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Arlt FA, Miske R, Machule ML, Broegger Christensen P, Mindorf S, Teegen B, Borowski K, Buthut M, Rößling R, Sánchez-Sendín E, van Hoof S, Cordero-Gómez C, Bünger I, Radbruch H, Kraft A, Ayzenberg I, Klausewitz J, Hansen N, Timäus C, Körtvelyessy P, Postert T, Baur-Seack K, Rost C, Brunkhorst R, Doppler K, Haigis N, Hamann G, Kunze A, Stützer A, Maschke M, Melzer N, Rosenow F, Siebenbrodt K, Stenør C, Dichgans M, Georgakis MK, Fang R, Petzold GC, Görtler M, Zerr I, Wunderlich S, Mihaljevic I, Turko P, Schmidt Ettrup M, Buchholz E, Foverskov Rasmussen H, Nasouti M, Talucci I, Maric HM, Heinemann SH, Endres M, Komorowski L, Prüss H. KCNA2 IgG autoimmunity in neuropsychiatric diseases. Brain Behav Immun 2024; 117:399-411. [PMID: 38309639 DOI: 10.1016/j.bbi.2024.01.220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 01/04/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND Autoantibodies against the potassium voltage-gated channel subfamily A member 2 (KCNA2) have been described in a few cases of neuropsychiatric disorders, but their diagnostic and pathophysiological role is currently unknown, imposing challenges to medical practice. DESIGN / METHODS We retrospectively collected comprehensive clinical and paraclinical data of 35 patients with KCNA2 IgG autoantibodies detected in cell-based and tissue-based assays. Patients' sera and cerebrospinal fluid (CSF) were used for characterization of the antigen, clinical-serological correlations, and determination of IgG subclasses. RESULTS KCNA2 autoantibody-positive patients (n = 35, median age at disease onset of 65 years, range of 16-83 years, 74 % male) mostly presented with cognitive impairment and/or epileptic seizures but also ataxia, gait disorder and personality changes. Serum autoantibodies belonged to IgG3 and IgG1 subclasses and titers ranged from 1:32 to 1:10,000. KCNA2 IgG was found in the CSF of 8/21 (38 %) patients and in the serum of 4/96 (4.2 %) healthy blood donors. KCNA2 autoantibodies bound to characteristic anatomical areas in the cerebellum and hippocampus of mammalian brain and juxtaparanodal regions of peripheral nerves but reacted exclusively with intracellular epitopes. A subset of four KCNA2 autoantibody-positive patients responded markedly to immunotherapy alongside with conversion to seronegativity, in particular those presenting an autoimmune encephalitis phenotype and receiving early immunotherapy. An available brain biopsy showed strong immune cell invasion. KCNA2 autoantibodies occurred in less than 10 % in association with an underlying tumor. CONCLUSION Our data suggest that KCNA2 autoimmunity is clinically heterogeneous. Future studies should determine whether KCNA2 autoantibodies are directly pathogenic or develop secondarily. Early immunotherapy should be considered, in particular if autoantibodies occur in CSF or if clinical or diagnostic findings suggest ongoing inflammation. Suspicious clinical phenotypes include autoimmune encephalitis, atypical dementia, new-onset epilepsy and unexplained epileptic seizures.
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Affiliation(s)
- Friederike A Arlt
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Ramona Miske
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Marie-Luise Machule
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | | | - Swantje Mindorf
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Bianca Teegen
- Clinical immunological Laboratory Prof. Stöcker, Groß Grönau, Germany
| | - Kathrin Borowski
- Clinical immunological Laboratory Prof. Stöcker, Groß Grönau, Germany
| | - Maria Buthut
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rosa Rößling
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Elisa Sánchez-Sendín
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Scott van Hoof
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - César Cordero-Gómez
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Isabel Bünger
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Helena Radbruch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Andrea Kraft
- Department of Neurology, Hospital Martha-Maria, Halle, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jaqueline Klausewitz
- Department of Neurology, St Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Niels Hansen
- Department of Psychiatry and Psychotherapy, University Göttingen Medical Center, Göttingen, Germany
| | - Charles Timäus
- Department of Psychiatry and Psychotherapy, University Göttingen Medical Center, Göttingen, Germany
| | - Peter Körtvelyessy
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany; German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Magdeburg, Germany
| | - Thomas Postert
- Department of Neurology, St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | - Kirsten Baur-Seack
- Department of Neurology, St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | - Constanze Rost
- Department of Neurology, St. Vincenz-Krankenhaus Paderborn, Paderborn, Germany
| | - Robert Brunkhorst
- Department of Neurology, University Hospital Aachen, Aachen, Germany
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Niklas Haigis
- Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Gerhard Hamann
- Department of Neurology and Neurological Rehabilitation, BKH Günzburg, Günzburg, Germany
| | - Albrecht Kunze
- Department of Neurology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Alexandra Stützer
- Department of Neurology, Zentralklinik Bad Berka, Bad Berka, Germany
| | - Matthias Maschke
- Department of Neurology, Campus Trier, University of Mainz, Trier, Germany
| | - Nico Melzer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt on the Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, Goethe University Frankfurt, Frankfurt on the Main, Germany; LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe University, Frankfurt, Germany
| | - Christian Stenør
- Department of Neurology, Copenhagen University Hospital, Herlev-Gentofte, Denmark
| | - Martin Dichgans
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany; German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany
| | - Marios K Georgakis
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Rong Fang
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Munich, Germany
| | - Gabor C Petzold
- German Center for Neurodegenerative Diseases (DZNE) Bonn, Bonn, Germany; Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Michael Görtler
- German Center for Neurodegenerative Diseases (DZNE) Magdeburg, Magdeburg, Germany; Department of Neurology, University Hospital, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Inga Zerr
- German Center for Neurodegenerative Diseases (DZNE) Göttingen, Göttingen, Germany; Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - Silke Wunderlich
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | | | - Paul Turko
- Institute for Integrative Neuroanatomy, Charité-Universitätsmedizin, Berlin, Germany
| | | | - Emilie Buchholz
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Helle Foverskov Rasmussen
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Mahoor Nasouti
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany
| | - Ivan Talucci
- Department of Neurology, University of Würzburg, Würzburg, Germany; Rudolf Virchow Center, Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Hans M Maric
- Rudolf Virchow Center, Center for Integrative and Translational Bioimaging, University of Würzburg, Würzburg, Germany
| | - Stefan H Heinemann
- Friedrich Schiller University and Jena University Hospital, Center for Molecular Biomedicine, Department of Biophysics, Jena, Germany
| | - Matthias Endres
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Komorowski
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Harald Prüss
- German Center for Neurodegenerative Diseases (DZNE) Berlin, Berlin, Germany; Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, Berlin, Germany.
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6
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Strippel C, Herrera-Rivero M, Wendorff M, Tietz AK, Degenhardt F, Witten A, Schroeter C, Nelke C, Golombeck KS, Madlener M, Rüber T, Ernst L, Racz A, Baumgartner T, Widman G, Doppler K, Thaler F, Siebenbrodt K, Dik A, Kerin C, Räuber S, Gallus M, Kovac S, Grauer OM, Grimm A, Prüss H, Wickel J, Geis C, Lewerenz J, Goebels N, Ringelstein M, Menge T, Tackenberg B, Kellinghaus C, Bien CG, Kraft A, Zettl U, Ismail FS, Ayzenberg I, Urbanek C, Sühs KW, Tauber SC, Mues S, Körtvélyessy P, Markewitz R, Paliantonis A, Elger CE, Surges R, Sommer C, Kümpfel T, Gross CC, Lerche H, Wellmer J, Quesada CM, Then Bergh F, Wandinger KP, Becker AJ, Kunz WS, Meyer zu Hörste G, Malter MP, Rosenow F, Wiendl H, Kuhlenbäumer G, Leypoldt F, Lieb W, Franke A, Meuth SG, Stoll M, Melzer N. A genome-wide association study in autoimmune neurological syndromes with anti-GAD65 autoantibodies. Brain 2022; 146:977-990. [PMID: 35348614 PMCID: PMC9976967 DOI: 10.1093/brain/awac119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/11/2022] [Accepted: 03/13/2022] [Indexed: 11/15/2022] Open
Abstract
Autoimmune neurological syndromes (AINS) with autoantibodies against the 65 kDa isoform of the glutamic acid decarboxylase (GAD65) present with limbic encephalitis, including temporal lobe seizures or epilepsy, cerebellitis with ataxia, and stiff-person-syndrome or overlap forms. Anti-GAD65 autoantibodies are also detected in autoimmune diabetes mellitus, which has a strong genetic susceptibility conferred by human leukocyte antigen (HLA) and non-HLA genomic regions. We investigated the genetic predisposition in patients with anti-GAD65 AINS. We performed a genome-wide association study (GWAS) and an association analysis of the HLA region in a large German cohort of 1214 individuals. These included 167 patients with anti-GAD65 AINS, recruited by the German Network for Research on Autoimmune Encephalitis (GENERATE), and 1047 individuals without neurological or endocrine disease as population-based controls. Predictions of protein expression changes based on GWAS findings were further explored and validated in the CSF proteome of a virtually independent cohort of 10 patients with GAD65-AINS and 10 controls. Our GWAS identified 16 genome-wide significant (P < 5 × 10-8) loci for the susceptibility to anti-GAD65 AINS. The top variant, rs2535288 [P = 4.42 × 10-16, odds ratio (OR) = 0.26, 95% confidence interval (CI) = 0.187-0.358], localized to an intergenic segment in the middle of the HLA class I region. The great majority of variants in these loci (>90%) mapped to non-coding regions of the genome. Over 40% of the variants have known regulatory functions on the expression of 48 genes in disease relevant cells and tissues, mainly CD4+ T cells and the cerebral cortex. The annotation of epigenomic marks suggested specificity for neural and immune cells. A network analysis of the implicated protein-coding genes highlighted the role of protein kinase C beta (PRKCB) and identified an enrichment of numerous biological pathways participating in immunity and neural function. Analysis of the classical HLA alleles and haplotypes showed no genome-wide significant associations. The strongest associations were found for the DQA1*03:01-DQB1*03:02-DRB1*04:01HLA haplotype (P = 4.39 × 10-4, OR = 2.5, 95%CI = 1.499-4.157) and DRB1*04:01 allele (P = 8.3 × 10-5, OR = 2.4, 95%CI = 1.548-3.682) identified in our cohort. As predicted, the CSF proteome showed differential levels of five proteins (HLA-A/B, C4A, ATG4D and NEO1) of expression quantitative trait loci genes from our GWAS in the CSF proteome of anti-GAD65 AINS. These findings suggest a strong genetic predisposition with direct functional implications for immunity and neural function in anti-GAD65 AINS, mainly conferred by genomic regions outside the classical HLA alleles.
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Affiliation(s)
| | | | - Mareike Wendorff
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anja K Tietz
- Department of Neurology, University of Kiel, Kiel, Germany
| | - Frauke Degenhardt
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Anika Witten
- Department of Genetic Epidemiology, Institute of Human Genetics, University of Münster, Münster, Germany
| | - Christina Schroeter
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christopher Nelke
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Kristin S Golombeck
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marie Madlener
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Theodor Rüber
- Department of Epileptology, University of Bonn, Bonn, Germany,Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, and LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Leon Ernst
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Attila Racz
- Department of Epileptology, University of Bonn, Bonn, Germany
| | | | - Guido Widman
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Kathrin Doppler
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Franziska Thaler
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Kai Siebenbrodt
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, and LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Andre Dik
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Constanze Kerin
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Saskia Räuber
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany,Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marco Gallus
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Stjepana Kovac
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Oliver M Grauer
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Alexander Grimm
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Harald Prüss
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jonathan Wickel
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christian Geis
- Section of Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Ulm, Germany
| | - Norbert Goebels
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany,Center for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Til Menge
- Department of Neurology, Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany,Center for Neurology and Neuropsychiatry, LVR Klinikum, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Björn Tackenberg
- Department of Neurology, University of Marburg/Gießen, Marburg, Germany
| | | | - Christian G Bien
- Department of Epileptology (Krankenhaus Mara), Bielefeld University, Medical School, Campus Bielefeld-Bethel, Bielefeld, Germany
| | | | - Uwe Zettl
- Department of Neurology, University of Rostock, Rostock, Germany
| | - Fatme Seval Ismail
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ilya Ayzenberg
- Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia,Department of Neurology, St Josefs Krankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Christian Urbanek
- Department of Neurology, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Kurt-Wolfram Sühs
- Department of Neurology, University Hospital, MHH, Hannover, Germany
| | - Simone C Tauber
- Department of Neurology, University Hospital RWTH Aachen, Aachen, Germany
| | - Sigrid Mues
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany,Department of Neurology, University Hospital Dresden, Dresden, Germany
| | - Peter Körtvélyessy
- Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany,Department of Neurology, University Hospital Magdeburg, Magdeburg, Germany
| | - Robert Markewitz
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | | | | | - Rainer Surges
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Claudia Sommer
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany,Biomedical Center (BMC), Medical Faculty, Ludwig-Maximilians-Universität Munich, Martinsried, Germany
| | - Catharina C Gross
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Jörg Wellmer
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| | - Carlos M Quesada
- Department of Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | | | - Klaus-Peter Wandinger
- Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Albert J Becker
- Section of Translational Epileptology, Institute of Neuropathology, University of Bonn, Bonn, Germany
| | - Wolfram S Kunz
- Department of Epileptology, University of Bonn, Bonn, Germany
| | - Gerd Meyer zu Hörste
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Michael P Malter
- Department of Neurology, University of Cologne, Cologne, Germany
| | - Felix Rosenow
- Epilepsy Center Frankfurt Rhine-Main, Department of Neurology, University Hospital Frankfurt, and LOEWE Center for Personalized Translational Epilepsy Research (CePTER), Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | | | - Frank Leypoldt
- Department of Neurology, University of Kiel, Kiel, Germany,Neuroimmunology, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | - Wolfgang Lieb
- Institute of Epidemiology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Andre Franke
- Institute of Clinical Molecular Biology, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Monika Stoll
- Correspondence may also be addressed to: Monika Stoll E-mail:
| | - Nico Melzer
- Correspondence to: Nico Melzer Department of Neurology, Medical Faculty, Heinrich-Heine University of Düsseldorf Moorenstraße 5, 40225 Düsseldorf, Germany E-mail:
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8
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Tietz AK, Angstwurm K, Baumgartner T, Doppler K, Eisenhut K, Elisak M, Franke A, Golombeck KS, Handreka R, Kaufmann M, Kraemer M, Kraft A, Lewerenz J, Lieb W, Madlener M, Melzer N, Mojzisova H, Möller P, Pfefferkorn T, Prüss H, Rostásy K, Schnegelsberg M, Schröder I, Siebenbrodt K, Sühs KW, Wickel J, Wandinger KP, Leypoldt F, Kuhlenbäumer G. Genome-wide Association Study Identifies 2 New Loci Associated With Anti-NMDAR Encephalitis. Neurol Neuroimmunol Neuroinflamm 2021; 8:e1085. [PMID: 34584012 PMCID: PMC8479862 DOI: 10.1212/nxi.0000000000001085] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 07/09/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To investigate the genetic determinants of the most common type of antibody-mediated autoimmune encephalitis, anti-NMDA receptor (anti-NMDAR) encephalitis. METHODS We performed a genome-wide association study in 178 patients with anti-NMDAR encephalitis and 590 healthy controls, followed by a colocalization analysis to identify putatively causal genes. RESULTS We identified 2 independent risk loci harboring genome-wide significant variants (p < 5 × 10-8, OR ≥ 2.2), 1 on chromosome 15, harboring only the LRRK1 gene, and 1 on chromosome 11 centered on the ACP2 and NR1H3 genes in a larger region of high linkage disequilibrium. Colocalization signals with expression quantitative trait loci for different brain regions and immune cell types suggested ACP2, NR1H3, MADD, DDB2, and C11orf49 as putatively causal genes. The best candidate genes in each region are LRRK1, encoding leucine-rich repeat kinase 1, a protein involved in B-cell development, and NR1H3 liver X receptor alpha, a transcription factor whose activation inhibits inflammatory processes. DISCUSSION This study provides evidence for relevant genetic determinants of antibody-mediated autoimmune encephalitides outside the human leukocyte antigen (HLA) region. The results suggest that future studies with larger sample sizes will successfully identify additional genetic determinants and contribute to the elucidation of the pathomechanism.
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Affiliation(s)
- Anja K. Tietz
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Klemens Angstwurm
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Tobias Baumgartner
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kathrin Doppler
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Katharina Eisenhut
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Martin Elisak
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Andre Franke
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kristin S. Golombeck
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Robert Handreka
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Max Kaufmann
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Markus Kraemer
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Andrea Kraft
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Jan Lewerenz
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Wolfgang Lieb
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Marie Madlener
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Nico Melzer
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Hana Mojzisova
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Peter Möller
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Thomas Pfefferkorn
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Harald Prüss
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kevin Rostásy
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Margret Schnegelsberg
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Ina Schröder
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kai Siebenbrodt
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Kurt-Wolfram Sühs
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Jonathan Wickel
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Klaus-Peter Wandinger
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Frank Leypoldt
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - Gregor Kuhlenbäumer
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
| | - on behalf of the German Network for Research on Autoimmune Encephalitis (GENERATE)
- From the Department of Neurology (A.K.T., F.L., G.K.), Kiel University; Department of Neurology (K.A.), University Hospital Regensburg; Department of Epileptiology (T.B.), University Hospital Bonn; Department of Neurology (K.D.), University Hospital Würzburg; Institute of Clinical Neuroimmunology (K.E.), Biomedical Center and University Hospital, Ludwig Maximilians University, Munich, Germany; Department of Neurology (M.E., H.M.), Charles University, Second Faculty of Medicine and Motol University Hospital, Prague, Czech Republic; Institute of Clinical Molecular Biology (A.F.), Kiel University; Department of Neurology (K.S.G.), University Hospital Münster; Department of Neurology (R.H.), Carl-Thiem-Klinikum Cottbus; Institute of Neuroimmunology and Multiple Sclerosis (INIMS) (Max Kaufmann), University Medical Center Hamburg-Eppendorf; Department of Neurology (Markus Kraemer), Alfried Krupp Hospital, Essen; Department of Neurology (Markus Kraemer, N.M.), Medical Faculty, Heinrich-Heine University Düsseldorf; Department of Neurology (A.K.), Martha-Maria Hospital Halle; Department of Neurology (J.L.), University of Ulm; Institute of Epidemiology (W.L.), Kiel University; Department of Neurology (M.M.), University Hospital Cologne; Department of Neurology and Clinical Neurophysiology (P.M.), Klinikum Weimar; Department of Neurology (T.P.), Klinikum Ingolstadt; Department of Neurology and Experimental Neurology (H.P.), Charité - Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases (DZNE) Berlin; Department of Pediatric Neurology (K.R.), Children's Hospital Datteln, Witten/Herdecke University; Department of Neurology (M.S.), Asklepios Hospitals Schildautal, Seesen; Neuroimmunology (I.S., K.-P.W., F.L.), Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck; Epilepsy Center Frankfurt Rhine-Main and Department of Neurology (K.S.), Unversity Hospital and Goethe Universiy Frankfurt; Department of Neurology (K.-W.S.), Hannover Medical School; and Section Translational Neuroimmunology (J.W.), Department of Neurology, University Hospital Jena, Germany.
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