N-methyl-d-aspartate receptor autoimmunity affects cognitive performance in herpes simplex encephalitis
| Autor: | Clas Ahlm, Bengt L. Persson, Gabriel Westman, Elisabeth Aurelius, Marie Studahl, Johan Rönnelid, Britt-Marie Eriksson, Silvia Schliamser |
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| Rok vydání: | 2016 |
| Předmět: |
Microbiology (medical)
Adult Male endocrine system diseases Acyclovir Neuropsychological Tests medicine.disease_cause Receptors N-Methyl-D-Aspartate Autoimmunity 03 medical and health sciences 0302 clinical medicine medicine Humans 030212 general & internal medicine Effects of sleep deprivation on cognitive performance Prospective Studies Receptor Aged Autoantibodies D aspartate Aged 80 and over Sweden business.industry Autoantibody nutritional and metabolic diseases Valine General Medicine Middle Aged medicine.disease Virology Infectious Diseases HEK293 Cells nervous system Valacyclovir Immunology NMDA receptor Female Encephalitis Herpes Simplex business Neurocognitive hormones hormone substitutes and hormone antagonists 030217 neurology & neurosurgery Encephalitis |
| Zdroj: | Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases. 22(11) |
| ISSN: | 1469-0691 |
| Popis: | To investigate the prevalence and temporal development of N-methyl-d-aspartate receptor (NMDAR) autoantibodies in relation to neurocognitive performance in patients with herpes simplex encephalitis (HSE).This prospective observational study enrolled a total of 49 HSE patients within a randomized controlled trial of valacyclovir. Cerebrospinal fluid and serum samples were drawn in the initial stage of disease, after 2 to 3 weeks and after 3 months. Anti-NMDAR IgG was detected with HEK293 cells transfected with plasmids encoding the NMDA NR1 type glutamate receptor. A batch of neurocognitive tests, including the Mattis Dementia Rating Scale (MDRS), Glasgow Coma Scale (GCS), Reaction Level Scale (RLS85), Mini-Mental State Examination (MMSE) and National Institutes of Health (NIH) stroke scale, was performed during 24 months' follow-up.Anti-NMDAR IgG was detected in 12 of 49 participants. None were antibody positive in the initial stage of disease. In ten of 12 positive cases, specific antibodies were detectable only after 3 months. Notably, the development of NMDAR autoantibodies was associated with significantly impaired recovery of neurocognitive performance. After 24 months' follow-up, the median increase in MDRS total score was 1.5 vs. 10 points in antibody-positive and -negative participants (p=0.018).Anti-NMDAR autoimmunity is a common complication to HSE that develops within 3 months after onset of disease. The association to impaired neurocognitive recovery could have therapeutical implications, as central nervous system autoimmunity is potentially responsive to immunotherapy. |
| Databáze: | OpenAIRE |
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