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Mitoma H, Manto M. Recent advances in diagnosis of immune-mediated cerebellar ataxias: novel concepts and fundamental questions on autoimmune mechanisms. J Neurol 2024:10.1007/s00415-024-12596-7. [PMID: 39052041 DOI: 10.1007/s00415-024-12596-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
Immune-mediated cerebellar ataxias (IMCAs) represent a group of disorders in which the immune system targets mainly the cerebellum and related structures. We address fundamental questions on the diagnosis and immunological pathogenesis of IMCAs, as illuminated by recent advances in the field. Various types of IMCAs have been identified, including post-infectious cerebellitis, Miller Fisher syndrome, gluten ataxia, paraneoplastic cerebellar degeneration (PCD), opsoclonus and myoclonus syndrome, and anti-GAD ataxia. In some cases, identification of several well-characterized autoantibodies points to a specific etiology in IMCAs and leads to a firm diagnosis. In other cases, various autoantibodies have been reported, but their interpretation requires a careful consideration. Indeed, some autoantibodies have only been documented in a limited number of cases and the causal relationship is not established. In order to facilitate an early treatment and prevent irreversible lesions, new entities have been defined in recent years, such as primary autoimmune cerebellar ataxia (PACA) and latent autoimmune cerebellar ataxia (LACA). PACA is characterized by autoimmune features which do not align with traditional etiologies, while LACA corresponds to a prodromal stage. LACA does not imply the initiation of an immunotherapy but requires a close follow-up. Concurrently, accumulation of clinical data has led to intriguing hypotheses regarding the mechanisms of autoimmunity, such as a pathogenesis of autoimmunity against synapses (synaptopathies), and the vulnerability of the entire nervous system when the immunity targets ion channels and astrocytes. The development of PCD in patients treated with immune-checkpoint inhibitors suggests that molecular mimicry specifically determines the direction of autoimmunity, and that the strength of this response is modulated by co-signaling molecules that either enhance or dampen signals from the antigen-specific T cell receptor.
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Affiliation(s)
- Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, 6000, Charleroi, Belgium.
- Service des Neurosciences, University of Mons, 7000, Mons, Belgium.
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Saiz A, Graus F. Neuronal antibodies in nonparaneoplastic autoimmune cerebellar ataxias. Curr Opin Neurol 2024; 37:322-328. [PMID: 38483149 DOI: 10.1097/wco.0000000000001260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW To describe relevant advances in nonparaneoplastic autoimmune cerebellar ataxias (ACA) with neuronal antibodies. RECENT FINDINGS Apart from metabotropic glutamate receptor 1(mGluR1) antibodies, in recent years, the number of neuronal antibodies against surface antigens in ACA has increased with the description of glutamate kainate receptor subunit 2 (GluK2) antibodies in young patients with cerebellitis. Around 20% of patients with contactin-associated protein-like 2 (CASPR2) encephalitis also present prominent cerebellar ataxia. However, isolate cerebellar ataxia is unusual (<4%). Outcome in patients with neuronal antibodies against surface antigens remains suboptimal despite the cerebellar ataxia probably is antibody-mediated.Concerning neuronal antibodies against intracellular antigens, up to 25% of patients with glutamic acid decarboxylase (GAD) antibodies present transient episodes of vertigo or diplopia that antedate the development of the ACA. There is in-vitro evidence that septin-5 is partially exposed to the membrane and the antibodies may interfere with septin-5 function. The clinical significance of the remaining antibodies against intracellular antigens remains unclear. SUMMARY The number of antibodies against surface antigens is increasing in ACA, but the response to the immunotherapy remains suboptimal. More studies are needed to clarify the role of most of the antibodies against intracellular antigens described in these patients.
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Affiliation(s)
- Albert Saiz
- Service of Neurology, Hospital Clinic
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francesc Graus
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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3
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Segal Y, Zekeridou A. Interest of rare autoantibodies in autoimmune encephalitis and paraneoplastic neurological syndromes: the utility (or futility) of rare antibody discovery. Curr Opin Neurol 2024; 37:295-304. [PMID: 38533672 DOI: 10.1097/wco.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW The increasing recognition and diagnosis of autoimmune encephalitis (AE) and paraneoplastic neurological syndromes (PNS) is partly due to neural autoantibody testing and discovery. The past two decades witnessed an exponential growth in the number of identified neural antibodies. This review aims to summarize recent rare antibody discoveries in the context of central nervous system (CNS) autoimmunity and evaluate the ongoing debate about their utility. RECENT FINDINGS In the last 5 years alone 15 novel neural autoantibody specificities were identified. These include rare neural antibody biomarkers of autoimmune encephalitis, cerebellar ataxia or other movement disorders, including multifocal presentations. SUMMARY Although the clinical applications of these rare antibody discoveries may be limited by the low number of positive cases, they still provide important diagnostic, prognostic, and therapeutic insights.
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Affiliation(s)
- Yahel Segal
- Department of Laboratory Medicine and Pathology
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology
- Department of Neurology
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Papi C, Milano C, Spatola M. Mechanisms of autoimmune encephalitis. Curr Opin Neurol 2024; 37:305-315. [PMID: 38667756 DOI: 10.1097/wco.0000000000001270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2024]
Abstract
PURPOSE OF REVIEW To provide an overview of the pathogenic mechanisms involved in autoimmune encephalitides mediated by antibodies against neuronal surface antigens, with a focus on NMDAR and LGI1 encephalitis. RECENT FINDINGS In antibody-mediated encephalitides, binding of IgG antibodies to neuronal surface antigens results in different pathogenic effects depending on the type of antibody, IgG subclass and epitope specificity. NMDAR IgG1 antibodies cause crosslinking and internalization of the target, synaptic and brain circuitry alterations, as well as alterations of NMDAR expressing oligodendrocytes, suggesting a link with white matter lesions observed in MRI studies. LGI1 IgG4 antibodies, instead, induce neuronal dysfunction by disrupting the interaction with cognate proteins and altering AMPAR-mediated signaling. In-vitro findings have been corroborated by memory and behavioral changes in animal models obtained by passive transfer of patients' antibodies or active immunization. These models have been fundamental to identify targets for innovative therapeutic strategies, aimed at counteracting or preventing antibody effects, such as the use of soluble ephrin-B2, NMDAR modulators (e.g., pregnenolone, SGE-301) or chimeric autoantibody receptor T cells (CAART) in models of NMDAR encephalitis. SUMMARY A deep understanding of the pathogenic mechanisms underlying antibody-mediated encephalitides is crucial for the development of new therapeutic approaches targeting brain autoimmunity.
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Affiliation(s)
- Claudia Papi
- Department of Neuroscience, Catholic University of the Sacred Heart, Rome, Italy
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
| | - Chiara Milano
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Marianna Spatola
- Fundació Recerca Biomedica Clinic - Institut d'Investigacions Biomèdiques August Pi i Sunyer (FRBC-IDIBAPS), Barcelona, Spain
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Koneczny I, Macher S, Hutterer M, Seifert-Held T, Berger-Sieczkowski E, Blaabjerg M, Breu M, Dreyhaupt J, Dutra LA, Erdler M, Fae I, Fischer G, Frommlet F, Heidbreder A, Högl B, Klose V, Klotz S, Liendl H, Nissen MS, Rahimi J, Reinecke R, Ricken G, Stefani A, Süße M, Teive HAG, Weis S, Berger T, Sabater L, Gaig C, Lewerenz J, Höftberger R. HLA dependency and possible clinical relevance of intrathecally synthesized anti-IgLON5 IgG4 in anti-IgLON5 disease. Front Immunol 2024; 15:1376456. [PMID: 38827736 PMCID: PMC11141242 DOI: 10.3389/fimmu.2024.1376456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 04/15/2024] [Indexed: 06/04/2024] Open
Abstract
Background Anti-IgLON5 disease is a rare chronic autoimmune disorder characterized by IgLON5 autoantibodies predominantly of the IgG4 subclass. Distinct pathogenic effects were described for anti-IgLON5 IgG1 and IgG4, however, with uncertain clinical relevance. Methods IgLON5-specific IgG1-4 levels were measured in 46 sera and 20 cerebrospinal fluid (CSF) samples from 13 HLA-subtyped anti-IgLON5 disease patients (six females, seven males) using flow cytometry. Intervals between two consecutive serum or CSF samplings (31 and 10 intervals, respectively) were categorized with regard to the immunomodulatory treatment active at the end of the interval, changes of anti-IgLON5 IgG1 and IgG4 levels, and disease severity. Intrathecal anti-IgLON5 IgG4 synthesis (IS) was assessed using a quantitative method. Results The median age at onset was 66 years (range: 54-75), disease duration 10 years (range: 15-156 months), and follow-up 25 months (range: 0-83). IgLON5-specific IgG4 predominance was observed in 38 of 46 (83%) serum and 11 of 20 (55%) CSF samples. Anti-IgLON5 IgG4 levels prior clinical improvement in CSF but not serum were significantly lower than in those prior stable/progressive disease. Compared to IgLON5 IgG4 levels in serum, CSF levels in HLA-DRB1*10:01 carriers were significantly higher than in non-carriers. Indeed, IgLON5-specific IgG4 IS was demonstrated not only in four of five HLA-DRB1*10:01 carriers but also in one non-carrier. Immunotherapy was associated with decreased anti-IgGLON5 IgG serum levels. In CSF, lower anti-IgLON5 IgG was associated with immunosuppressive treatments used in combination, that is, corticosteroids and/or azathioprine plus intravenous immunoglobulins or rituximab. Conclusion Our findings might indicate that CSF IgLON5-specific IgG4 is frequently produced intrathecally, especially in HLA-DRB1*10:01 carriers. Intrathecally produced IgG4 may be clinically relevant. While many immunotherapies reduce serum IgLON5 IgG levels, more intense immunotherapies induce clinical improvement and may be able to target intrathecally produced anti-IgLON5 IgG. Further studies need to confirm whether anti-IgLON5 IgG4 IS is a suitable prognostic and predictive biomarker in anti-IgLON5 disease.
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Affiliation(s)
- Inga Koneczny
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Stefan Macher
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Markus Hutterer
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
- Department of Neurology with Stroke Unit and Acute Geriatrics, Saint John of God Hospital Linz, Linz, Austria
| | - Thomas Seifert-Held
- Department of Neurology, Medical University of Graz, Graz, Austria
- Department of Neurology, Landeskrankenhaus (LKH) Murtal, Standort Knittelfeld, Austria
| | | | - Morten Blaabjerg
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Markus Breu
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Jens Dreyhaupt
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Marcus Erdler
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders Klinik Donaustadt, Vienna, Austria
| | - Ingrid Fae
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Gottfried Fischer
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center of Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Anna Heidbreder
- Department of Neurology, Johannes Kepler University Linz, Linz, Austria
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Birgit Högl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Veronika Klose
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Sigrid Klotz
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Herburg Liendl
- Department of Neurology, Landeskrankenhaus (LKH) Murtal, Standort Knittelfeld, Austria
| | - Mette S. Nissen
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Jasmin Rahimi
- Department of Neurology and Karl Landsteiner Institute for Neuroimmunological and Neurodegenerative Disorders Klinik Donaustadt, Vienna, Austria
| | - Raphael Reinecke
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Gerda Ricken
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Ambra Stefani
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Marie Süße
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Helio A. G. Teive
- Movement Disorders Unit, Neurology Service, Internal Medicine Department, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - Serge Weis
- Division of Neuropathology, Department of Pathology and Molecular Pathology, Johannes Kepler University Linz, Linz, Austria
| | - Thomas Berger
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Lidia Sabater
- Fundació de recerca clínic-Institut d’Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Institute (CRI), Universitat de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
| | - Carles Gaig
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Madrid, Spain
- Department of Neurology, Hospital Clínic, Barcelona, Spain
| | - Jan Lewerenz
- Department of Neurology, University Hospital Ulm, Ulm, Germany
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Sanvito F, Pichiecchio A, Paoletti M, Rebella G, Resaz M, Benedetti L, Massa F, Morbelli S, Caverzasi E, Asteggiano C, Businaro P, Masciocchi S, Castellan L, Franciotta D, Gastaldi M, Roccatagliata L. Autoimmune encephalitis: what the radiologist needs to know. Neuroradiology 2024; 66:653-675. [PMID: 38507081 PMCID: PMC11031487 DOI: 10.1007/s00234-024-03318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Autoimmune encephalitis is a relatively novel nosological entity characterized by an immune-mediated damage of the central nervous system. While originally described as a paraneoplastic inflammatory phenomenon affecting limbic structures, numerous instances of non-paraneoplastic pathogenesis, as well as extra-limbic involvement, have been characterized. Given the wide spectrum of insidious clinical presentations ranging from cognitive impairment to psychiatric symptoms or seizures, it is crucial to raise awareness about this disease category. In fact, an early diagnosis can be dramatically beneficial for the prognosis both to achieve an early therapeutic intervention and to detect a potential underlying malignancy. In this scenario, the radiologist can be the first to pose the hypothesis of autoimmune encephalitis and refer the patient to a comprehensive diagnostic work-up - including clinical, serological, and neurophysiological assessments.In this article, we illustrate the main radiological characteristics of autoimmune encephalitis and its subtypes, including the typical limbic presentation, the features of extra-limbic involvement, and also peculiar imaging findings. In addition, we review the most relevant alternative diagnoses that should be considered, ranging from other encephalitides to neoplasms, vascular conditions, and post-seizure alterations. Finally, we discuss the most appropriate imaging diagnostic work-up, also proposing a suggested MRI protocol.
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Affiliation(s)
- Francesco Sanvito
- Unit of Radiology, Department of Clinical, Surgical, Diagnostic, and Paediatric Sciences, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy.
- UCLA Brain Tumor Imaging Laboratory (BTIL), Center for Computer Vision and Imaging Biomarkers, University of California Los Angeles, Los Angeles, CA, USA.
- Department of Radiological Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Paoletti
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Giacomo Rebella
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Martina Resaz
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Luana Benedetti
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Federico Massa
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, Largo Daneo 3, 16132, Genoa, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
| | - Eduardo Caverzasi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Carlo Asteggiano
- Advanced Imaging and Artificial Intelligence Center, Department of Neuroradiology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Pietro Businaro
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Stefano Masciocchi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Lucio Castellan
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory and Neuroimmunology Research Section, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Luca Roccatagliata
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 10, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Via Antonio Pastore 1, 16132, Genoa, Italy
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Sachs N, Zohar-Dayan E, Ben Zeev B, Gilboa T, Kurd M, Latzer IT, Meirson H, Krause I, Dizitzer Y, Cohen EG. Autoimmune encephalitis in Israeli children - A retrospective nationwide study. Eur J Paediatr Neurol 2024; 50:1-5. [PMID: 38518418 DOI: 10.1016/j.ejpn.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/08/2024] [Accepted: 03/02/2024] [Indexed: 03/24/2024]
Abstract
Immune-mediated or autoimmune encephalitis (AE) is a relatively new, rare and elusive form of encephalitis in children. We retrospectively collected seropositive children (0-18 years old) with well characterized antibodies through 3 reference laboratories in Israel. Clinical symptoms, MRI and EEG findings and treatment courses were described. A total of 16 patients were included in the study, with 10 females. Anti NMDA encephalitis was most common followed by anti HU and anti mGLuR1. Psychiatric symptoms, abnormal movements, seizures and behavioral changes were the most common presentation. Pathological MRI and EEG findings were described in 37% and 56% of children, respectively. Treatment with corticosteroids, Intravenous immunoglobulins (IVIG) was first line in most children. Following inadequate response children were treated with plasmapheresis and/or rituximab. Two patients relapsed following both first and second line protocols. In terms of long term prognosis, 9 children (56%) had one or more residual behavioral, psychiatric or neurologic findings. Three children required hospitalization for rehabilitation. AE remains a rare diagnosis with variable presenting symptoms, requiring a high index of suspicion. Consensus recommended treatment is generally effective in the pediatric population. Female gender was associated with a higher chance of severe disease. Larger cohorts would be needed to identify prognostic factors in the pediatric population.
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Affiliation(s)
- Nimrod Sachs
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Efrat Zohar-Dayan
- Pediatric Neurology Unit, Safra Pediatric Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Bruria Ben Zeev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Unit, Safra Pediatric Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Tal Gilboa
- Pediatric Neurology Unit, Hadassah Medical Center, Jerusalem, Israel; School of Medicine, The Hebrew University of Jerusalem, Israel
| | - Mohammad Kurd
- Pediatric Neurology Unit, Hadassah Medical Center, Jerusalem, Israel
| | - Itay Tokatly Latzer
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Israel
| | - Hadas Meirson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel-Aviv Medical Center, Israel
| | - Irit Krause
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yotam Dizitzer
- Department of Pediatrics C, Schneider Children's Medical Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Esther Ganelin Cohen
- The Neuro-immunological Clinic, The Neurological Institute, Schneider Children's Center of Israel, Petah Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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8
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Shimizu F. [Blood-brain barrier breakdown and autoimmune cerebellar ataxia]. Rinsho Shinkeigaku 2024; 64:148-156. [PMID: 38403685 DOI: 10.5692/clinicalneurol.cn-001932] [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: 02/27/2024]
Abstract
Autoimmune cerebellar ataxia is a disease entity that affects the cerebellum and is induced by autoimmune mechanisms. The disease is classified into several etiologies, including gluten ataxia, anti-glutamate decarboxylase (GAD) ataxia, paraneoplastic cerebellar degeneration, primary autoimmune cerebellar ataxia and postinfectious cerebellar ataxia. The autoimmune response in the periphery cross-reacts with similar antigens in the cerebellum due to molecular mimicry. Breakdown of the blood‒brain barrier (BBB) could potentially explain the vulnerability of the cerebellum during the development of autoimmune cerebellar ataxia, as it gives rise to the entry of pathogenic autoantibodies or lymphocytes into the cerebellum. In this review, the maintenance of the BBB under normal conditions and the molecular basis of BBB disruption under pathological conditions are highlighted. Next, the pathomechanism of BBB breakdown in each subtype of autoimmune cerebellar ataxia is discussed. We recently identified glucose-regulated protein (GRP) 78 antibodies in paraneoplastic cerebellar degeneration and Lambert-Eaton myasthenic syndrome, and GRP78 antibodies induced by cross-reactivity with tumors can disrupt the BBB and penetrate anti-P/Q type voltage-gated calcium channel (VGCC) antibodies into the cerebellum, thus leading to cerebellar ataxia in this disease.
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Affiliation(s)
- Fumitaka Shimizu
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine
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9
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Chen X, Chen Y, Di L, Liu N, Liu T, Cai Y, Di W. Cerebellar encephalitis associated with anti-mGluR1 antibodies: a case report and comprehensive literature review. Front Neurol 2024; 15:1333658. [PMID: 38410193 PMCID: PMC10894994 DOI: 10.3389/fneur.2024.1333658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Anti-metabotropic glutamate receptor 1 encephalitis is an uncommon autoimmune condition characterized by a subacute onset of cerebellar syndrome. Frequently, it also manifests as sleep disorders and cognitive or behavioral changes. While immunotherapy is the primary treatment approach, the disease remains poorly understood. Herein, we present a case of anti-metabotropic glutamate receptor 1 encephalitis, highlighting its primary cerebellar syndrome manifestation. The first magnetic resonance imaging scan showed no obvious abnormality. Lumbar puncture showed increased cerebrospinal fluid pressure, increased white blood cell count and protein level. The next-generation sequencing of cerebrospinal fluid showed Epstein-Barr virus infection, and the patient was diagnosed with viral cerebellar encephalitis. However, antiviral therapy was ineffective. Finally, anti-metabotropic glutamate receptor 1 was measured at 1:1,000, and the patient was definitely diagnosed with anti-metabotropic glutamate receptor 1 encephalitis. Therefore, clinicians should pay attention to such diseases to avoid misdiagnosis.
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Affiliation(s)
- Xue Chen
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yanan Chen
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Lu Di
- Hospital of Stomatology Hebei Medical University, Shijiazhuang, China
| | - Na Liu
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Ting Liu
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Yun Cai
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Weiying Di
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
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10
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McKeon A, Tracy J. Paraneoplastic movement disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:211-227. [PMID: 38494279 DOI: 10.1016/b978-0-12-823912-4.00004-9] [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 movement disorders are diverse autoimmune neurological illnesses occurring in the context of systemic cancer, either in isolation or as part of a multifocal neurological disease. Movement phenomena may be ataxic, hypokinetic (parkinsonian), or hyperkinetic (myoclonus, chorea, or other dyskinetic disorders). Some disorders mimic neurodegenerative or hereditary illnesses. The subacute onset and coexisting nonclassic features of paraneoplastic disorders aid distinction. Paraneoplastic autoantibodies provide further information regarding differentiating cancer association, disease course, and treatment responses. A woman with cerebellar ataxia could have metabotropic glutamate receptor 1 autoimmunity, in the setting of Hodgkin lymphoma, a mild neurological phenotype and response to immunotherapy. A different woman, also with cerebellar ataxia, could have Purkinje cytoplasmic antibody type 1 (anti-Yo), accompanying ovarian adenocarcinoma, a rapidly progressive phenotype and persistent disabling deficits despite immune therapy. The list of antibody biomarkers is growing year-on-year, each with its own ideal specimen type for detection (serum or CSF), accompanying neurological manifestations, cancer association, treatment response, and prognosis. Therefore, a profile-based approach to screening both serum and CSF is recommended. Immune therapy trials are generally undertaken, and include one or more of corticosteroids, IVIg, plasma exchange, rituximab, or cyclophosphamide. Symptomatic therapies can also be employed for hyperkinetic disorders.
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Affiliation(s)
- Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
| | - Jennifer Tracy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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11
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Briani C, Visentin A. Hematologic malignancies and hematopoietic stem cell transplantation. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:419-429. [PMID: 38494294 DOI: 10.1016/b978-0-12-823912-4.00016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic neurologic syndromes are rarely associated with hematologic malignancies. In their rarity, lymphomas are the diseases with more frequent paraneoplastic neurologic syndrome. High-risk antibodies are absent in most lymphoma-associated paraneoplastic neurologic syndromes, with the exception of antibodies to Tr/DNER in paraneoplastic cerebellar degeneration, mGluR5 in limbic encephalitis, and mGluR1 in some cerebellar ataxias. Peripheral nervous system paraneoplastic neurologic syndromes are rare and heterogeneous, with a prevalence of demyelinating polyradiculoneuropathy in non-Hodgkin lymphoma. Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes (POEMS) is a rare, paraneoplastic syndrome due to an underlying plasma cell disorder. The diagnosis is based on defined criteria, and vascular endothelial growth factor (VEGF), not an antibody, is considered a reliable diagnostic marker that also mirrors therapy response. As with the paraneoplastic neurologic syndromes in solid tumors, therapies rely on cancer treatment associated with immunomodulatory treatment with better response in PNS with antibodies to surface antigens. The best outcome is generally present in Ophelia syndrome/limbic encephalitis with anti-mGluR5 antibodies, with frequent complete recovery. Besides patients with isolated osteosclerotic lesions (where radiotherapy is indicated), hematopoietic stem-cell transplantation is the therapy of choice in patients with POEMS syndrome. In the paraneoplastic neurologic syndromes secondary to immune checkpoint inhibitors, discontinuation of the drug together with immunomodulatory treatment is recommended.
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Affiliation(s)
- Chiara Briani
- Department of Neurosciences, Neurology Unit, University of Padova, Padova, Italy.
| | - Andrea Visentin
- Department of Medicine, Hematology Unit, University of Padova, Padova, Italy
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12
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Villagrán-García M, Farina A, Campetella L, Arzalluz-Luque J, Honnorat J. Autonomic nervous system involvement in autoimmune encephalitis and paraneoplastic neurological syndromes. Rev Neurol (Paris) 2024; 180:107-116. [PMID: 38142198 DOI: 10.1016/j.neurol.2023.12.001] [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: 09/11/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 12/25/2023]
Abstract
In autoimmune neurological diseases, the autonomic nervous system can be the primary target of autoimmunity (e.g. autoimmune autonomic ganglionopathy), or, more frequently, be damaged together with other areas of the nervous system (e.g. Guillain-Barré syndrome). Patients with autoimmune encephalitis and paraneoplastic neurological syndromes (PNS) often develop dysautonomia; however, the frequency and spectrum of autonomic signs and symptoms remain ill defined except for those scenarios in which dysautonomia is a core feature of the disease. Such is the case of Lambert-Eaton myasthenic syndrome, Morvan syndrome or anti-NMDAR encephalitis; in the latter, patients with dysautonomia have been reported to carry a more severe disease and to retain higher disability than those without autonomic dysfunction. Likewise, the presence of autonomic involvement indicates a higher risk of death due to neurological cause in patients with anti-Hu PNS. However, in anti-Hu and other PNS, as well as in the context of immune checkpoint inhibitors' toxicities, the characterization of autonomic involvement is frequently overshadowed by the severity of other neurological symptoms and signs. When evaluated with tests specific for autonomic function, patients with autoimmune encephalitis or PNS usually show a more widespread autonomic involvement than clinically suggested, which may reflect a potential gap of care when it comes to diagnosing dysautonomia. This review aims to revise the autonomic involvement in patients with autoimmune encephalitis and PNS, using for that purpose an antibody-based approach. We also discuss and provide general recommendations for the evaluation and management of dysautonomia in these patients.
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Affiliation(s)
- M Villagrán-García
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, hôpital neurologique, Bron, France; Inserm U1314, MeLiS-UCBL-CNRS UMR 5284, University Claude-Bernard Lyon 1, Lyon, France
| | - A Farina
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, hôpital neurologique, Bron, France; Inserm U1314, MeLiS-UCBL-CNRS UMR 5284, University Claude-Bernard Lyon 1, Lyon, France; Department of Neuroscience, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - L Campetella
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, hôpital neurologique, Bron, France; Inserm U1314, MeLiS-UCBL-CNRS UMR 5284, University Claude-Bernard Lyon 1, Lyon, France
| | - J Arzalluz-Luque
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, hôpital neurologique, Bron, France; Department of Neurology, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Honnorat
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, hôpital neurologique, Bron, France; Inserm U1314, MeLiS-UCBL-CNRS UMR 5284, University Claude-Bernard Lyon 1, Lyon, France.
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13
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Shelly S, Dubey D, Mills JR, Klein CJ. Paraneoplastic neuropathies and peripheral nerve hyperexcitability disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:239-273. [PMID: 38494281 DOI: 10.1016/b978-0-12-823912-4.00020-7] [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
Peripheral neuropathy is a common referral for patients to the neurologic clinics. Paraneoplastic neuropathies account for a small but high morbidity and mortality subgroup. Symptoms include weakness, sensory loss, sweating irregularity, blood pressure instability, severe constipation, and neuropathic pain. Neuropathy is the first presenting symptom of malignancy among many patients. The molecular and cellular oncogenic immune targets reside within cell bodies, axons, cytoplasms, or surface membranes of neural tissues. A more favorable immune treatment outcome occurs in those where the targets reside on the cell surface. Patients with antibodies binding cell surface antigens commonly have neural hyperexcitability with pain, cramps, fasciculations, and hyperhidrotic attacks (CASPR2, LGI1, and others). The antigenic targets are also commonly expressed in the central nervous system, with presenting symptoms being myelopathy, encephalopathy, and seizures with neuropathy, often masked. Pain and autonomic components typically relate to small nerve fiber involvement (nociceptive, adrenergic, enteric, and sudomotor), sometimes without nerve fiber loss but rather hyperexcitability. The specific antibodies discovered help direct cancer investigations. Among the primary axonal paraneoplastic neuropathies, pathognomonic clinical features do not exist, and testing for multiple antibodies simultaneously provides the best sensitivity in testing (AGNA1-SOX1; amphiphysin; ANNA-1-HU; ANNA-3-DACH1; CASPR2; CRMP5; LGI1; PCA2-MAP1B, and others). Performing confirmatory antibody testing using adjunct methods improves specificity. Antibody-mediated demyelinating paraneoplastic neuropathies are limited to MAG-IgM (IgM-MGUS, Waldenström's, and myeloma), with the others associated with cytokine elevations (VEGF, IL6) caused by osteosclerotic myeloma, plasmacytoma (POEMS), and rarely angiofollicular lymphoma (Castleman's). Paraneoplastic disorders have clinical overlap with other idiopathic antibody disorders, including IgG4 demyelinating nodopathies (NF155 and Contactin-1). This review summarizes the paraneoplastic neuropathies, including those with peripheral nerve hyperexcitability.
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Affiliation(s)
- Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States; Department of Neurology, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Christopher J Klein
- 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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14
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Kadish R, Clardy SL. Epidemiology of paraneoplastic neurologic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:57-77. [PMID: 38494297 DOI: 10.1016/b978-0-12-823912-4.00011-6] [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), initially depicted as seemingly cryptic remote manifestations of malignancy, were first described clinically in the early 20th century, with pathophysiologic correlates becoming better elucidated in the latter half of the century. There remain many questions not only about the pathophysiology but also regarding the epidemiology of these conditions. The continuous discovery of novel autoantigens and related neurologic disease has broadened the association in classical PNS to include conditions such as paraneoplastic cerebellar degeneration. It has also brought into focus several other neurologic syndromes with a putative neoplastic association. These conditions are overall rare, making it difficult to capture large numbers of patients to study, and raising the question of whether incidence is increasing over time or improved identification is driving the increased numbers of cases. With the rise and increasing use of immunotherapy for cancer treatment, the incidence of these conditions is additionally expected to rise and may present with various clinical symptoms. As we enter an era of clinical trial intervention in these conditions, much work is needed to capture more granular data on population groups defined by socioeconomic characteristics such as age, ethnicity, economic resources, and gender to optimize care and clinical trial planning.
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Affiliation(s)
- Robert Kadish
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Stacey L Clardy
- Department of Neurology, University of Utah, Salt Lake City, UT, United States; George E. Wahlen Department of Veterans Affairs Medical Center, Salt Lake City, UT, United States.
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15
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Abbatemarco JR, Vedeler CA, Greenlee JE. Paraneoplastic cerebellar and brainstem disorders. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:173-191. [PMID: 38494276 DOI: 10.1016/b978-0-12-823912-4.00030-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 cerebellar and brainstem disorders are a heterogeneous group that requires prompt recognition and treatment to help prevent irreversible neurologic injury. Paraneoplastic cerebellar degeneration is best characterized by Yo antibodies in patients with breast or ovarian cancer. Tr (DNER) antibodies in patients with Hodgkin lymphoma can also present with a pure cerebellar syndrome and is one of the few paraneoplastic syndromes found with hematological malignancy. Opsoclonus-myoclonus-ataxia syndrome presents in both pediatric and adult patients with characteristic clinical findings. Other paraneoplastic brainstem syndromes are associated with Ma2 and Hu antibodies, which can cause widespread neurologic dysfunction. The differential for these disorders is broad and also includes pharmacological side effects, infection or postinfectious processes, and neurodegenerative diseases. Although these immune-mediated disorders have been known for many years, mechanisms of pathogenesis are still unclear, and optimal treatment has not been established.
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Affiliation(s)
- Justin R Abbatemarco
- Mellen Center for Multiple Sclerosis Treatment and Research, Neurological Institute, Cleveland Clinic Foundation, Cleveland, OH, United States.
| | - Christian A Vedeler
- Neuro-SysMed, Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - John E Greenlee
- Neurology Service, George E. Wahlen Veterans Affairs Health Care System, Salt Lake City, UT, United States; Department of Neurology, University of Utah, Salt Lake City, UT, United States
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16
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Kudo A, Yaguchi H, Tanaka K, Kimura A, Yabe I. A retrospective study of autoimmune cerebellar ataxia over a 20-year period in a single institution. J Neurol 2024; 271:553-563. [PMID: 37610447 DOI: 10.1007/s00415-023-11946-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/08/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND It is important to differentiate autoimmune cerebellar ataxia (ACA) from neurodegenerative CA, but this is sometimes difficult. We performed a retrospective study in a single institution in Japan over a 20-year period to reveal the clinical features of ACA. METHODS Patients with CA as the primary neurological symptom were enrolled from those admitted to the Department of Neurology, Hokkaido University Hospital between April 2002 and March 2022. ACA was diagnosed retrospectively according to the following criteria: (1) CA being the predominant symptom; (2) identification of cancer within 2 years of onset; (3) improvement in cerebellar symptoms following immunotherapy; and (4) ruling out alternative causes of CA. Patients fulfilling criteria (1), (2), and (4) were classified as paraneoplastic cerebellar degeneration (PCD), while those fulfilling (1), (3), and (4) were classified as non-PCD and enrolled as patients with ACA. Neurodegenerative diseases, e.g., multiple system atrophy (MSA), were confirmed retrospectively based on generally used diagnostic criteria and enrolled. Furthermore, the ACA diagnostic criteria proposed by Dalmau and Graus were applied retrospectively to the ACA patients to examine the validity of the diagnoses. RESULTS Among the 243 patients with CA, 13 were enrolled as ACA; five were PCD and eight were non-PCD. Eight of these cases met the proposed diagnostic criteria by Dalmau and Graus. MSA was the most prevalent disease among CA patients, with 93 cases. The incidence of cerebellar atrophy was significantly lower in ACA (3/13) than in MSA (92/92). Cerebrospinal fluid (CSF) pleocytosis was significantly more frequent in ACA than in MSA (4/13 vs. 2/55, respectively). However, there was no significant difference in the presence of oligoclonal bands, increased protein in CSF, and laterality differences in ataxia. CONCLUSION ACA was present in ~ 5% of Japanese CA patients. The absence of cerebellar atrophy, despite the presence of CA, strongly supports ACA over MSA. While CSF pleocytosis was observed more often in ACA, the positivity rate was only ~ 30%. Since ACA is treatable, further studies are needed to identify additional clinical features and accurate diagnostic biomarkers.
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Affiliation(s)
- Akihiko Kudo
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15 W-7, Kita-Ku, Sapporo, Japan
| | - Hiroaki Yaguchi
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15 W-7, Kita-Ku, Sapporo, Japan.
| | - Keiko Tanaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ichiro Yabe
- Department of Neurology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N-15 W-7, Kita-Ku, Sapporo, Japan.
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Jean MJ, Samkoff L, Mohile N. Management of Paraneoplastic Syndromes in the Era of Immune Checkpoint Inhibitors. Curr Treat Options Oncol 2024; 25:42-65. [PMID: 38198120 DOI: 10.1007/s11864-023-01157-1] [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] [Accepted: 11/22/2023] [Indexed: 01/11/2024]
Abstract
OPINION STATEMENT Our understanding of paraneoplastic neurologic syndromes (PNS) has blossomed over the past few decades. Clinicians have access to more robust diagnostic criteria and have a heightened index of suspicion for these disorders. Nonetheless, treatment, which typically includes immunosuppression, and response to treatment, varies. Due to persistent difficulty in making a definitive diagnosis, we favor empiric treatment when a possible diagnosis of PNS is suspected, and other alternative causes have substantially been excluded (e.g., infections, toxic-metabolic derangements, metastasis, or leptomeningeal disease). Treatment of the underlying cancer, if identified, is the first therapeutic step and can prevent disease worsening and in rare cases, can reverse neurologic symptoms. In addition to anti-cancer treatment, first line immunotherapies, which include corticosteroids, intravenous immunoglobulins (IVIG), or plasma exchange (PLEX) are typically used. If partial or no benefit is seen, second line immunotherapeutic agents such as rituximab are considered. Additionally, the severity of the initial presentation and possible risk for relapse influences the use of the latter agents. Symptomatic management is also an important component in our practice and will depend on the syndrome being treated. One of the more novel entities we are facing currently is the management of immune checkpoint (ICI)-induced PNS. In those cases, current American Society of Clinical Oncology (ASCO) guidelines are followed.
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Affiliation(s)
- Maxime Junior Jean
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Lawrence Samkoff
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA
| | - Nimish Mohile
- University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY, 14642, USA.
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Budhram A, Sechi E. Antibodies to neural cell surface and synaptic proteins in paraneoplastic neurologic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:347-364. [PMID: 38494289 DOI: 10.1016/b978-0-12-823912-4.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Among patients with paraneoplastic neurologic syndromes (PNS), emphasis has historically been placed on neural antibodies against intracellular proteins that have a strong association with malignancy. Because of the intracellular location of their antigenic targets, these antibodies are typically considered to be non-pathogenic surrogate markers of immune cell-mediated neural injury. Unfortunately, patients with these antibodies often have suboptimal response to immunotherapy and poor prognosis. Over the last two decades, however, dramatic advancements have been made in the discovery and clinical characterization of neural antibodies against extracellular targets. These antibodies are generally considered to be pathogenic, given their potential to directly alter antigen structure or function, and patients with these antibodies often respond favorably to prompt immunotherapy. These antibodies also associate with tumors and may thus occur as PNS, albeit more variably than neural antibodies against intracellular targets. The updated 2021 PNS diagnostic criteria, which classifies antibodies as high-risk, intermediate-risk, or lower-risk for an associated cancer, better clarifies how neural antibodies against extracellular targets relate to PNS. Using this recently created framework, the clinical presentations, ancillary test findings, oncologic associations, and treatment responses of syndromes associated with these antibodies are discussed.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Waters P, Mills JR, Fox H. Evolution of methods to detect paraneoplastic antibodies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:113-130. [PMID: 38494273 DOI: 10.1016/b978-0-12-823912-4.00010-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
An adaptive immune response in less than 1% of people who develop cancer produces antibodies against neuronal proteins. These antibodies can be associated with paraneoplastic syndromes, and their accurate detection should instigate a search for a specific cancer. Over the years, multiple systems, from indirect immunofluorescence to live cell-based assays, have been developed to identify these antibodies. As the specific antigens were identified, high throughput, multi-antigen substrates such as line blots and ELISAs were developed for clinical laboratories. However, the evolution of assays required to identify antibodies to membrane targets has shone a light on the importance of antigen conformation for antibody detection. This chapter discusses the early antibody assays used to detect antibodies to nuclear and cytosolic targets and how new approaches are required to detect antibodies to membrane targets. The chapter presents recent data that support international recommendations against the sole use of line blots for antibody detection and highlights a new antigen-specific approach that appears promising for the detection of submembrane targets.
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Affiliation(s)
- Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Hannah Fox
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Masciocchi S, Businaro P, Scaranzin S, Morandi C, Franciotta D, Gastaldi M. General features, pathogenesis, and laboratory diagnostics of autoimmune encephalitis. Crit Rev Clin Lab Sci 2024; 61:45-69. [PMID: 37777038 DOI: 10.1080/10408363.2023.2247482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Autoimmune encephalitis (AE) is a group of inflammatory conditions that can associate with the presence of antibodies directed to neuronal intracellular, or cell surface antigens. These disorders are increasingly recognized as an important differential diagnosis of infectious encephalitis and of other common neuropsychiatric conditions. Autoantibody diagnostics plays a pivotal role for accurate diagnosis of AE, which is of utmost importance for the prompt recognition and early treatment. Several AE subgroups can be identified, either according to the prominent clinical phenotype, presence of a concomitant tumor, or type of neuronal autoantibody, and recent diagnostic criteria have provided important insights into AE classification. Antibodies to neuronal intracellular antigens typically associate with paraneoplastic neurological syndromes and poor prognosis, whereas antibodies to synaptic/neuronal cell surface antigens characterize many AE subtypes that associate with tumors less frequently, and that are often immunotherapy-responsive. In addition to the general features of AE, we review current knowledge on the pathogenic mechanisms underlying these disorders, focusing mainly on the potential role of neuronal antibodies in the most frequent conditions, and highlight current theories and controversies. Then, we dissect the crucial aspects of the laboratory diagnostics of neuronal antibodies, which represents an actual challenge for both pathologists and neurologists. Indeed, this diagnostics entails technical difficulties, along with particularly interesting novel features and pitfalls. The novelties especially apply to the wide range of assays used, including specific tissue-based and cell-based assays. These assays can be developed in-house, usually in specialized laboratories, or are commercially available. They are widely used in clinical immunology and in clinical chemistry laboratories, with relevant differences in analytic performance. Indeed, several data indicate that in-house assays could perform better than commercial kits, notwithstanding that the former are based on non-standardized protocols. Moreover, they need expertise and laboratory facilities usually unavailable in clinical chemistry laboratories. Together with the data of the literature, we critically evaluate the analytical performance of the in-house vs commercial kit-based approach. Finally, we propose an algorithm aimed at integrating the present strategies of the laboratory diagnostics in AE for the best clinical management of patients with these disorders.
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Affiliation(s)
- Stefano Masciocchi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Pietro Businaro
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Morandi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
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Ryding M, Mikkelsen AW, Nissen MS, Nilsson AC, Blaabjerg M. Pathophysiological Effects of Autoantibodies in Autoimmune Encephalitides. Cells 2023; 13:15. [PMID: 38201219 PMCID: PMC10778077 DOI: 10.3390/cells13010015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/12/2024] Open
Abstract
The heterogeneity of autoantibody targets in autoimmune encephalitides presents a challenge for understanding cellular and humoral pathophysiology, and the development of new treatment strategies. Thus, current treatment aims at autoantibody removal and immunosuppression, and is primarily based on data generated from other autoimmune neurological diseases and expert consensus. There are many subtypes of autoimmune encephalitides, which now entails both diseases with autoantibodies targeting extracellular antigens and classical paraneoplastic syndromes with autoantibodies targeting intracellular antigens. Here, we review the current knowledge of molecular and cellular effects of autoantibodies associated with autoimmune encephalitis, and evaluate the evidence behind the proposed pathophysiological mechanisms of autoantibodies in autoimmune encephalitis.
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Affiliation(s)
- Matias Ryding
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
| | - Anne With Mikkelsen
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | | | - Anna Christine Nilsson
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Department of Clinical Immunology, Odense University Hospital, 5000 Odense, Denmark;
| | - Morten Blaabjerg
- Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark;
- Neurobiology Research, Institute of Molecular Medicine, University of Southern Denmark, 5000 Odense, Denmark
- Department of Neurology, Odense University Hospital, 5000 Odense, Denmark;
- Brain Research—Inter Disciplinary Guided Excellence (BRIDGE), 5000 Odense, Denmark
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22
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Quack L, Glatter S, Wegener-Panzer A, Cleaveland R, Bertolini A, Endmayr V, Seidl R, Breu M, Wendel E, Schimmel M, Baumann M, Rauchenzauner M, Pritsch M, Boy N, Muralter T, Kluger G, Makoswski C, Kraus V, Leiz S, Loehr-Nilles C, Kreth JH, Braig S, Schilling S, Kern J, Blank C, Tro Baumann B, Vieth S, Wallot M, Reindl M, Ringl H, Wandinger KP, Leypoldt F, Höftberger R, Rostásy K. Autoantibody status, neuroradiological and clinical findings in children with acute cerebellitis. Eur J Paediatr Neurol 2023; 47:118-130. [PMID: 38284996 DOI: 10.1016/j.ejpn.2023.10.005] [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: 06/04/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Acute cerebellitis (AC) in children and adolescents is an inflammatory disease of the cerebellum due to viral or bacterial infections but also autoimmune-mediated processes. OBJECTIVE To investigate the frequency of autoantibodies in serum and CSF as well as the neuroradiological features in children with AC. MATERIAL AND METHODS Children presenting with symptoms suggestive of AC defined as acute/subacute onset of cerebellar symptoms and MRI evidence of cerebellar inflammation or additional CSF pleocytosis, positive oligoclonal bands (OCBs), and/or presence of autoantibodies in case of negative cerebellar MRI. Children fulfilling the above-mentioned criteria and a complete data set including clinical presentation, CSF studies, testing for neuronal/cerebellar and MOG antibodies as well as MRI scans performed at disease onset were eligible for this retrospective multicenter study. RESULTS 36 patients fulfilled the inclusion criteria for AC (f:m = 14:22, median age 5.5 years). Ataxia was the most common cerebellar symptom present in 30/36 (83 %) in addition to dysmetria (15/36) or dysarthria (13/36). A substantial number of children (21/36) also had signs of encephalitis such as somnolence or seizures. In 10/36 (28 %) children the following autoantibodies (abs) were found: MOG-abs (n = 5) in serum, GFAPα-abs (n = 1) in CSF, GlyR-abs (n = 1) in CSF, mGluR1-abs (n = 1) in CSF and serum. In two further children, antibodies were detected only in serum (GlyR-abs, n = 1; GFAPα-abs, n = 1). MRI signal alterations in cerebellum were found in 30/36 children (83 %). Additional supra- and/or infratentorial lesions were present in 12/36 children, including all five children with MOG-abs. Outcome after a median follow-up of 3 months (range: 1 a 75) was favorable with an mRS ≤2 in 24/36 (67 %) after therapy. Antibody (ab)-positive children were significantly more likely to have a better outcome than ab-negative children (p = .022). CONCLUSION In nearly 30 % of children in our study with AC, a range of abs was found, underscoring that autoantibody testing in serum and CSF should be included in the work-up of a child with suspected AC. The detection of MOG-abs in AC does expand the MOGAD spectrum.
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Affiliation(s)
- L Quack
- Department of Pediatric Neurology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - S Glatter
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria; Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - A Wegener-Panzer
- Department of Pediatric Radiology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - R Cleaveland
- Department of Pediatric Radiology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - A Bertolini
- Department of Pediatric Neurology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - V Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - R Seidl
- Department of Pediatrics, Bethanien Hospital, Moers, Germany
| | - M Breu
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - E Wendel
- Division of Pediatric Neurology, Department of Pediatrics, Olgahospital, Stuttgart, Germany
| | - M Schimmel
- Division of Pediatric Neurology, Clinic of Pediatrics, Augsburg University Hospital, University of Augsburg, Augsburg, Germany
| | - M Baumann
- Department of Pediatric I, Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Rauchenzauner
- Department of Pediatric I, Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria; Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Hospital for Neuropediatrics and Neurological Rehabilitation, Vogtareuth, Germany
| | - M Pritsch
- Department of Neuropediatrics, Children's Hospital DRK Siegen, Siegen, Germany
| | - N Boy
- Centre for Child and Adolescent Medicine, Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - T Muralter
- Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Hospital for Neuropediatrics and Neurological Rehabilitation, Vogtareuth, Germany
| | - G Kluger
- Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Hospital for Neuropediatrics and Neurological Rehabilitation, Vogtareuth, Germany; Research Institute for Rehabilitation, Transition, and Palliation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Makoswski
- Pediatric Neurology, Department of Pediatrics, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, Germany
| | - V Kraus
- Pediatric Neurology, Department of Pediatrics, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, Germany; Social Pediatrics, Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - S Leiz
- Department of Pediatrics and Adolescent Medicine, Hospital Dritter Orden, Munich, Germany
| | - C Loehr-Nilles
- Department of Neuropediatrics, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - J H Kreth
- Department of Neuropediatrics, Social Pediatric Center, Klinikum Leverkusen, Leverkusen, Germany
| | - S Braig
- Department of Pediatrics, Klinikum Bayreuth, Bayreuth, Germany
| | - S Schilling
- Department of Neuropediatrics, Clinic of Pediatrics, Barmherzige Brüder St. Hedwig Hospital, Regensburg, Germany
| | - J Kern
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Germany
| | - C Blank
- Department of Pediatric Neurology, Children's Hospital St. Marien, Landshut, Germany
| | - B Tro Baumann
- Department of Neuropediatrics, Children's Hospital DRK Siegen, Siegen, Germany
| | - S Vieth
- Department of Pediatrics, University Medical Center Schleswig Holstein, Kiel, Germany
| | - M Wallot
- Department of Pediatrics, Bethanien Hospital, Moers, Germany
| | - M Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - H Ringl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria; Department of Radiology, Klinik Donaustadt, Vienna, Austria
| | - K P Wandinger
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | - F Leypoldt
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - K Rostásy
- Department of Pediatric Neurology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany.
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Wang H, Yi B, Wang M, Wang Y, Fu J, Wang X, Cao L. Cerebellar ataxia with anti-mGluR1 auto-antibody in a pediatric patient: A case report. J Neuroimmunol 2023; 378:578082. [PMID: 37119682 DOI: 10.1016/j.jneuroim.2023.578082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023]
Abstract
Cerebellar ataxia (CA) related to anti-metabolic glutamate receptor 1 (mGluR1) is a rare autoimmune encephalitis, which is manifested as acute or subacute CA in most cases.To the best of our knowledge, only three cases of pediatric patients have been reported in the literature so far. This article reports the 4th case of mGluR1 related CA in a pediatric patient.
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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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25
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Sakashita K, Nishida K, Takenaka Y, Yokota I, Yamasaki H, Nishimoto K, Kawamoto K, Mitani M, Funakawa I, Yoshikura N, Kimura A, Shimohata T, Futamura N. Favorable Outcome with Intravenous Immunoglobulin Therapy in Late-Onset Anti-mGluR1 Encephalitis: A Case Report and Literature Review. Case Rep Neurol 2023; 14:494-500. [PMID: 36654530 PMCID: PMC9841793 DOI: 10.1159/000526632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/01/2022] [Indexed: 01/20/2023] Open
Abstract
Anti-metabotropic glutamate receptor 1 (mGluR1) encephalitis is a rare autoimmune disorder manifesting with cerebellar syndrome. Patients with mGluR1 encephalitis have been treated with immunomodulatory therapies; however, little is known about the efficacy of this therapy. A 58-year-old Japanese woman presented with dizziness when walking and standing up. Symptoms persisted and the patient gradually deteriorated. The neurological examination revealed a broad-based gait, horizontal and slightly gaze-evoked nystagmus, noticeable head titubation, and truncal ataxia without limb ataxia. Magnetic resonance imaging was normal. The 123I-isopropyl-iodoamphetamine single-photon emission-computed tomography scans showed normal cerebellar perfusion. Based on a positive antibody test for anti-mGluR1, the patient was diagnosed with anti-mGluR1 encephalitis. She was treated with intravenous methylprednisolone and intravenous immunoglobulin (IVIg). Symptoms gradually improved over 1 month and almost disappeared after additional IVIg therapy. Anti-mGluR1 encephalitis is a rare disease, and effective treatment is unclear. In this case, a favorable outcome was obtained with immunomodulatory therapy, even though the neurological disability of the disease course is worse. We emphasize the importance of early diagnosis and therapeutic intervention, suspecting the disease on the basis of its characteristic symptoms.
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Affiliation(s)
- Kento Sakashita
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan,*Kento Sakashita,
| | - Katsuya Nishida
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Yu Takenaka
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Ichiro Yokota
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Hiroshi Yamasaki
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Keisuke Nishimoto
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Kunihiko Kawamoto
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Maki Mitani
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Itaru Funakawa
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
| | - Nobuaki Yoshikura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akio Kimura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takayoshi Shimohata
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Naonobu Futamura
- Department of Neurology, National Hospital Organization Hyogo-Chuo National Hospital, Sanda, Japan
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26
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Mitoma H, Manto M. Advances in the Pathogenesis of Auto-antibody-Induced Cerebellar Synaptopathies. CEREBELLUM (LONDON, ENGLAND) 2023; 22:129-147. [PMID: 35064896 PMCID: PMC9883363 DOI: 10.1007/s12311-021-01359-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/12/2021] [Indexed: 02/07/2023]
Abstract
The presence of auto-antibodies that target synaptic machinery proteins was documented recently in immune-mediated cerebellar ataxias. The autoantigens include glutamic acid decarboxylase 65 (GAD65), voltage-gated Ca2+ channel (VGCC), metabotropic glutamate receptor type 1 (mGluR1), and glutamate receptor delta (GluRdelta). GAD65 is involved in the synthesis, packaging, and release of GABA, whereas the other three play important roles in the induction of long-term depression (LTD). Thus, the auto-antibodies toward these synaptic molecules likely impair fundamental synaptic machineries involved in unique functions of the cerebellum, potentially leading to the development of cerebellar ataxias (CAs). This concept has been substantiated recently by a series of physiological studies. Anti-GAD65 antibody (Ab) acts on the terminals of inhibitory neurons that suppress GABA release, whereas anti-VGCC, anti-mGluR1, and anti-GluR Abs impair LTD induction. Notably, the mechanisms that link synaptic dysfunction with the manifestations of CAs can be explained by disruption of the "internal models." The latter can be divided into three levels. First, since chained inhibitory neurons shape the output signals through the mechanism of disinhibition/inhibition, impairments of GABA release and LTD distort the conversion process from the "internal model" to the output signals. Second, these antibodies impair the induction of synaptic plasticity, rebound potentiation, and LTD, on Purkinje cells, resulting in loss of restoration and compensation of the distorted "internal models." Finally, the cross-talk between glutamate and microglia/astrocytes could involve a positive feedback loop that accelerates excitotoxicity. This mini-review summarizes the pathophysiological mechanisms and aims to establish the basis of "auto-antibody-induced cerebellar synaptopathies."
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Affiliation(s)
- Hiroshi Mitoma
- Department of Medical Education, Tokyo Medical University, Tokyo, Japan
| | - Mario Manto
- Unité des Ataxies Cérébelleuses, Service de Neurologie, Médiathèque Jean Jacquy, CHU-Charleroi, 6000 Charleroi, Belgium ,Service des Neurosciences, University of Mons, 7000 Mons, Belgium
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Guo K, Liu X, Gong X, Li A, Liu Y, Li X, Zhou D, Hong Z. Autoimmune encephalitis with mGluR5 antibodies: A case series from China and review of the literature. Front Immunol 2023; 14:1146536. [PMID: 37025999 PMCID: PMC10070949 DOI: 10.3389/fimmu.2023.1146536] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/03/2023] [Indexed: 04/08/2023] Open
Abstract
Background Only 15 patients of autoimmune encephalitis with metabotropic glutamate receptor 5 (mGluR5) antibodies have been reported worldwide since 2011, mostly from western countries. Patients with different genetic backgrounds are necessary to further clarify the clinical phenotype and prognosis of this rare disease. Objective We initially describe a case series from China to confirm the previous findings, expand the clinical phenotype, and identify the prognostic factors of autoimmune encephalitis with mGluR5 antibodies. Methods Observational data with follow-up were prospectively collected from autoimmune encephalitis patients with mGluR5 antibodies. Clinical information and outcomes on current and previously reported cases were combined and analyzed. Results We identified five patients (median age 35 years); two were female. The main clinical manifestations were behavioral/personality changes (five of five, 100%) and cognitive disorders (four of five, 80%), accompanied with other neurologic symptoms. Hypoventilation occurred in two (40%) patients, which was life-threatening. One patient had meningoencephalitis, suggesting a new phenotype in anti-mGluR5 encephalitis. All patients received immunotherapy. At the last follow-up (median 18 months), two (40%) patients showed complete recovery, two (40%) patients showed partial recovery, and one (20%) patient died. One (20%) patient had multiple relapses. Together with the 15 previously reported cases, associated tumors occurred in seven of 12 (58%) Western patients vs. one of eight (13%) Chinese patients. Modified Rankin Scale (mRS) scores at the last follow-up (median 31 months) were available in 16 patients. Patients with bad outcomes (mRS > 2, n = 4) were more likely to have hypoventilation at onset and higher mRS scores at peak of the disease. Conclusions In patients with different genetic background, as Chinese, the clinical phenotype of anti-mGluR5 encephalitis is similar. Fewer paraneoplastic cases were observed in Chinese patients. Most patients showed good responses to immunotherapy and cancer treatment. The clinical outcomes were favorable in most patients.
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Affiliation(s)
- Kundian Guo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xu Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xue Gong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Aiqing Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Liu
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xingjie Li
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dong Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhen Hong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Institute of Brain Science and Brain-inspired Technology of West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Neurology, Chengdu Shangjin Nanfu Hospital, Chengdu, Sichuan, China
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28
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Khojah O, Makkawi S, Alghamdi S. Anti-mGluR1 encephalitis: Case illustration and systematic review. Front Neurol 2023; 14:1142160. [PMID: 37139064 PMCID: PMC10149714 DOI: 10.3389/fneur.2023.1142160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background The literature for immune-mediated neurological disorders is evolving like no other field of neurological illnesses. Many new antibodies or disorders have been described in the last decade. The cerebellum is a brain structure susceptible to these immune-mediated pathologies, and anti-metabotropic glutamate receptor 1 (mGluR1) antibody has a predilection to the cerebellar tissue. Anti-mGluR1 encephalitis is a rare autoimmune disease affecting the central and peripheral nervous systems, triggering an acute or subacute cerebellar syndrome with varying degrees of severity. Anti-mGluR1 encephalitis is a rare autoimmune disease affecting the central nervous system. We aimed to systematically review reported cases of anti-mGluR1 encephalitis and summarize their clinical presentation, management, outcomes, and case reports. Methods A search of the PubMed and Google Scholar databases was conducted and included all cases of anti-mGluR1 encephalitis published in English before October 1, 2022. A comprehensive systematic review was conducted using "metabotropic glutamate receptor type 1," "mGluR1," autoantibodies," "autoantibodies," "autoimmunity," and "antibody" as keywords. The risk of bias assessment of the evidence was performed using appropriate tools. The qualitative variables were presented as frequency and percentage. Results Including our case, 36 cases of anti-mGluR1 encephalitis (19 males, median age 52.5 years, 11.1% pediatric cases) have been reported. The most common clinical manifestations are ataxia, dysarthria, and nystagmus. Initial imaging was normal in 44.4% of patients; however, 75% of patients showed abnormality later in the disease course. The first-line therapy options include glucocorticoids, intravenous immunoglobulin, and plasma exchange. Rituximab is the most commonly used second-line treatment. Complete remission was achieved in only 22.2% of patients, and 61.8% were disabled by the end of their course. Conclusion Anti-mGluR1 encephalitis manifests as symptoms of cerebellar pathology. Although the natural history has not been completely elucidated, early diagnosis with prompt initiation of immunotherapy could be imperative. Any patient suspected to have autoimmune cerebellitis should be tested for the presence of anti-mGluR1 antibody in the serum and cerebrospinal fluid. Escalation to an aggressive therapy approach should be applied in cases that do not respond to first-line therapies, and extended follow-up durations are required in all cases.
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Affiliation(s)
- Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- *Correspondence: Saeed Alghamdi,
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29
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Gaig C, Graus F. Motor symptoms in nonparaneoplastic CNS disorders associated with neural antibodies. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:277-294. [PMID: 37620074 DOI: 10.1016/b978-0-323-98817-9.00004-1] [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: 08/26/2023]
Abstract
Motor symptoms are common, and sometimes predominant, in almost all nonparaneoplastic CNS disorders associated with neural antibodies. These CNS disorders can be classified into five groups: (1) Autoimmune encephalitis with antibodies against synaptic receptors, (2) cerebellar ataxias associated with neuronal antibodies that mostly target intracellular antigens. (3) Stiff-person syndrome and progressive encephalomyelitis with rigidity and myoclonus which have antibodies against glutamic acid decarboxylase and glycine receptor, respectively. Both diseases have in common the presence of predominant muscle stiffness and rigidity. (4) Three diseases associated with glial antibodies. Two present motor symptoms mainly due to the involvement of the spinal cord: neuromyelitis optica spectrum disorders with aquaporin-4 antibodies and myelin oligodendrocyte glycoprotein antibody-associated disease. The third disorder is the meningoencephalitis associated with glial fibrillar acidic protein antibodies which frequently also presents a myelopathy. (5) Two antibody-related diseases which are characterized by prominent sleep dysfunction: anti-IgLON5 disease, a disorder that frequently presents a variety of movement disorders, and Morvan syndrome associated with contactin-associated protein-like 2 antibodies and clinical manifestations of peripheral nerve hyperexcitability. In this chapter, we describe the main clinical features of these five groups with particular emphasis on the presence, frequency, and types of motor symptoms.
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Affiliation(s)
- Carles Gaig
- Neurology Service, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Francesc Graus
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
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30
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Binks S, Lamquet S, Crawford AH, Meurs A, Irani SR, Pakozdy A. Parallel roles of neuroinflammation in feline and human epilepsies. Vet J 2022; 290:105912. [PMID: 36209994 PMCID: PMC10912827 DOI: 10.1016/j.tvjl.2022.105912] [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: 01/22/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Autoimmune encephalitis refers to a group of disorders characterised by a non-infectious encephalitis, often with prominent seizures and surface neuronal autoantibodies. AE is an important cause of new-onset refractory status epilepticus in humans and is frequently responsive to immunotherapies including corticosteroids, plasma exchange, intravenous immunoglobulin G and rituximab. Recent research suggests that parallel autoantibodies can be detected in non-human mammalian species. The best documented example is leucine-rich glioma-inactivated 1 (LGI1)-antibodies in domestic cats with limbic encephalitis (LE). In this review, we discuss the role of neuroinflammation and autoantibodies in human and feline epilepsy and LE.
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Affiliation(s)
- Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK.
| | - Simon Lamquet
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Abbe H Crawford
- Clinical Science and Services, The Royal Veterinary College, Hertfordshire AL9 7TA, UK
| | - Alfred Meurs
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK
| | - Akos Pakozdy
- University Clinic for Small Animals, University of Veterinary Medicine Vienna, Austria
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31
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Goh L, Wang FS, Han VX, Lin JB. Teaching Video NeuroImage: Subacute Cerebellar Ataxia in an Adolescent With Antibodies Against Metabotropic Glutamate Receptor Type 1. Neurology 2022; 99:862-863. [PMID: 36240082 DOI: 10.1212/wnl.0000000000201268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- LiTing Goh
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore
| | - Furene Sijia Wang
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore
| | - Velda Xinying Han
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore.
| | - Jeremy Bingyuan Lin
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore
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Peter E, Do LD, Hannoun S, Muñiz-Castrillo S, Vogrig A, Wucher V, Pinto AL, Chounlamountri N, Zakaria W, Rogemond V, Picard G, Hedou JJ, Ambati A, Alentorn A, Traverse-Glehen A, Manto M, Psimaras D, Mignot E, Cotton F, Desestret V, Honnorat J, Joubert B. Cerebellar Ataxia With Anti-DNER Antibodies. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/5/e200018. [PMID: 35940913 PMCID: PMC9359625 DOI: 10.1212/nxi.0000000000200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
Background and Objectives There is no report on the long-term outcomes of ataxia with antibodies against Delta and Notch-like epidermal growth factor–related (DNER). We aimed to describe the clinical-immunologic features and long-term outcomes of patients with anti-DNER antibodies. Methods Patients tested positive for anti-DNER antibodies between 2000 and 2020 were identified retrospectively. In those with available samples, immunoglobulin G (IgG) subclass analysis, longitudinal cerebellum volumetry, human leukocyte antigen isotyping, and CSF proteomic analysis were performed. Rodent brain membrane fractionation and organotypic cerebellar slices were used to study DNER cell-surface expression and human IgG binding to the Purkinje cell surface. Results Twenty-eight patients were included (median age, 52 years, range 19–81): 23 of 28 (82.1%) were male and 23 of 28 (82.1%) had a hematologic malignancy. Most patients (27/28, 96.4%) had cerebellar ataxia; 16 of 28 (57.1%) had noncerebellar symptoms (cognitive impairment, neuropathy, and/or seizures), and 27 of 28 (96.4%) became moderately to severely disabled. Half of the patients (50%) improved, and 32.1% (9/28) had no or slight disability at the last visit (median, 26 months; range, 3–238). Good outcome significantly associated with younger age, milder clinical presentations, and less decrease of cerebellar gray matter volumes at follow-up. No human leukocyte antigen association was identified. Inflammation-related proteins were overexpressed in the patients' CSF. In the rodent brain, DNER was enriched in plasma membrane fractions. Patients' anti-DNER antibodies were predominantly IgG1/3 and bound live Purkinje cells in vitro. Discussion DNER ataxia is a treatable condition in which nearly a third of patients have a favorable outcome. DNER antibodies bind to the surface of Purkinje cells and are therefore potentially pathogenic, supporting the use of B-cell–targeting treatments.
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Affiliation(s)
- Elise Peter
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Le Duy Do
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Salem Hannoun
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Sergio Muñiz-Castrillo
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Alberto Vogrig
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Valentin Wucher
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Anne-Laurie Pinto
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Naura Chounlamountri
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Walaa Zakaria
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Veronique Rogemond
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Geraldine Picard
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Julien-Jacques Hedou
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Aditya Ambati
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Agusti Alentorn
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Alexandra Traverse-Glehen
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Mario Manto
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Dimitri Psimaras
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Emmanuel Mignot
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Francois Cotton
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Virginie Desestret
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Jérôme Honnorat
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France
| | - Bastien Joubert
- From the Centre National de Référence pour les Syndromes Neurologiques Paranéoplasiques (E.P., S.M.-C., A.V., A.-L.P., V.R., G.P., V.D.,J.H., B.J.), Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Synaptopathies and Autoantibodies (SynatAc) Team (E.P., L.D.D., S.M.-C., A.V., V.W., N.C., V.D., J.H., B.J.), Institut NeuroMyoGène-MeLis, INSERM U1314/CNRS UMR 5284, Université de Lyon, France; Medical Imaging Sciences Program (S.H., W.Z.), Division of Health Professions, Faculty of Health Sciences, American University of Beirut, Lebanon; Center for Sleep Sciences and Medicine (J.-J.H., Aditya Ambati, E.M.), Stanford University, Palo Alto, CA; Service de Neurologie 2-Mazarin (Agusti Alentorn, D.P.), Hôpitaux Universitaires La Pitié-Salpêtrière-Charles Foix, APHP; Inserm U1127 CNRS UMR 7225 (Agusti Alentorn, D.P.), Institut du Cerveau et de la Moelle épinière, ICM, Université Pierre-et-Marie-Curie, Sorbonne Universités, Paris, France; INSERM Unité Mixte de Recherche (UMR) S1052 (A.T.-G.), Centre National de la Recherche UMR 5286, Centre de Recherche en Cancérologie de Lyon, France; Département de Pathologie (A.T.-G.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite Cedex, France; Service des Neurosciences (M.M.), UMons, Mons, Belgium; Service de Neurologie (M.M.), CHU-Charleroi, Charleroi, Belgium; Department of Radiology (F.C.), Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre-Bénite, France; and Université Lyon 1 (F.C.), CREATIS-LRMN, CNRS/UMR/5220-INSERM U630, Villeurbanne, France.
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Autoimmune encephalitis and CSF anti-AMPA GluR3 antibodies in childhood: a case report and literature review. Neurol Sci 2022; 43:5237-5241. [PMID: 35639215 DOI: 10.1007/s10072-022-06170-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/22/2022] [Indexed: 10/18/2022]
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Rare Etiologies in Immune-Mediated Cerebellar Ataxias: Diagnostic Challenges. Brain Sci 2022; 12:brainsci12091165. [PMID: 36138901 PMCID: PMC9496914 DOI: 10.3390/brainsci12091165] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/06/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
The cerebellum is particularly enriched in antigens and represents a vulnerable target to immune attacks. Immune-mediated cerebellar ataxias (IMCAs) have diverse etiologies, such as gluten ataxia (GA), post-infectious cerebellitis (PIC), Miller Fisher syndrome (MFS), paraneoplastic cerebellar degeneration (PCD), opsoclonus myoclonus syndrome (OMS), and anti-GAD ataxia. Apart from these well-established entities, cerebellar ataxia (CA) occurs also in association with autoimmunity against ion channels and related proteins, synaptic adhesion/organizing proteins, transmitter receptors, glial cells, as well as the brainstem antigens. Most of these conditions manifest diverse neurological clinical features, with CAs being one of the main clinical phenotypes. The term primary autoimmune cerebellar ataxia (PACA) refers to ataxic conditions suspected to be autoimmune even in the absence of specific well-characterized pathogenic antibody markers. We review advances in the field of IMCAs and propose a clinical approach for the understanding and diagnosis of IMCAs, focusing on rare etiologies which are likely underdiagnosed. The frontiers of PACA are discussed. The identification of rare immune ataxias is of importance since they are potentially treatable and may lead to a severe clinical syndrome in absence of early therapy.
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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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Wu Q, Gong B, Jiang A, Qin X. Case report and literature analysis: Autoimmune cerebellar ataxia associated with homer-3 antibodies. Front Neurol 2022; 13:951659. [PMID: 35959384 PMCID: PMC9360609 DOI: 10.3389/fneur.2022.951659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/04/2022] [Indexed: 11/23/2022] Open
Abstract
Objective We present a case of autoimmune cerebellar ataxia (ACA) associated with Homer protein homolog 3 (Homer-3) antibodies. Then, a review of the literature was conducted to summarize its clinical spectrum to improve clinicians' understanding of this rare entity. Case presentation A 25-year-old man suffered from the subacute onset of cerebellar ataxia and psychiatric symptoms with abnormalities in the cerebellum on initial brain MRI and Homer-3 antibodies titers of 1:100 in the serum. His neurological symptoms did not improve after intravenous methylprednisolone but significantly improved following plasma exchange with a modified Rankin Scale (mRS) score of 1. However, 5 months later, he experienced relapse during oral prednisone tapering with enhanced cerebellar lesions and obvious cerebellar atrophy on repeated MRI. Various immunomodulatory approaches, including corticosteroids and plasma exchange, were utilized with no improvement. Then rituximab was given for the first time to treat Homer-3 autoimmunity with partial improvement of symptoms. However, the patient remained profoundly disabled with an mRS score of 4. Conclusion ACA associated with Homer-3 antibodies may have a suboptimal response to corticosteroid therapy. More intense immunotherapy such as rituximab may contribute to the improvement of cerebellar syndrome. Relapsing courses and presentation of cerebellar atrophy may suggest a poor prognosis in this entity.
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Affiliation(s)
- Qisi Wu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Beibei Gong
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Anan Jiang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- *Correspondence: Xinyue Qin
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Kelch-like protein 11 antibody-associated paraneoplastic neurological syndrome: A state-of-the-art review. Clin Immunol 2022; 241:109074. [PMID: 35809856 DOI: 10.1016/j.clim.2022.109074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/01/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022]
Abstract
The Kelch-like protein 11 antibody-associated paraneoplastic neurological syndrome (KLHL 11-PNS) was first identified in 2019. This novel antibody, targeting the intracellular KLHL 11 antigen, can be detected in serum and cerebrospinal fluid using tissue-based and cell-based assays. It is thought to be a biomarker for a T-cell autoimmunity response. The most likely immunopathogenesis of KLHL 11-PNS appears to be linked to cytotoxic T-cell-mediated neuronal injury and loss. Patients have adult-male predilection, rhombencephalitis (brainstem and / or cerebellar involvement), and a robust oncological correlation with testicular germ cell tumors (predominately seminoma). Brain magnetic resonance imaging demonstrated T2 / fluid-attenuated inversion recovery hyperintensities and atrophy of the temporal lobe, cerebellum, and brainstem. Most patients responded poorly to immunotherapy and oncotherapy and thus had a poor long-term prognosis. We review the literature and provide an update of current knowledge regarding KLHL 11-PNS, including epidemiology, underlying mechanism, clinical presentations, paraclinical and oncological findings, diagnostic workup, and treatment approaches.
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Winklehner M, Bauer J, Endmayr V, Schwaiger C, Ricken G, Motomura M, Yoshimura S, Shintaku H, Ishikawa K, Tsuura Y, Iizuka T, Yokota T, Irioka T, Höftberger R. Paraneoplastic Cerebellar Degeneration With P/Q-VGCC vs Yo Autoantibodies. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:e200006. [PMID: 36070310 PMCID: PMC9278121 DOI: 10.1212/nxi.0000000000200006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 04/14/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Paraneoplastic cerebellar degeneration (PCD) is characterized by a widespread loss of Purkinje cells (PCs) and may be associated with autoantibodies against intracellular antigens such as Yo or cell surface neuronal antigens such as the P/Q-type voltage-gated calcium channel (P/Q-VGCC). Although the intracellular location of the target antigen in anti-Yo-PCD supports a T cell-mediated pathology, the immune mechanisms in anti-P/Q-VGCC-PCD remain unclear. In this study, we compare neuropathologic characteristics of PCD with anti-P/Q-VGCC and anti-Yo autoantibodies in an archival autopsy cohort. METHODS We performed neuropathology, immunohistochemistry, and multiplex immunofluorescence on formalin-fixed and paraffin-embedded brain tissue of 1 anti-P/Q-VGCC, 2 anti-Yo-PCD autopsy cases and controls. RESULTS Anti-Yo-PCD revealed a diffuse and widespread PC loss together with microglial nodules with pSTAT1+ and CD8+granzymeB+ T cells and neuronal upregulation of major histocompatibility complex (MHC) Class I molecules. Some neurons showed a cytoplasmic immunoglobulin G (IgG) staining. In contrast, PC loss in anti-P/Q-VGCC-PCD was focal and predominantly affected the upper vermis, whereas caudal regions and lateral hemispheres were spared. Inflammation was characterized by scattered CD8+ T cells, single CD20+/CD79a+ B/plasma cells, and an IgG staining of the neuropil in the molecular layer of the cerebellar cortex and neuronal cytoplasms. No complement deposition or MHC-I upregulation was detected. Moreover, synaptophysin was reduced, and neuronal P/Q-VGCC was downregulated. In affected areas, axonal spheroids and the accumulation of amyloid precursor protein and glucose-regulated protein 78 in PCs indicate endoplasmatic reticulum stress and impairment of axonal transport. In both PCD types, calbindin expression was reduced or lost in the remaining PCs. DISCUSSION Anti-Yo-PCD showed characteristic features of a T cell-mediated pathology, whereas this was not observed in 1 case of anti-P/Q-VGCC-PCD. Our findings support a pathogenic role of anti-P/Q-VGCC autoantibodies in causing neuronal dysfunction, probably due to altered synaptic transmission resulting in calcium dysregulation and subsequent PC death. Because disease progression may lead to irreversible PC loss, anti-P/Q-VGCC-PCD patients could benefit from early oncologic and immunologic therapies.
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Affiliation(s)
- Michael Winklehner
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Jan Bauer
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Verena Endmayr
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Carmen Schwaiger
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Gerda Ricken
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Masakatsu Motomura
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Shunsuke Yoshimura
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Hiroshi Shintaku
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Kinya Ishikawa
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Yukio Tsuura
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Takahiro Iizuka
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
| | - Takanori Yokota
- From the Division of Neuropathology and Neurochemistry (M.W., V.E., C.S., G.R.,
R.H.), Department of Neurology, and Department of Neuroimmunology (J.B.), Center
for Brain Research, Medical University of Vienna, Austria; Department of
Electrical and Electronics Engineering (M.M.), Faculty of Engineering, Nagasaki
Institute of Applied Science; Department of Neurology and Strokology (S.Y.),
Nagasaki University Hospital; Neurology Clinic with Neuromorphomics Laboratory
(H.S.), Nitobe Memorial Nakano General Hospital, Tokyo; Division of Surgical
Pathology (H.S.), Tokyo Medical and Dental University Hospital; The Center for
Personalized Medicine for Healthy Aging (K.I.), Tokyo Medical and Dental
University; Departments of Diagnostic Pathology and Clinical Laboratory (Y.T.),
Yokosuka Kyosai Hospital, Kanagawa; Department of Neurology (T. Iizuka),
Kitasato University School of Medicine, Kanagawa; Department of Neurology and
Neurological Science (T.Y.), Graduate School, Tokyo Medical and Dental
University; and Department of Neurology (T. Irioka), Yokosuka Kyosai Hospital,
Kanagawa, Japan
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Vinke AM, Zong S, Janssen JH, Correia-Hoffmann C, Mané-Damas M, Damoiseaux JG, de Vries J, Pröpper D, Molenaar P, Losen M, Martinez Martinez P, Rouhl RP. Autoimmune Encephalitis With mGluR1 Antibodies Presenting With Epilepsy, but Without Cerebellar Signs. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/4/e1171. [PMID: 35450924 PMCID: PMC9028296 DOI: 10.1212/nxi.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/27/2022] [Indexed: 11/26/2022]
Abstract
Objective To describe the unique case history of a patient with mGluR1 antibodies, with mainly limbic and without cerebellar symptoms. Methods A 50-year-old woman initially presented with focal seizures with epigastric rising and déjà-vu sensations, next to cognitive complaints, and musical auditory hallucinations. MRI, EEG, and neuronal autoantibody tests were performed. Results EEG findings showed slow and sharp activity (sharp waves and sharp-wave–slow-wave complex) in the left temporal lobe. A test for autoantibodies was negative initially. Because of persistent symptoms, serum and CSF were tested 4 years later and found positive for mGluR1 antibodies. Treatment started with monthly IV immunoglobulins and azathioprine that was replaced by mycophenolate mofetil later. Especially cognitive symptoms and hallucinations did not respond well to the treatment. During treatment, mGluR1 antibodies remained present in CSF. Discussion Whereas cerebellar symptoms are present in 97% of mGluR1-positive cases, our patient presented without ataxia. Therefore, we suggest that the clinical presentation of patients with mGluR1 antibodies is probably more diverse than previously described. Testing for mGluR1 antibodies should be considered in patients with limbic encephalitis and epilepsy, especially when negative for more common antibodies.
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40
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Kuang Z, Baizabal-Carvallo JF, Mofatteh M, Xie S, Wang Z, Chen Y. Anti-homer-3 Antibody Encephalitis in a 10-Year-Old Child: Case Report and Review of the Literature. Front Neurol 2022; 13:929778. [PMID: 35769364 PMCID: PMC9234694 DOI: 10.3389/fneur.2022.929778] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We present a rare case with anti-Homer-3 antibodies positive encephalitis in the youngest patient ever identified and reviewed the literature. Case Report A 10-year-old, Chinese boy came for evaluation of a 2-week history of cognitive impairment, irritability, dysarthria, and cautious gait. The neurological examination was consistent with the pan-cerebellar syndrome and encephalopathy. Cerebrospinal fluid (CSF) was inflammatory with increased leukocytes. Magnetic resonance imaging of the brain showed hyperintensities in both cerebellar hemispheres and vermis in Fluid-attenuated inversion recovery (FLAIR) and T2- weighted sequences. Infectious disorders were ruled out, but positivity for anti-Homer-3 antibodies was detected in the CSF, but not in the serum. Additionally, low titers of voltage-gated calcium channel (VGCC) antibodies were found in the serum. Treatment with intravenous (IV) corticosteroids did not provide meaningful clinical improvement; however, the patient achieved almost complete recovery (modified Ranking Scale score: 1) following IV immunoglobulin. Conclusion Anti-Homer-3 cerebellar ataxia with encephalopathy should be considered within the differential diagnosis of acute inflammatory cerebellar disease in children and it may coexist with VGCC antibodies.
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Affiliation(s)
- Zuying Kuang
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - José Fidel Baizabal-Carvallo
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, United States
- Department of Sciences and Engineering, University of Guanajuato, León, Mexico
| | - Mohammad Mofatteh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Sifen Xie
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
| | - Zhanhang Wang
- Department of Neurology, Guangdong 999 Brain Hospital, Guangzhou, China
- *Correspondence: Yimin Chen
| | - Yimin Chen
- Department of Neurology, Foshan Sanshui District People's Hospital, Foshan, China
- Zhanhang Wang
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Abstract
PURPOSE OF REVIEW Autoimmune encephalitis (AE) refers to immune-mediated neurological syndromes often characterised by the detection of pathogenic autoantibodies in serum and/or cerebrospinal fluid which target extracellular epitopes of neuroglial antigens. There is increasing evidence these autoantibodies directly modulate function of their antigens in vivo. Early treatment with immunotherapy improves outcomes. Yet, these patients commonly exhibit chronic disability. Importantly, optimal therapeutic strategies at onset and during escalation remain poorly understood. In this review of a rapidly emerging field, we evaluate recent studies on larger cohorts, registries, and meta-analyses to highlight existing evidence for contemporary therapeutic approaches in AE. RECENT FINDINGS We highlight acute and long-term treatments used in specific AE syndromes, exemplify how understanding disease pathogenesis can inform precision therapy and outline challenges of defining disability outcomes in AE. SUMMARY Early first-line immunotherapies, including corticosteroids and plasma exchange, improve outcomes, with emerging evidence showing second-line immunotherapies (especially rituximab) reduce relapse rates. Optimal timing of immunotherapy escalation remains unclear. Routine reporting of outcome measures which incorporate cognitive impairment, fatigue, pain, and mental health will permit more accurate quantification of residual disability and comprehensive comparisons between international multicentre cohorts, and enable future meta-analyses with the aim of developing evidence-based therapeutic guidelines.
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Affiliation(s)
- Benjamin P Trewin
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Isaak Freeman
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neurology, Concord Hospital, Sydney, Australia
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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Rare antibody-mediated and seronegative autoimmune encephalitis: An update. Autoimmun Rev 2022; 21:103118. [PMID: 35595048 DOI: 10.1016/j.autrev.2022.103118] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/15/2022] [Indexed: 01/14/2023]
Abstract
Paralleling advances with respect to more common antibody-mediated encephalitides, such as anti-N-methyl-D-aspartate receptor (NMDAR) and anti-leucine-rich glioma-inactivated 1 (LGI1) Ab-mediated encephalitis, the discovery and characterisation of novel antibody-mediated encephalitides accelerated over the past decade, adding further depth etiologically to the spectrum of antibody-mediated encephalitis. Herein, we review the major mechanistic, clinical features and management considerations with respect to anti-γ-aminobutyric acid B (GABAB)-, anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropinoic receptor- (AMPAR), anti-GABAA-, anti-dipeptidyl-peptidase-like protein-6 (DPPX) Ab-mediated encephalitides, delineate rarer subtypes and summarise findings to date regarding seronegative autoimmune encephalitis.
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43
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Gill AJ, Venkatesan A. Pathogenic mechanisms in neuronal surface autoantibody-mediated encephalitis. J Neuroimmunol 2022; 368:577867. [DOI: 10.1016/j.jneuroim.2022.577867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/22/2022] [Accepted: 04/09/2022] [Indexed: 11/16/2022]
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Miao A, Yu C, Sun Y, Wang L, Ge J, Wang X. Acute Cerebellitis Associated With Anti-homer 3 Antibodies: A Rare Case Report and Literature Review. Front Neurol 2022; 13:837937. [PMID: 35250837 PMCID: PMC8895947 DOI: 10.3389/fneur.2022.837937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/27/2022] [Indexed: 11/13/2022] Open
Abstract
Acute cerebellitis associated with Homer-3 antibodies is very rare. Here we present a 20-year-old woman who suffered from uncontrollable head shaking quickly from side to side and an unsteady gait for 2 days after the cold. Antibodies were screened by cell-based assays. The indirect immunofluorescence technique results revealed anti-Homer-3 antibody titers of 1:3.2 in the CSF and 1:100 in the serum. The woman was obviously improved after antiviral and immunosuppression (immunoglobin, methylprednisolone and mycophenolate mofetil) treatment. Our report indicated immune-mediated causes should be considered in the acute cerebellitis. Immunotherapy can contribute to the improvement of cerebellar syndrome.
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Affiliation(s)
- Ailiang Miao
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Video-Electroencephalpgram, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- *Correspondence: Ailiang Miao
| | - Chuanyong Yu
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Video-Electroencephalpgram, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Yulei Sun
- Department of Neurology, Affiliated Mingji Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Lingling Wang
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Video-Electroencephalpgram, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Jianqing Ge
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Video-Electroencephalpgram, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
| | - Xiaoshan Wang
- Department of Neurology, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
- Department of Video-Electroencephalpgram, Affiliated Brain Hospital of Nanjing Medical University, Nanjing Medical University, Nanjing, China
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45
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Damato V, Papi C, Spagni G, Evoli A, Silvestri G, Masi G, Sabatelli E, Campetella L, McKeon A, Andreetta F, Riso V, Monte G, Luigetti M, Primiano G, Calabresi P, Iorio R. Clinical features and outcome of patients with autoimmune cerebellar ataxia evaluated with the Scale for the Assessment and Rating of Ataxia. Eur J Neurol 2022; 29:564-572. [PMID: 34710286 PMCID: PMC9564532 DOI: 10.1111/ene.15161] [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: 08/12/2021] [Revised: 10/08/2021] [Accepted: 10/21/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND PURPOSE This study was undertaken to assess the long-term outcome of patients with paraneoplastic and non paraneoplastic autoimmune cerebellar ataxia (ACA) using the Scale for the Assessment and Rating of Ataxia (SARA). METHODS Patients with subacute cerebellar ataxia admitted to our institution between September 2012 and April 2020 were prospectively recruited. Serum and/or cerebrospinal fluid was tested for neural autoantibodies by indirect immunofluorescence on mouse brain, cell-based assays, and radioimmunoassay. SARA and modified Rankin Scale (mRS) score were employed to assess patients' outcome. RESULTS Fifty-five patients were recruited, of whom 23 (42%) met the criteria for cerebellar ataxia of autoimmune etiology. Neural autoantibodies were detected in 22 of 23 patients (Yo-immunoglobulin G [IgG], n = 6; glutamic acid decarboxylase 65-IgG, n = 3; metabotropic glutamate receptor 1-IgG, n = 2; voltage-gated calcium channel P/Q type-IgG, n = 2; Hu-IgG, n = 1; glial fibrillary acidic protein-IgG, n = 1; IgG-binding unclassified antigens, n = 7). Thirteen patients were diagnosed with paraneoplastic cerebellar syndrome (PCS) and 10 with idiopathic ACA. All patients received immunotherapy. Median SARA score was higher in the PCS group at all time points (p = 0.0002), while it decreased significantly within the ACA group (p = 0.049) after immunotherapy. Patients with good outcome (mRS ≤ 2) had less neurological disability (SARA < 15) at disease nadir (p = 0.039) and presented less frequently with paraneoplastic neurological syndrome (p = 0.0028). The univariate linear regression model revealed a good correlation between mRS and SARA score both at disease onset (p < 0.0001) and at last follow-up (p < 0.0001). SARA score < 11 identified patients with good outcome. CONCLUSIONS Patients with idiopathic ACA significantly improved after immunotherapy. SARA score accurately reflects patients' clinical status and may be a suitable outcome measure for patients with ACA.
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Affiliation(s)
- Valentina Damato
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Claudia Papi
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Gregorio Spagni
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Amelia Evoli
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Gabriella Silvestri
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Gianvito Masi
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Eleonora Sabatelli
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Lucia Campetella
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Andrew McKeon
- Departments of Neurology and Laboratory Medicine and Pathology Mayo Clinic, Rochester, Minnesota, USA
| | - Francesca Andreetta
- Neurology Unit IV, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittorio Riso
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Gabriele Monte
- Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Marco Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Guido Primiano
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Paolo Calabresi
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
| | - Raffaele Iorio
- UOC Neurologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS. Rome, Italy,Dipartimento di Neuroscienze. Università Cattolica del Sacro Cuore. Rome, Italy
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46
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Chandler E, Arvantis N, Morgan B. A Novel Case of Idiopathic MGluR1 Encephalitis in a Pediatric Patient. Child Neurol Open 2022; 9:2329048X221095695. [PMID: 35497371 PMCID: PMC9047037 DOI: 10.1177/2329048x221095695] [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: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
Metabotropic Glutamate Receptor 1 (mGluR1) encephalitis is a rare encephalitis characterized by ataxia, neuropsychiatric symptoms, dysarthria and cognitive impairment. This disease process has been described in several adult patients and has been associated with paraneoplastic syndrome in Hodgkin's lymphoma and other cancers as well as parainfectious and underlying autoimmune etiologies. However, only two cases of anti-mGluR1 encephalitis in children have been reported in the literature. The underlying etiology of one case was not provided but post-infectious disease has been reported. Here, we report the first case of anti-mGluR1 encephalitis in a child with a presumed “idiopathic” basis.
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Affiliation(s)
- Erika Chandler
- University of Louisville, Louisville, USA.,Division of Child Neurology, Louisville, USA
| | | | - Bethanie Morgan
- University of Louisville, Louisville, USA.,Division of Child Neurology, Louisville, USA.,Norton Children's Medical Group, Louisville, USA
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47
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Ancona C, Masenello V, Tinnirello M, Toscano LM, Leo A, La Piana C, Toldo I, Nosadini M, Sartori S. Autoimmune Encephalitis and Other Neurological Syndromes With Rare Neuronal Surface Antibodies in Children: A Systematic Literature Review. Front Pediatr 2022; 10:866074. [PMID: 35515348 PMCID: PMC9067304 DOI: 10.3389/fped.2022.866074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Neuronal surface antibody syndromes (NSAS) are an expanding group of autoimmune neurological diseases, whose most frequent clinical manifestation is autoimmune encephalitis (AE). Anti-NMDAR, anti-LGI1, and anti-CASPR2 autoimmunity represent the most described forms, while other NSAS are rarer and less well-characterized, especially in children. We carried out a systematic literature review of children with rare NSAS (with antibodies targeting D2R, GABAAR, GlyR, GABABR, AMPAR, amphiphysin, mGluR5, mGluR1, DPPX, IgLON5, and neurexin-3alpha) and available individual data, to contribute to improve their clinical characterization and identification of age-specific features. Ninety-four children were included in the review (47/94 female, age range 0.2-18 years). The most frequent NSAS were anti-D2R (28/94, 30%), anti-GABAAR (23/94, 24%), and anti-GlyR (22/94, 23%) autoimmunity. The most frequent clinical syndromes were AE, including limbic and basal ganglia encephalitis (57/94, 61%; GABAAR, D2R, GABABR, AMPAR, amphiphysin, and mGluR5), and isolated epileptic syndromes (15/94, 16%; GlyR, GABAAR). With the limitations imposed by the low number of cases, the main distinctive features of our pediatric literature cohort compared to the respective NSAS in adults included: absent/lower tumor association (exception made for anti-mGluR5 autoimmunity, and most evident in anti-amphiphysin autoimmunity); loss of female preponderance (AMPAR); relatively frequent association with preceding viral encephalitis (GABAAR, D2R). Moreover, while SPS and PERM are the most frequent syndromes in adult anti-GlyR and anti-amphiphysin autoimmunity, in children isolated epileptic syndromes and limbic encephalitis appear predominant, respectively. To our knowledge, this is the first systematic review on rare pediatric NSAS. An improved characterization may aid their recognition in children.
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Affiliation(s)
- Claudio Ancona
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Valentina Masenello
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Matteo Tinnirello
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Luca Mattia Toscano
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Andrea Leo
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Chiara La Piana
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Irene Toldo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy
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48
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Durovic E, Bien C, Bien CG, Isenmann S. MOG antibody-associated encephalitis secondary to Covid-19: case report. BMC Neurol 2021; 21:414. [PMID: 34706651 PMCID: PMC8549422 DOI: 10.1186/s12883-021-02449-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While Covid-19 predominantly affects the respiratory system, neurological manifestations including encephalitis occur in some patients, possibly affecting the course and outcome of the disease. Here, we describe a unique case of a young man with Covid-19 and transient MOG-positive encephalitis, with a benign course. CASE PRESENTATION A 22-year-old male, with PCR confirmed Covid-19 infection was admitted because of persistent headache. The clinical examination was normal. Neuropsychological testing revealed distinct executive deficits. Brain MRI and cerebrospinal fluid (CSF) analysis were suggestive for encephalitis. Further laboratory examination revealed a serum MOG antibody titre. The headache improved with analgetic treatment and i.v. methylprednisolone. Consequently, the MOG antibody titer decreased and MRI lesions were resolving. The patient made a full recovery, with no signs of deterioration over the following months. CONCLUSIONS Covid-19 manifestations in the CNS include encephalitis with variable course and prognosis. This case highlights a possible association between inflammation due to COVID-19 and transient secondary autoimmunity with transient MOG antibodies and atypical clinical presentation.
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Affiliation(s)
- Ervin Durovic
- Department of Neurology, Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers, Asbergerstr. 4, 47441, Moers, Germany
| | | | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Stefan Isenmann
- Department of Neurology, Klinik für Neurologie und klinische Neurophysiologie, St. Josef Krankenhaus Moers, Asbergerstr. 4, 47441, Moers, Germany.
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49
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Liu M, Ren H, Fan S, Zhang W, Xu Y, Zhao W, Guan H. Neurological Autoimmunity Associated With Homer-3 Antibody: A Case Series From China. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1077. [PMID: 34580182 PMCID: PMC8477375 DOI: 10.1212/nxi.0000000000001077] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE To present 6 new cases with Homer-3 antibodies that expand their clinical spectra and to evaluate the effect of immunotherapy. METHODS Patients with suspected autoimmune cerebellar disorder were tested for rare autoimmune cerebellar ataxia (ACA) antibodies (anti-Tr(DNER)/Zic4/ITPR1/Homer-3/NCDN/PKCγ/PCA-2/AP3B2/mGluR1/ATP1A3 antibodies) using both cell-based and tissue-based assays. Patients with positive serum or CSF results who were diagnosed with ACA were registered and followed up. This study reports and analyzes cases with Homer-3 antibodies. RESULTS Of the serum and CSF samples of 750 patients tested, 6 were positive for Homer-3 antibodies. All manifested subacute or insidious-onset cerebellar ataxia. Furthermore, 2 patients each exhibited encephalopathy, myeloradiculopathy, REM sleep behavior disorder, and autonomic dysfunction. Brain magnetic resonance images were normal (n = 1) or revealed cerebellar atrophy (n = 1), cerebellum and pons atrophy with the hot cross bun sign (n = 2), and bilateral cerebral abnormalities (n = 2). Definite leukocytosis was identified in the CSF of 2 patients, protein concentration elevation was observed in the CSF of 1 patient, and oligoclonal bands were present in 2 patients. All patients received immunotherapy, including corticosteroid, IV immunoglobulin, plasma exchange, and mycophenolate mofetil, after which the residual disability was still severe (modified Rankin Scale score ≥3 at the last follow-up in 4 patients and final Scale for the Assessment and Rating of Ataxia scores of 12-29), although 4 patients partially improved and 1 patient stabilized. The remaining 1 patient continued to deteriorate after repeated immunotherapy. Two patients relapsed. DISCUSSION Disorders associated with Homer-3 antibody can mimic multiple system atrophy with cerebellar features in both clinical and radiologic aspects. Accurate identification of autoimmune-mediated cases is critical. Timely, comprehensive immunotherapy is warranted, given the possibility of long-term clinical benefit.
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Affiliation(s)
- Mange Liu
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China
| | - Haitao Ren
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China
| | - Siyuan Fan
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China
| | - Weihe Zhang
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China
| | - Yao Xu
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China
| | - Weili Zhao
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China
| | - Hongzhi Guan
- From the Department of Neurology (M.L., H.R., S.F., H.G.), Peking Union Medical College Hospital, Beijing; Peking Union Medical College and Chinese Academy of Medical Sciences (M.L., H.R., S.F., H.G.), Beijing; Department of Neurology (Weihe Zhang), China-Japan Friendship Hospital, Beijing; Department of Neurology (Y.X.), Medical Collage of Yangzhou University, Jiangsu; and Department of Neurology (Weili Zhao), Affiliated Hospital of Chifeng University, Inner Mongolia, China.
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50
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Binks S, Uy C, Honnorat J, Irani SR. Paraneoplastic neurological syndromes: a practical approach to diagnosis and management. Pract Neurol 2021; 22:19-31. [PMID: 34510016 DOI: 10.1136/practneurol-2021-003073] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2021] [Indexed: 01/13/2023]
Abstract
Paraneoplastic neurological syndromes (PNS) are the immune-mediated effects of a remote cancer and are characterised by an autoantibody response against antigens expressed by the tumour. Classically, well-characterised 'onconeuronal' antibodies target intracellular antigens and hence cannot access their antigens across intact cell membranes. The pathogenic mediators are likely to be neuronal-specific T cells. There is a variable response to immunotherapies and the clinical syndrome helps to direct the search for a specific set of tumours. By contrast, many newly emerging autoantibodies with oncological associations target cell surface epitopes and can exert direct pathogenic effects on both the central and peripheral nervous systems. Patients with these cell-surface directed autoantibodies often clearly respond to immunotherapies. Overall, the clinical, serological and oncological features in an individual patient helps determine the clinical relevance of the syndrome and hence guide its management. We summarise current knowledge and a practical approach to the investigation, diagnosis, treatment and outcomes of patients with suspected PNS.
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Affiliation(s)
- Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.,Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Christopher Uy
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.,Department of Medicine (Division of Neurology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jerome Honnorat
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hopital Neurologique, Lyon, France.,SynatAc Team, Institute NeuroMyoGene INSERM U1217/CNRS UMR 5310, Universite de Lyon, Universit Claude Bernard Lyon 1, Lyon, France
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK .,Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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