Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome
Autor: | Wolf-Rüdiger Schäbitz, Verena Eigler, Fatme Seval Ismail, Martin Kurthen, Olga Simova, Corinna I. Bien, Carl-Albrecht Haensch, Christian G. Bien, Romana Höftberger, Andrea O. Rossetti, Müjgan Dogan Onugoren, Nico Melzer, Helmut Rauschka, Desiree De Simoni, Felix von Podewils, Martin Holtkamp, Kristina Mayer, Karsten Witt, Theodor W. May |
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Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
Male
0301 basic medicine Neuropil Neurology medicine.medical_treatment Receptors Glycine 0302 clinical medicine Cerebrospinal fluid Interquartile range Autoimmune encephalitis Child Outcome Aged 80 and over Original Communication biology Glutamate Decarboxylase Mental Disorders Intracellular Signaling Peptides and Proteins Antibody titer Middle Aged Titer Potassium Channels Voltage-Gated Child Preschool Female Immunotherapy Antibody Adult medicine.medical_specialty Adolescent Neural autoantibodies Diagnostic Techniques Neurological Nerve Tissue Proteins Immunologic Tests Receptors N-Methyl-D-Aspartate Young Adult 03 medical and health sciences Autoimmune Diseases of the Nervous System Internal medicine medicine Humans Receptors AMPA Laboratory test evaluation ddc:610 Aged Autoantibodies Retrospective Studies business.industry Infant Membrane Proteins Reproducibility of Results Correction HEK293 Cells 030104 developmental biology Receptors GABA-B biology.protein Neurology (clinical) business 030217 neurology & neurosurgery |
Zdroj: | Journal of Neurology Journal of neurology, vol. 267, no. 7, pp. 2101-2114 |
ISSN: | 1432-1459 0340-5354 |
Popis: | Objective To determine frequencies, interlaboratory reproducibility, clinical ratings, and prognostic implications of neural antibodies in a routine laboratory setting in patients with suspected neuropsychiatric autoimmune conditions. Methods Earliest available samples from 10,919 patients were tested for a broad panel of neural antibodies. Sera that reacted with leucine-rich glioma-inactivated protein 1 (LGI1), contactin-associated protein-2 (CASPR2), or the voltage-gated potassium channel (VGKC) complex were retested for LGI1 and CASPR2 antibodies by another laboratory. Physicians in charge of patients with positive antibody results retrospectively reported on clinical, treatment, and outcome parameters. Results Positive results were obtained for 576 patients (5.3%). Median disease duration was 6 months (interquartile range 0.6–46 months). In most patients, antibodies were detected both in CSF and serum. However, in 16 (28%) patients with N-methyl-d-aspartate receptor (NMDAR) antibodies, this diagnosis could be made only in cerebrospinal fluid (CSF). The two laboratories agreed largely on LGI1 and CASPR2 antibody diagnoses (κ = 0.95). The clinicians (413 responses, 71.7%) rated two-thirds of the antibody-positive patients as autoimmune. Antibodies against the α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR), NMDAR (CSF or high serum titer), γ-aminobutyric acid-B receptor (GABABR), and LGI1 had ≥ 90% positive ratings, whereas antibodies against the glycine receptor, VGKC complex, or otherwise unspecified neuropil had ≤ 40% positive ratings. Of the patients with surface antibodies, 64% improved after ≥ 3 months, mostly with ≥ 1 immunotherapy intervention. Conclusions This novel approach starting from routine diagnostics in a dedicated laboratory provides reliable and useful results with therapeutic implications. Counseling should consider clinical presentation, demographic features, and antibody titers of the individual patient. |
Databáze: | OpenAIRE |
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