1
|
Bhatia K, Balint B. Autoimmunity Panels: Needs and Implementation in the Underdeveloped Regions and how to Approach the Disparities. Mov Disord Clin Pract 2024; 11:119-122. [PMID: 38386486 PMCID: PMC10883400 DOI: 10.1002/mdc3.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 02/24/2024] Open
Affiliation(s)
- Kailash Bhatia
- Department of Clinical and Movement NeurosciencesUCL Queen Square Institute of Neurology University College LondonLondonUnited Kingdom
| | - Bettina Balint
- Department of NeurologyUniversity Hospital Zurich, University of ZurichSwitzerland
| |
Collapse
|
2
|
Vlad B, Wang Y, Newsome SD, Balint B. Stiff Person Spectrum Disorders-An Update and Outlook on Clinical, Pathophysiological and Treatment Perspectives. Biomedicines 2023; 11:2500. [PMID: 37760941 PMCID: PMC10525659 DOI: 10.3390/biomedicines11092500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/29/2023] Open
Abstract
Stiff person spectrum disorders (SPSD) are paradigm autoimmune movement disorders characterized by stiffness, spasms and hyperekplexia. Though rare, SPSD represent a not-to-miss diagnosis because of the associated disease burden and treatment implications. After decades as an enigmatic orphan disease, major advances in our understanding of the evolving spectrum of diseases have been made along with the identification of multiple associated autoantibodies. However, the most important recent developments relate to the recognition of a wider affection, beyond the classic core motor symptoms, and to further insights into immunomodulatory and symptomatic therapies. In this review, we summarize the recent literature on the clinical and paraclinical spectrum, current pathophysiological understanding, as well as current and possibly future therapeutic strategies.
Collapse
Affiliation(s)
- Benjamin Vlad
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland;
| | - Yujie Wang
- Department of Neurology, University of Washington, Seattle, WA 98195, USA
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Scott D. Newsome
- Division of Neuroimmunology and Neurological Infections, Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Bettina Balint
- Department of Neurology, University Hospital Zurich, 8091 Zurich, Switzerland;
- Faculty of Medicine, University of Zurich, 8091 Zurich, Switzerland
| |
Collapse
|
3
|
Balint B. Relevance of Antibody Testing in Movement Disorders. Mov Disord Clin Pract 2023; 10:S32-S35. [PMID: 37637987 PMCID: PMC10448132 DOI: 10.1002/mdc3.13772] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/03/2023] [Accepted: 05/04/2023] [Indexed: 08/29/2023] Open
Affiliation(s)
- Bettina Balint
- Department of NeurologyUniversity Hospital Zurich, University of ZurichZurichSwitzerland
| |
Collapse
|
4
|
Challenging diagnosis and treatment decision of a long-history autoantibody-negative autoimmune encephalitis. Parkinsonism Relat Disord 2023; 107:105232. [PMID: 36509623 DOI: 10.1016/j.parkreldis.2022.105232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/14/2022] [Accepted: 11/26/2022] [Indexed: 12/12/2022]
|
5
|
van Egmond ME, Lagrand TJ, Lizaitiene G, Smit M, Tijssen MAJ. A novel diagnostic approach for patients with adult-onset dystonia. J Neurol Neurosurg Psychiatry 2022; 93:1039-1048. [PMID: 35688632 DOI: 10.1136/jnnp-2021-328120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/07/2022] [Indexed: 11/04/2022]
Abstract
Adult-onset dystonia can be acquired, inherited or idiopathic. The dystonia is usually focal or segmental and for a limited number of cases causal treatment is available. In recent years, rapid developments in neuroimmunology have led to increased knowledge on autoantibody-related dystonias. At the same time, genetic diagnostics in sequencing technology have evolved and revealed several new genes associated with adult-onset dystonia. Furthermore, new phenotype-genotype correlations have been elucidated. Consequently, clinicians face the dilemma of which additional investigations should be performed and whether to perform genetic testing or not. To ensure early diagnosis and to prevent unnecessary investigations, integration of new diagnostic strategies is needed.We designed a new five-step diagnostic approach for adult-onset dystonia. The first four steps are based on a broad literature search and expert opinion, the fifth step, on when to perform genetic testing, is based on a detailed systematic literature review up to 1 December 2021.The basic principle of the algorithm is that genetic testing is unlikely to lead to changes in management in three groups: (1) patients with an acquired form of adult-onset dystonia; (2) patients with neurodegenerative disorders, presenting with a combined movement disorder including dystonic symptoms and (3) patients with adult-onset isolated focal or segmental dystonia. Throughout the approach, focus lies on early identification of treatable forms of dystonia, either acquired or genetic.This novel diagnostic approach for adult-onset dystonia can help clinicians to decide when to perform additional tests, including genetic testing and facilitates early aetiological diagnosis, to enable timely treatment.
Collapse
Affiliation(s)
- Martje E van Egmond
- Neurology, University Medical Centre Groningen, Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Tjerk J Lagrand
- Neurology, University Medical Centre Groningen, Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Neurology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Gintaute Lizaitiene
- Neurology, University Medical Centre Groningen, Groningen, The Netherlands.,Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marenka Smit
- Neurology, University Medical Centre Groningen, Groningen, The Netherlands.,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Marina A J Tijssen
- Neurology, University Medical Centre Groningen, Groningen, The Netherlands .,Expertise Centre Movement Disorders Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Antczak‐Kowalska M, Członkowska A, Eyileten C, Palejko A, Cudna A, Wolska M, Piechal A, Litwin T. Autoantibodies in Wilson disease: Impact on clinical course. JIMD Rep 2022; 63:508-517. [PMID: 36101827 PMCID: PMC9458613 DOI: 10.1002/jmd2.12317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/02/2022] [Accepted: 07/11/2022] [Indexed: 11/21/2022] Open
Abstract
Symptoms of Wilson disease (WD) vary and additional factors such as autoimmunity may play an important role in WD pathogenesis. The presence of antinuclear antibodies (ANA), anti‐neutrophil cytoplasmic antibodies, neuronal surface antibodies, and onconeural antibodies in WD was investigated using standardized indirect immunofluorescence assays and Western Blot analysis. The presence of all studied autoantibodies was higher in WD patients in comparison to healthy subjects, but there was no statistically significant difference in autoantibodies frequency according to disease manifestation. D‐penicillamine treatment was associated with a higher presence of ANA than zinc sulfate but without an increase in autoimmune diseases rate.
Collapse
Affiliation(s)
| | - Anna Członkowska
- 2nd Department of Neurology Institute of Psychiatry and Neurology Warsaw Poland
| | - Ceren Eyileten
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology Medical University of Warsaw Warsaw Poland
| | - Anna Palejko
- 2nd Department of Neurology Institute of Psychiatry and Neurology Warsaw Poland
| | - Agnieszka Cudna
- 2nd Department of Neurology Institute of Psychiatry and Neurology Warsaw Poland
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology Medical University of Warsaw Warsaw Poland
| | - Marta Wolska
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology Medical University of Warsaw Warsaw Poland
- Doctoral School, Medical University of Warsaw Warsaw Poland
| | - Agnieszka Piechal
- 2nd Department of Neurology Institute of Psychiatry and Neurology Warsaw Poland
- Center for Preclinical Research and Technology CEPT, Department of Experimental and Clinical Pharmacology Medical University of Warsaw Warsaw Poland
| | - Tomasz Litwin
- 2nd Department of Neurology Institute of Psychiatry and Neurology Warsaw Poland
| |
Collapse
|
7
|
Chang YC, Nouri MN, Mirsattari S, Burneo JG, Budhram A. "Obvious" indications for Neural antibody testing in Epilepsy or Seizures: The ONES checklist. Epilepsia 2022; 63:1658-1670. [PMID: 35340020 PMCID: PMC9544067 DOI: 10.1111/epi.17238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Numerous predictive scores have been developed to help determine which patients with epilepsy or seizures of unknown etiology should undergo neural antibody testing. However, their diagnostic advantage compared to only performing testing in patients with "obvious" indications (e.g. broader features of autoimmune encephalitis, characteristic seizure semiologies) requires further study. We aimed to develop a checklist that identifies patients who have "obvious" indications for neural antibody testing, and compare its diagnostic performance to predictive scores. METHODS We developed the "Obvious" indications for Neural antibody testing in Epilepsy or Seizures (ONES) checklist through literature review. We then retrospectively reviewed patients who underwent neural antibody testing for epilepsy or seizures at our center between March 2019 and January 2021, to determine and compare the sensitivity and specificity of the ONES checklist to the recently-proposed Antibody Prevalence in Epilepsy and Encephalopathy (APE2)/Antibodies Contributing to Focal Epilepsy Signs and Symptoms (ACES) reflex score. RESULTS One-hundred-seventy patients who underwent neural antibody testing for epilepsy or seizures were identified. Seventy-four of 170 (43.5%) with a known etiology were excluded from sensitivity/specificity analyses; none had a true-positive neural antibody. Of the 96 patients with an unknown etiology, fourteen (15%) had a true-positive neural antibody. The proportion of false-positives was significantly higher among patients with a known etiology (3/3, 100%) compared to an unknown etiology (2/16, 13%) (P = .01). There was no significant difference of the APE2/ACES reflex score compared to the ONES checklist with regard to sensitivity (93% for both, P > .99) or specificity (71% versus 78%, P = .18) for true-positive neural antibodies. SIGNIFICANCE Compared to only performing neural antibody testing in patients with epilepsy or seizures of unknown etiology who have "obvious" indications, predictive scores confer no clear diagnostic advantage. Pre-specified definitions of what constitutes a true-positive neural antibody is required in future studies to avoid false-positives that can confound results.
Collapse
Affiliation(s)
- Yiu-Chia Chang
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Maryam N Nouri
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.,Department of Paediatrics, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Seyed Mirsattari
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.,Department of Medical Biophysics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jorge G Burneo
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.,Neuroepidemiology Unit, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Western University, London, Ontario, Canada.,Department of Pathology and Laboratory Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
| |
Collapse
|
8
|
Pedroso JL, Tonholo Silva TY, Simabukuro MM, Rosa ABR, G Barsottini O. From VUS to AUS: The Connection and the Differences between Genetics and Immune-Mediated Disorders. Mov Disord 2021; 36:2453-2454. [PMID: 34658069 DOI: 10.1002/mds.28770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- José Luiz Pedroso
- Department of Neurology, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | |
Collapse
|
9
|
Balint B, Bhatia KP, Dalmau J. Reply to: Comparing VUS and AUS: Parallels and Differences in Neurogenetics and Neuroimmunology. Mov Disord 2021; 36:2454-2456. [PMID: 34658066 DOI: 10.1002/mds.28764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/08/2022] Open
Affiliation(s)
- Bettina Balint
- Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Kailash P Bhatia
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, United Kingdom
| | - Josep Dalmau
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain.,Service of Neurology, Hospital Clinic de Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Centro de Investigación Biomédica en Red de Enfermedades Raras, Valencia, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| |
Collapse
|