Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome.

Details

Serval ID
serval:BIB_A460149D5347
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Routine diagnostics for neural antibodies, clinical correlates, treatment and functional outcome.
Journal
Journal of neurology
Author(s)
Bien C.G., Bien C.I., Dogan Onugoren M., De Simoni D., Eigler V., Haensch C.A., Holtkamp M., Ismail F.S., Kurthen M., Melzer N., Mayer K., von Podewils F., Rauschka H., Rossetti A.O., Schäbitz W.R., Simova O., Witt K., Höftberger R., May T.W.
ISSN
1432-1459 (Electronic)
ISSN-L
0340-5354
Publication state
Published
Issued date
07/2020
Peer-reviewed
Oui
Volume
267
Number
7
Pages
2101-2114
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
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.
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.
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.
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.
Keywords
Autoimmune encephalitis, Immunotherapy, Laboratory test evaluation, Neural autoantibodies, Outcome
Pubmed
Web of science
Create date
25/04/2020 22:43
Last modification date
28/07/2020 6:21
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