Longitudinal CSF Findings in Autoimmune Encephalitis—A Monocentric Cohort Study

Autoimmune encephalitis (AIE) poses a diagnostic challenge due to its heterogeneous clinical presentation, which overlaps with various neurological and psychiatric diseases. During the diagnostic work-up, cerebrospinal fluid (CSF) is routinely obtained, allowing for differential diagnostics as well...

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Vydané v:Frontiers in Immunology Ročník 12; s. 646940
Hlavní autori: Zrzavy, Tobias, Höftberger, Romana, Wimmer, Isabella, Berger, Thomas, Rommer, Paulus, Macher, Stefan
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Switzerland Frontiers Media SA 22.03.2021
Frontiers Media S.A
Predmet:
auto-antibodies
Autoantibodies
Autoimmune Diseases of the Nervous System
autoimmune encephalitis
Cell Adhesion Molecules, Neuronal
CSF
Encephalitis
Female
Humans
Immunoglobulin G
Immunologic diseases. Allergy
Immunology
Intracellular Signaling Peptides and Proteins
Longitudinal Studies
Male
Membrane Proteins
Middle Aged
Nerve Tissue Proteins
oligoclonal bands
pleocytosis
RC581-607
Receptors, Glutamate
Receptors, N-Methyl-D-Aspartate
Retrospective Studies
Sensitivity and Specificity
autoimmune encephalitis
pleocytosis
auto-antibodies
CSF
oligoclonal bands
ISSN:1664-3224, 1664-3224
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Shrnutí:Autoimmune encephalitis (AIE) poses a diagnostic challenge due to its heterogeneous clinical presentation, which overlaps with various neurological and psychiatric diseases. During the diagnostic work-up, cerebrospinal fluid (CSF) is routinely obtained, allowing for differential diagnostics as well as for the determination of antibody subclasses and specificities. In this monocentric cohort study, we describe initial and serial CSF findings of 33 patients diagnosed with antibody-associated AIE (LGI1 (n=8), NMDA (n=7), CASPR2 (n=3), IgLON5 (n=3), AMPAR (n=1), GAD65/67 (n=4), Yo (n=3), Ma-1/2 (n=2), CV2 (n=2)). Routine CSF parameters of 12.1% of AIE patients were in normal ranges, while 60.6% showed elevated protein levels and 45.4% had intrathecal oligoclonal bands (OCBs). Repeated CSF analyses showed a trend towards normalization of initial pathological CSF findings, while relapses were more likely to be associated with increased cell counts and total protein levels. OCB status conversion in anti-NMDARE patients coincided with clinical improvement. In summary, we show that in routine CSF analysis at diagnosis, a considerable number of patients with AIE did not exhibit alteration in the CSF and therefore, diagnosis may be delayed if antibody testing is not performed. Moreover, OCB status in anti-NMDAR AIE patients could represent a potential prognostic biomarker, however further studies are necessary to validate these exploratory findings.
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Edited by: Tatsuro Misu, Tohoku University, Japan
This article was submitted to Multiple Sclerosis and Neuroimmunology, a section of the journal Frontiers in Immunology
Reviewed by: Frank Leypoldt, Kiel University, Germany; Matteo Gastaldi, Neurological Institute Foundation Casimiro Mondino (IRCCS), Italy
ISSN:1664-3224
1664-3224
DOI:10.3389/fimmu.2021.646940