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Serafim AB, Olivé-Cirera G, Ortega-González Á, Kruer MC, Weese-Mayer D, Rand CM, Fons C, Fernández-Ramos JA, Clemente M, Simabukuro MM, Embiruçu EK, Ibáñez-Micó S, Dalmau JO, Graus F, Armangué T, Sabater L. Antibodies Against ZSCAN1 in Pediatric and Adult Patients With Non-Paraneoplastic ROHHAD Syndrome. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200276. [PMID: 38917381 PMCID: PMC11204383 DOI: 10.1212/nxi.0000000000200276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 05/06/2024] [Indexed: 06/27/2024]
Abstract
OBJECTIVES To report the association of zinc finger and SCAN domain containing 1 antibodies (ZSCAN1-abs) with rapid-onset obesity, hypothalamic dysfunction, hypoventilation, and autonomic dysregulation (ROHHAD) syndrome in patients without tumor. METHODS Patients with symptoms compatible with ROHHAD syndrome but without an associated tumor were selected from our database. Serum and CSF samples were examined for the presence of ZSCAN1-abs by an in-house cell-based assay. In addition, samples from 149 patients with several inflammatory and noninflammatory disorders and 50 healthy participants served as controls. RESULTS Thirteen patients with ROHHAD syndrome were identified. Of these, we had paired serum/CSF samples from 6 patients and only serum from the other 7. Five of 6 patients (83.3%) with paired serum/CSF (4 children, 1 adult) had ZSCAN-abs only in CSF and 1 had antibodies in serum and CSF. ZSCAN1-abs were not detected in the remaining 7 patients with ROHHAD with only serum available or in any of the 199 control samples. DISCUSSION Patients with ROHHAD syndrome should be investigated for the presence of ZSCAN1-abs in CSF. The antibodies do not necessarily predict the presence of a tumor. The detection of ZSCAN1-abs in an adult patient suggests that this condition also occurs beyond the pediatric age.
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Affiliation(s)
- Ana Beatriz Serafim
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Gemma Olivé-Cirera
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Ángel Ortega-González
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Michael C Kruer
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Debra Weese-Mayer
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Casey M Rand
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Carmen Fons
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Joaquín Alejandro Fernández-Ramos
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Maria Clemente
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Mateus Mistieri Simabukuro
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Emilia Katiane Embiruçu
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Salvador Ibáñez-Micó
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Josep O Dalmau
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Francesc Graus
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Thais Armangué
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
| | - Lidia Sabater
- From the Neuroimmunology Program (A.B.S., G.O.-C., J.O.D., F.G., T.A., L.S.), Fundació de recerca clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (FCRB-IDIBAPS), Caixa Research Intitute (CRI), Universitat de Barcelona; Pediatric Neurology Section (G.O.-C.), Hospital Parc Taulí, Sabadell, Barcelona; Department of Pulmonology (Á.O.-G.), Hospital General Universitario Nuestra Señora del Prado, Talavera de la Reina, Spain; Neuroimmunology Program Barrow Neurological Institute (M.C.K.), Phoenix Children's Hospital, Phoenix, AZ; Departments of Child Health, Cellular and Molecular Medicine, Genetics, and Neurology, University of Arizona College of Medicine-Phoenix; Division of Autonomic Medicine (D.W.-M., C.M.R.), Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA; Department of Pediatrics (D.W.-M.), Northwestern University Feinberg School of Medicine; Stanley Manne Children's Research Institute (D.W.-M., C.M.R.), Chicago, IL; Pediatric Neurology Department (C.F., T.A.), Institut de Recerca Sant Joan de Déu, Sant Joan de Déu Children's Hospital, Barcelona; Department of Pediatric Neurology (J.A.F.-R.), Reina Sofia University Hospital, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, CIBERER-ISCIII, Spain; Paediatric Endocrinology Section (M.C.), Hospital Materno-Infantil Vall d'Hebron, Universitat Autònoma, Barcelona, Spain; Division of Neurology (M.M.S.), Hospital das Clínicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo; Department of Neurology (E.K.E.), University of State of Bahia, Salvador, Brazil; Servicio de Neuropediatria (S.I.-M.), servicio de Pediatria, Hospital Virgen de la Arrixaca, Murcia, España; Centro de Investigación Biomédica en Red (J.O.D., L.S.), Enfermedades Raras (CIBERER-ISCIII), Madrid, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institution for Research and Advanced Studies; and Hospital Clínic de Barcelona (T.A.), Barcelona, Spain
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