Distinct movement disorders in contactin-associated-protein-like-2 antibody-associated autoimmune encephalitis

自身抗体 边缘脑炎 自身免疫性脑炎 医学 运动障碍 脑炎 共济失调 自身免疫 免疫学 肌阵挛 舞蹈病 神经肌强直 内科学 病理 抗体 疾病 精神科 病毒
作者
Saiju Jacob,Ligia Abrante,Jos S. Becktepe,Bettina Balint,Christos Ganos,Ulrich Hofstadt-van Oy,Christos Krogias,James Varley,Sarosh R. Irani,Sofija Paneva,Maarten J. Titulaer,Juna M. de Vries,Agnita J.W. Boon,Marco W. J. Schreurs,Bastien Joubert,Jérôme Honnorat,Alberto Vogrig,Helena Ariño,Lidia Sabater,Josep Dalmau,Sangeeta Scotton,Saiju Jacob,Nico Melzer,Christian G. Bien,Christian Geis,Jan Lewerenz,Harald Prüß,Klaus Peter Wandinger,Günther Deuschl,Frank Leypoldt
出处
期刊:Brain [Oxford University Press]
卷期号:146 (2): 657-667 被引量:8
标识
DOI:10.1093/brain/awac276
摘要

Abstract Autoimmune encephalitis can be classified into antibody-defined subtypes, which can manifest with immunotherapy-responsive movement disorders sometimes mimicking non-inflammatory aetiologies. In the elderly, anti-LGI1 and contactin associated protein like 2 (CASPR2) antibody-associated diseases compose a relevant fraction of autoimmune encephalitis. Patients with LGI1 autoantibodies are known to present with limbic encephalitis and additionally faciobrachial dystonic seizures may occur. However, the clinical spectrum of CASPR2 autoantibody-associated disorders is more diverse including limbic encephalitis, Morvan’s syndrome, peripheral nerve hyperexcitability syndrome, ataxia, pain and sleep disorders. Reports on unusual, sometimes isolated and immunotherapy-responsive movement disorders in CASPR2 autoantibody-associated syndromes have caused substantial concern regarding necessity of autoantibody testing in patients with movement disorders. Therefore, we aimed to systematically assess their prevalence and manifestation in patients with CASPR2 autoimmunity. This international, retrospective cohort study included patients with CASPR2 autoimmunity from participating expert centres in Europe. Patients with ataxia and/or movement disorders were analysed in detail using questionnaires and video recordings. We recruited a comparator group with anti-LGI1 encephalitis from the GENERATE network. Characteristics were compared according to serostatus. We identified 164 patients with CASPR2 autoantibodies. Of these, 149 (90.8%) had only CASPR2 and 15 (9.1%) both CASPR2 and LGI1 autoantibodies. Compared to 105 patients with LGI1 encephalitis, patients with CASPR2 autoantibodies more often had movement disorders and/or ataxia (35.6 versus 3.8%; P < 0.001). This was evident in all subgroups: ataxia 22.6 versus 0.0%, myoclonus 14.6 versus 0.0%, tremor 11.0 versus 1.9%, or combinations thereof 9.8 versus 0.0% (all P < 0.001). The small group of patients double-positive for LGI1/CASPR2 autoantibodies (15/164) significantly more frequently had myoclonus, tremor, ‘mixed movement disorders’, Morvan’s syndrome and underlying tumours. We observed distinct movement disorders in CASPR2 autoimmunity (14.6%): episodic ataxia (6.7%), paroxysmal orthostatic segmental myoclonus of the legs (3.7%) and continuous segmental spinal myoclonus (4.3%). These occurred together with further associated symptoms or signs suggestive of CASPR2 autoimmunity. However, 2/164 patients (1.2%) had isolated segmental spinal myoclonus. Movement disorders and ataxia are highly prevalent in CASPR2 autoimmunity. Paroxysmal orthostatic segmental myoclonus of the legs is a novel albeit rare manifestation. Further distinct movement disorders include isolated and combined segmental spinal myoclonus and autoimmune episodic ataxia.
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