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Vaisvilas M, Petrosian D, Bagdonaite L, Taluntiene V, Kralikiene V, Daugelaviciene N, Neniskyte U, Kaubrys G, Giedraitiene N. Seroprevalence of neuronal antibodies in diseases mimicking autoimmune encephalitis. Sci Rep 2024; 14:5352. [PMID: 38438516 PMCID: PMC10912693 DOI: 10.1038/s41598-024-55995-6] [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: 09/18/2023] [Accepted: 02/29/2024] [Indexed: 03/06/2024] Open
Abstract
Detection of neuronal antibodies for autoimmune encephalitis and paraneoplastic neurological syndromes relies on commercially available cell-based assays and lineblots. However, lineblots may reveal the presence of neuronal antibodies in patients with various non-autoimmune etiologies. Herein we describe patients with non-autoimmune etiologies (cohort B) and detectable neuronal antibodies and compare them to definite cases of autoimmune encephalitis (cohort A) for differences in clinical data. All patients positive for at least one neuronal antibody were retrospectively evaluated for autoimmune encephalitis and/or paraneoplastic neurological syndrome between 2016 and 2022. 39 cases in cohort B and 23 in cohort A were identified. In cohort B, most common diagnoses were neurodegenerative disorders in 9/39 (23.1%), brain tumors in 6/39 (15.4%) while most common detected antibodies were anti-titin (N10), anti-recoverin (N11), anti-Yo (N8) and all were detected in serum only. Differential aspects between cohort A and B were CSF pleocytosis (14/23 (60.8%) vs 11/35 (31.4%), p = 0.042, respectively), MRI features suggestive of encephalitis (6/23 (26.1%) vs 0 (0%), p = 0.002, respectively) and epilepsy restricted to temporal lobes (14/23 (60.9%) vs 2/30 (6.7%), p = 0.0003, respectively). A large proportion of lineblot results were non-specific when only serum was tested and were frequently found in non-autoimmune neurological conditions.
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Affiliation(s)
- Mantas Vaisvilas
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
- Department of Neurology, Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania.
| | | | - Loreta Bagdonaite
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vera Taluntiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Viktorija Kralikiene
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Neringa Daugelaviciene
- VU LSC-EMBL Partnership for Genome Editing Technologies, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Urte Neniskyte
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- VU LSC-EMBL Partnership for Genome Editing Technologies, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Natasa Giedraitiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
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Lopes J, Malaquias MJ, Freitas J, Valido R, Carneiro P, Neves E, Moreira AM, Samões R, Santos E, Correia AP. Blood and CSF anti-neuronal antibodies testing in psychotic syndromes: a retrospective analysis from a tertiary psychiatric hospital. Immunol Res 2024:10.1007/s12026-024-09457-w. [PMID: 38291273 DOI: 10.1007/s12026-024-09457-w] [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: 11/08/2023] [Accepted: 01/13/2024] [Indexed: 02/01/2024]
Abstract
A Consensus of Psychoimmunology Experts (Pollak et al., 2019) established a set of red flags and proposed diagnostic criteria for psychosis of autoimmune origin (AIP). Previous studies on AIP are limited by the scarcity of CSF analysis, preventing the valorization of blood anti-neuronal antibodies (Ab). The aims of this study are to determine the relative frequency and characterize AIP in a cohort of psychotic patients that underwent CSF workup. This work is a retrospective study in a tertiary psychiatric hospital. Clinical and paraclinical data were collected from medical records, and patients were classified according to Pollak et al. (2019) criteria. From 68 patients, ten (14.7%) had positive anti-neuronal antibodies (Ab): n = 5 in CSF and blood (n = 4 anti-NMDAr, n = 1 -GAD65), and n = 5 in blood only (n = 1 anti-GABAb, n = 1 -GAD65, n = 1 -SOX1, n = 1 -NMDAr, n = 1 -zic4). After 5- (2-10)-year follow-up, n = 6/68 (8.8%) had AIP diagnosis in context of autoimmune encephalitis (AE), and the remaining (n = 4/10, blood-only Ab) alternative diagnoses (n = 2 dementia, n = 1 schizophrenia, n = 1 intellectual disability). Ten of the 13 patients that fulfilled criteria for possible AIP were mimics, and only three AE had criteria for probable AIP. All AIP developed neurological manifestations (mostly cognitive dysfunction); EEG was usually abnormal (66.7%), and all had normal MRI. We found statistically significant associations between AIP/AE and systemic autoimmune disease, presentation with seizures and EEG abnormalities. All AE developed neurological symptoms alongside psychosis. Ab positivity occurred predominantly in AE but also in other neuropsychiatric disorders. Clinical suspicion based on the knowledge of the described presentations of established Ab is crucial in the psychotic patient approach.
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Affiliation(s)
- Joana Lopes
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal.
| | - Maria João Malaquias
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
| | - Joana Freitas
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Rodrigo Valido
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Paula Carneiro
- Department of Immunology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Esmeralda Neves
- Department of Immunology, Centro Hospitalar Universitário de Santo António, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Ana Maria Moreira
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Raquel Samões
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Ernestina Santos
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine (UMIB), Instituto de Ciencias Biomedicas Abel Salazar, Universidade Do Porto, Porto, Portugal
| | - Ana Paula Correia
- Neurology Department, Centro Hospitalar Universitário de Santo António, Largo Do Prof. Abel Salazar, 4099-001, Porto, Portugal
- Psychiatry Department, Hospital de Magalhães Lemos, Centro Hospitalar Universitário de Santo António, Porto, Portugal
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Hoffer J, Frem W, Alkana J, Chih C, Liu AK. SOX1 Antibody in a Patient With Serotonin Syndrome. Cureus 2023; 15:e48516. [PMID: 37946854 PMCID: PMC10631746 DOI: 10.7759/cureus.48516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 11/12/2023] Open
Abstract
SOX1 antibody is an autoimmune antibody, usually associated with Lambert-Eaton myasthenic syndrome, paraneoplastic conditions, and encephalitis. This antibody has also been found among psychiatric patients. However, the role of SOX1 antibody in serotonin syndrome has not yet been defined, as a literature search yielded no results. Therefore, the treatment as such has unknown clinical significance. In this case study, we report a patient with SOX1 antibodies and altered mental status out of proportion to serotonin syndrome whose symptoms improved with simultaneous treatment of both conditions.
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Affiliation(s)
- Julia Hoffer
- Internal Medicine, Adventist Health White Memorial, Los Angeles, USA
| | - William Frem
- Internal Medicine, Adventist Health White Memorial, Los Angeles, USA
| | - Jessica Alkana
- Neurology, Adventist Health White Memorial, Los Angeles, USA
| | - Charisse Chih
- Neurology, Adventist Health White Memorial, Los Angeles, USA
| | - Antonio K Liu
- Neurology, Adventist Health White Memorial, Los Angeles, USA
- Neurology, Loma Linda University School of Medicine, Loma Linda, USA
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