Mittelbronn M, Lanoiselée HM, Michenet P, Benaiteau M, Pariente J, Zéphir H, Giordana C, Montaut S, Salhi H, Bachoumas P, Montcuquet A, Letovanec I, Uro-Coste E, Honnorat J. Immunopathogenesis and proposed clinical score for identifying Kelch-like protein-11 encephalitis. Brain Commun 2021; 3:fcab185. [PMID: 34557666 PMCID: PMC8453430 DOI: 10.1093/braincomms/fcab185] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/23/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022] Open
Abstract
In this study, we report the clinical features of Kelch-like protein 11 antibody-associated paraneoplastic neurological syndrome, design and validate a clinical score to facilitate the identification of patients that should be tested for Kelch-like protein 11 antibodies, and examine in detail the nature of the immune response in both the brain and the tumour samples for a better characterization of the immunopathogenesis of this condition. The presence of Kelch-like protein 11 antibodies was retrospectively assessed in patients referred to the French Reference Center for paraneoplastic neurological syndrome and autoimmune encephalitis with (i) antibody-negative paraneoplastic neurological syndrome [limbic encephalitis (n = 105), cerebellar degeneration (n = 33)] and (ii) antibody-positive paraneoplastic neurological syndrome [Ma2-Ab encephalitis (n = 34), antibodies targeting N-methyl-D-aspartate receptor encephalitis with teratoma (n = 49)]. Additionally, since 1 January 2020, patients were prospectively screened for Kelch-like protein 11 antibodies as new usual clinical practice. Overall, Kelch-like protein 11 antibodies were detected in 11 patients [11/11, 100% were male; their median (range) age was 44 (35-79) years], 9 of them from the antibody-negative paraneoplastic neurological syndrome cohort, 1 from the antibody-positive (Ma2-Ab) cohort and 1 additional prospectively detected patient. All patients manifested a cerebellar syndrome, either isolated (4/11, 36%) or part of a multi-system neurological disorder (7/11, 64%). Additional core syndromes were limbic encephalitis (5/11, 45%) and myelitis (2/11, 18%). Severe weight loss (7/11, 64%) and hearing loss/tinnitus (5/11, 45%) were common. Rarer neurologic manifestations included hypersomnia and seizures (2/11, 18%). Two patients presented phenotypes resembling primary neurodegenerative disorders (progressive supranuclear palsy and flail arm syndrome, respectively). An associated cancer was found in 9/11 (82%) patients; it was most commonly (7/9, 78%) a spontaneously regressed ('burned-out') testicular germ cell tumour. A newly designed clinical score (MATCH score: male, ataxia, testicular cancer, hearing alterations) with a cut-off ≥4 successfully identified patients with Kelch-like protein 11 antibodies (sensitivity 78%, specificity 99%). Pathological findings (three testicular tumours, three lymph node metastases of testicular tumours, one brain biopsy) showed the presence of a T-cell inflammation with resulting anti-tumour immunity in the testis and one chronic, exhausted immune response-demonstrated by immune checkpoint expression-in the metastases and the brain. In conclusion, these findings suggest that Kelch-like protein 11 antibody paraneoplastic neurological syndrome is a homogeneous clinical syndrome and its detection can be facilitated using the MATCH score. The pathogenesis is probably T-cell mediated, but the stages of inflammation are different in the testis, metastases and the brain.
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Affiliation(s)
- Alberto Vogrig
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, 69008 Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, 69622 Villeurbanne, France
| | - Sarah Péricart
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, 31300 Toulouse, France.,INSERM U1037, Cancer Research Center of Toulouse (CRCT), 31100 Toulouse, France.,Université Toulouse III Paul Sabatier, 31062 Toulouse, France
| | - Anne-Laurie Pinto
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, 69008 Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, 69622 Villeurbanne, France
| | - Véronique Rogemond
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, 69008 Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, 69622 Villeurbanne, France
| | - Sergio Muñiz-Castrillo
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, 69008 Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, 69622 Villeurbanne, France
| | - Géraldine Picard
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, 69008 Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, 69622 Villeurbanne, France
| | - Marion Selton
- Department of Neurology, CHRU Nancy, 54035 Nancy, France
| | - Michel Mittelbronn
- Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, 4362 Esch/Alzette, Luxembourg.,Luxembourg Center of Neuropathology (LCNP), L-1526 Luxembourg, Luxembourg.,National Center of Pathology (NCP), Laboratoire National de Santé (LNS), 3555 Dudelange, Luxembourg.,Department of Oncology (DONC), Luxembourg Institute of Health (LIH), L-1020 Luxembourg, Luxembourg
| | | | | | - Marie Benaiteau
- Department of Neurology, CHU de Toulouse, 31300 Toulouse, France
| | - Jérémie Pariente
- Department of Neurology, CHU de Toulouse, 31300 Toulouse, France
| | - Helene Zéphir
- University of Lille, Inserm, CHU Lille, U1172 - Laboratory of neuroinflammation and Multiple Sclerosis, Lille Neuroscience & cognition, 59000 Lille, France.,Department of Neurology, Centre de Ressources et Compétence SEP, 59000 Lille, France
| | - Caroline Giordana
- Department of Movement Disorders and Neurology, CHU Nice, 06003 Nice, France
| | - Solveig Montaut
- Department of Neurology, CHRU de Strasbourg, 67091 Strasbourg, France
| | - Hayet Salhi
- Centre Expert Parkinson, Hôpital Henri-Mondor, AP-HP, 94010 Créteil, France
| | - Panagiotis Bachoumas
- Department of Neurology, Centre Hospitalier Public du Cotentin, 50100 Cherbourg-en-Cotentin, France
| | | | - Igor Letovanec
- Institute of Pathology, Lausanne University Hospital (CHUV), 1011 Lausanne, Switzerland
| | - Emmanuelle Uro-Coste
- Department of Pathology, CHU de Toulouse, IUC-Oncopole, 31300 Toulouse, France.,INSERM U1037, Cancer Research Center of Toulouse (CRCT), 31100 Toulouse, France.,Université Toulouse III Paul Sabatier, 31062 Toulouse, France
| | - Jérôme Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, 69677 Bron, France.,NeuroMyoGene Institute, INSERM U1217/CNRS UMR5310, 69008 Lyon, France.,Université Claude Bernard Lyon 1, Université de Lyon, Lyon, 69622 Villeurbanne, France
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Ye F, Fan C, Peng M, Liu S, Yu Y, Yang L. Anti-IgLON5 disease in a pediatric patient with Langerhans cell histiocytosis. Clin Chim Acta 2021; 521:212-214. [PMID: 34270954 DOI: 10.1016/j.cca.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Anti-IgLON5 disease is a rare autoimmune disease of the central nervous system. Different from the previous autoimmune encephalitis, the disease is a chronic progressive disease characterized by abnormal sleep, sleep apnea and motor disorders, which is prone to misdiagnosis and missed diagnosis. METHODS We report a unique case of anti-IgLON5 disease in a pediatric patient with Langerhans cell histiocytosis (LCH). He gradually developed increased muscle tone and nystagmus during chemotherapy and showed signs of meningeal enhancement on cranial imaging. Due to insufficient evidence of LCH invasion of the central nervous system, the presence of autoimmune encephalitis-related antibodies was investigated by using cell-based assay (CBA) experiment in indirect immuno-fluorescence assay (IFA). RESULTS Clinical manifestations of sleep disorders and motor disorders, plus the presence of IgLON5 IgG antibodies (1:30) in the serum leading to a confirmed diagnosis of anti-IgLON5 disease. CONCLUSION Anti-IgLON5 disease is rare and almost no cases of children have been reported. In view of the difficult to recognize symptoms in pediatric patients, especially those with other comorbidities. Clinicians should raise their awareness of this disease and pay attention to the detection of autoimmune antibodies.
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Affiliation(s)
- Fanghua Ye
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Chenying Fan
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Min Peng
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Siqin Liu
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Yan Yu
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan 410008, People's Republic of China
| | - Liangchun Yang
- Department of Pediatrics, Xiangya Hospital Central South University, Changsha, Hunan 410008, People's Republic of China.
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Immune checkpoint inhibitors-related encephalitis in melanoma and non-melanoma cancer patients: a single center experience. Support Care Cancer 2021; 29:7563-7568. [PMID: 34120259 PMCID: PMC8550117 DOI: 10.1007/s00520-021-06331-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 06/01/2021] [Indexed: 12/17/2022]
Abstract
Background Treatment with immune checkpoint inhibitors (ICI) has greatly improved survival for patients with a number of malignant diseases in recent years. Neurological immune-related adverse events (n-irAE) of varying severity have been reported in the literature. We aimed to identify the incidence of n-irAE, focusing on immune-related encephalitis (IRE), in patients treated with ICI for multiple non-hematological malignancies in our institution. Methods All patients with histologically verified cancer that received treatment with ICI at the Sheba Medical Center between January 2017 and August 2019 were surveyed. Medical records for each patient were reviewed and information regarding n-irAE was recorded. Results In total, 1993 patients were included. Eleven cases of IRE were recorded, affecting 0.55% of patients overall, eight had non-melanoma cancer. Eight patients had made a full recovery. Conclusions IRE is a n-irAE more frequent than previously reported, particularly in non-melanoma patients. The diagnostic criteria and optimal treatment needs to be determined. ICI re-challenge after IRE can be considered for selected patients.
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Feldheim J, Deuschl C, Glas M, Kleinschnitz C, Hagenacker T. Simultaneous paraneoplastic cerebellar degeneration, Lambert-Eaton syndrome and neuropathy associated with AGNA/anti-SOX1 and VGCC antibodies. Neurol Res Pract 2021; 3:30. [PMID: 34030742 PMCID: PMC8142469 DOI: 10.1186/s42466-021-00129-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 05/06/2021] [Indexed: 12/17/2022] Open
Abstract
Anti-glial nuclear antibody (AGNA) is an onconeuroal antibody targeting the nuclei of Bergmann glia in the cerebellum and Anti-SRY-related HMG-box 1 (SOX1). It is highly specific for small cell lung cancer (SCLC) and correlates to the appearance of paraneoplastic neurological syndromes such as Lambert-Eaton myasthenic syndrome (pLEMS) and paraneoplastic cerebellar degeneration (PCD) amongst others. Herein, we present a SCLC patient with rapidly progressive PCD, LEMS and axonal polyneuropathy associated with AGNA/SOX1-antibodies, successfully treated with plasma-exchange (PLEX).
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Affiliation(s)
- Jonas Feldheim
- Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.,Department of Neurology, Division of Clinical Neurooncology, University Hospital, Essen, Germany.,Tumorbiology Laboratory, Department of Neurosurgery, University of Würzburg, Würzburg, Germany
| | - Cornelius Deuschl
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Martin Glas
- Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.,Department of Neurology, Division of Clinical Neurooncology, University Hospital, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University Hospital Essen, Essen, Germany.,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.,Department of Neurology, Division of Clinical Neurooncology, University Hospital, Essen, Germany
| | - Tim Hagenacker
- Department of Neurology, University Hospital Essen, Essen, Germany. .,Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, Germany.
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Flanagan EP. Paraneoplastic disorders of the nervous system. J Neurol 2021; 268:4899-4907. [PMID: 33904967 DOI: 10.1007/s00415-021-10570-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/13/2021] [Accepted: 04/16/2021] [Indexed: 12/19/2022]
Abstract
This article on paraneoplastic neurologic disorders provides an update on the diagnostic approach, utility and pitfalls of autoantibody testing and emerging settings in which these disorders are encountered. Recognition of the clinical and neuroimaging features accompanying paraneoplastic neurologic disorders is crucial to select those at highest risk who need neural antibody testing and screening for cancer. Cursory knowledge of the antibody assay methodology being ordered is important as the false positive rate varies by the technique utilized for detection. Antibodies can generally be stratified by the location of the target antigen (intraceullar versus cell-surface/synaptic) which informs frequency of cancer association, treatment response and prognosis. The therapeutic approach generally involves detection of the underlying cancer and combinations of oncologic treatments and immunosuppressant medications. The occurrence of paraneoplastic autoimmune neurologic disorders in novel settings, such as with immune checkpoint inhibitor use, has improved understanding of their pathogenesis and increased the likelihood neurologists will encounter such patients in their practice.
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Affiliation(s)
- Eoin P Flanagan
- Department of Neurology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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49
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Fonseca E, Varas R, Godoy-Santín J, Valenzuela R, Sandoval P. Opsoclonus-myoclonus syndrome associated with anti Kelch-like protein-11 antibodies in a young female patient without cancer. J Neuroimmunol 2021; 355:577570. [PMID: 33862421 DOI: 10.1016/j.jneuroim.2021.577570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/27/2022]
Abstract
Opsoclonus-myoclonus syndrome (OMS) is a rare neurological disorder. The pathogenesis is thought to be immune-mediated. In adults, it may be idiopathic or paraneoplastic in origin. However, most cases of paraneoplastic OMS in adults are not associated with well-characterized antibodies, except for a small subgroup who have anti-Ri antibodies. Herein, we provide the first detailed description of a case of OMS associated with a Kelch-like protein-11 antibody, a newly discovered biomarker for paraneoplastic neurological syndromes associated with germ-cell tumors. This was a young female patient in whom no tumor was ever detected and who had an excellent response to rituximab.
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Affiliation(s)
- Elianet Fonseca
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile. Chile.
| | - René Varas
- Neurology Service, Hospital Naval de Talcahuano, Talcahuano, Chile
| | - Jaime Godoy-Santín
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile. Chile
| | - Raúl Valenzuela
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile. Chile
| | - Patricio Sandoval
- Department of Neurology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile. Chile
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50
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Pous A, Izquierdo C, Cucurull M, Sánchez S, Lezcano C, Domenech M, Llobera L, Plaja A, Moran T. Immune-checkpoint inhibitors for lung cancer patients amid the COVID-19 pandemic: a case report of severe meningoencephalitis after switching to an extended-interval higher flat-dose nivolumab regimen. Transl Lung Cancer Res 2021; 10:1917-1923. [PMID: 34012801 PMCID: PMC8107731 DOI: 10.21037/tlcr-20-1315] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Alternative dosage regimens for some anticancer therapies have been proposed in the midst of the SARS-COV-2 pandemic in order to protect the patients from attending to health care facilities. Flat-dosing of several immune-checkpoint inhibitors (ICIs), including nivolumab, have been established. Although generally well tolerated with no new safety signals, new dosages can associate novel individual toxicities. As the use of ICIs is increasing in cancer patients, the present case report is a reminder for clinicians of potential novel toxicities, as well as the need for an interdisciplinary approach for their recognition and treatment. We report the occurrence of a severe neurologic toxicity in a patient with non-small cell lung cancer (NSCLC) who developed should be changed to which occurred after two doses of extended higher interval flat-dose nivolumab despite two years of clinical stability on prior nivolumab regimen. Patient developed fever, language impairment and altered mental status. The work-up tests excluded other potential causes and the most likely diagnosis was meningoencephalitis. Fortunately, with medical treatment, which consisted of high dose steroids, the patient recovered to his baseline situation and symptoms did not recurred, even though nivolumab was resumed. Alternate ICI regimens may have unique immune-related adverse event profiles.
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Affiliation(s)
- Anna Pous
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Cristina Izquierdo
- Neurology Department. Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Marc Cucurull
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Institut Germans Trias i Pujol, Barcelona, Spain.,Badalona Applied Research Group in Oncology, Barcelona, Spain
| | - Silvia Sánchez
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Clara Lezcano
- Pharmacy Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Marta Domenech
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Institut Germans Trias i Pujol, Barcelona, Spain.,Badalona Applied Research Group in Oncology, Barcelona, Spain
| | - Laia Llobera
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Andrea Plaja
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain
| | - Teresa Moran
- Medical Oncology Department, Catalan Institute of Oncology Badalona, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain.,Institut Germans Trias i Pujol, Barcelona, Spain.,Badalona Applied Research Group in Oncology, Barcelona, Spain.,Department of Medicine, Universitat Autònoma de Barcelona (UAB), Campus Can Ruti, Barcelona, Spain
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