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Wang H, Yi B, Wang M, Wang Y, Fu J, Wang X, Cao L. Cerebellar ataxia with anti-mGluR1 auto-antibody in a pediatric patient: A case report. J Neuroimmunol 2023; 378:578082. [PMID: 37119682 DOI: 10.1016/j.jneuroim.2023.578082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/14/2023] [Accepted: 04/01/2023] [Indexed: 04/05/2023]
Abstract
Cerebellar ataxia (CA) related to anti-metabolic glutamate receptor 1 (mGluR1) is a rare autoimmune encephalitis, which is manifested as acute or subacute CA in most cases.To the best of our knowledge, only three cases of pediatric patients have been reported in the literature so far. This article reports the 4th case of mGluR1 related CA in a pediatric patient.
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Khojah O, Makkawi S, Alghamdi S. Anti-mGluR1 encephalitis: Case illustration and systematic review. Front Neurol 2023; 14:1142160. [PMID: 37139064 PMCID: PMC10149714 DOI: 10.3389/fneur.2023.1142160] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
Background The literature for immune-mediated neurological disorders is evolving like no other field of neurological illnesses. Many new antibodies or disorders have been described in the last decade. The cerebellum is a brain structure susceptible to these immune-mediated pathologies, and anti-metabotropic glutamate receptor 1 (mGluR1) antibody has a predilection to the cerebellar tissue. Anti-mGluR1 encephalitis is a rare autoimmune disease affecting the central and peripheral nervous systems, triggering an acute or subacute cerebellar syndrome with varying degrees of severity. Anti-mGluR1 encephalitis is a rare autoimmune disease affecting the central nervous system. We aimed to systematically review reported cases of anti-mGluR1 encephalitis and summarize their clinical presentation, management, outcomes, and case reports. Methods A search of the PubMed and Google Scholar databases was conducted and included all cases of anti-mGluR1 encephalitis published in English before October 1, 2022. A comprehensive systematic review was conducted using "metabotropic glutamate receptor type 1," "mGluR1," autoantibodies," "autoantibodies," "autoimmunity," and "antibody" as keywords. The risk of bias assessment of the evidence was performed using appropriate tools. The qualitative variables were presented as frequency and percentage. Results Including our case, 36 cases of anti-mGluR1 encephalitis (19 males, median age 52.5 years, 11.1% pediatric cases) have been reported. The most common clinical manifestations are ataxia, dysarthria, and nystagmus. Initial imaging was normal in 44.4% of patients; however, 75% of patients showed abnormality later in the disease course. The first-line therapy options include glucocorticoids, intravenous immunoglobulin, and plasma exchange. Rituximab is the most commonly used second-line treatment. Complete remission was achieved in only 22.2% of patients, and 61.8% were disabled by the end of their course. Conclusion Anti-mGluR1 encephalitis manifests as symptoms of cerebellar pathology. Although the natural history has not been completely elucidated, early diagnosis with prompt initiation of immunotherapy could be imperative. Any patient suspected to have autoimmune cerebellitis should be tested for the presence of anti-mGluR1 antibody in the serum and cerebrospinal fluid. Escalation to an aggressive therapy approach should be applied in cases that do not respond to first-line therapies, and extended follow-up durations are required in all cases.
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Affiliation(s)
- Osama Khojah
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Seraj Makkawi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia
| | - Saeed Alghamdi
- Neuroscience Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- *Correspondence: Saeed Alghamdi,
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Goh L, Wang FS, Han VX, Lin JB. Teaching Video NeuroImage: Subacute Cerebellar Ataxia in an Adolescent With Antibodies Against Metabotropic Glutamate Receptor Type 1. Neurology 2022; 99:862-863. [PMID: 36240082 DOI: 10.1212/wnl.0000000000201268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/03/2022] [Indexed: 11/15/2022] Open
Affiliation(s)
- LiTing Goh
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore
| | - Furene Sijia Wang
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore
| | - Velda Xinying Han
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore.
| | - Jeremy Bingyuan Lin
- From the Khoo-Teck Puat-National University Children's Medical Institute (L.G., F.S.W., V.X.H., J.B.L.), National University Health System, Singapore; and Department of Paediatrics (J.B.L.), Yong Loo Lin School of Medicine, National University of Singapore
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Chandler E, Arvantis N, Morgan B. A Novel Case of Idiopathic MGluR1 Encephalitis in a Pediatric Patient. Child Neurol Open 2022; 9:2329048X221095695. [PMID: 35497371 PMCID: PMC9047037 DOI: 10.1177/2329048x221095695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/30/2022] Open
Abstract
Metabotropic Glutamate Receptor 1 (mGluR1) encephalitis is a rare encephalitis characterized by ataxia, neuropsychiatric symptoms, dysarthria and cognitive impairment. This disease process has been described in several adult patients and has been associated with paraneoplastic syndrome in Hodgkin's lymphoma and other cancers as well as parainfectious and underlying autoimmune etiologies. However, only two cases of anti-mGluR1 encephalitis in children have been reported in the literature. The underlying etiology of one case was not provided but post-infectious disease has been reported. Here, we report the first case of anti-mGluR1 encephalitis in a child with a presumed “idiopathic” basis.
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Affiliation(s)
- Erika Chandler
- University of Louisville, Louisville, USA.,Division of Child Neurology, Louisville, USA
| | | | - Bethanie Morgan
- University of Louisville, Louisville, USA.,Division of Child Neurology, Louisville, USA.,Norton Children's Medical Group, Louisville, USA
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Ancona C, Masenello V, Tinnirello M, Toscano LM, Leo A, La Piana C, Toldo I, Nosadini M, Sartori S. Autoimmune Encephalitis and Other Neurological Syndromes With Rare Neuronal Surface Antibodies in Children: A Systematic Literature Review. Front Pediatr 2022; 10:866074. [PMID: 35515348 PMCID: PMC9067304 DOI: 10.3389/fped.2022.866074] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Neuronal surface antibody syndromes (NSAS) are an expanding group of autoimmune neurological diseases, whose most frequent clinical manifestation is autoimmune encephalitis (AE). Anti-NMDAR, anti-LGI1, and anti-CASPR2 autoimmunity represent the most described forms, while other NSAS are rarer and less well-characterized, especially in children. We carried out a systematic literature review of children with rare NSAS (with antibodies targeting D2R, GABAAR, GlyR, GABABR, AMPAR, amphiphysin, mGluR5, mGluR1, DPPX, IgLON5, and neurexin-3alpha) and available individual data, to contribute to improve their clinical characterization and identification of age-specific features. Ninety-four children were included in the review (47/94 female, age range 0.2-18 years). The most frequent NSAS were anti-D2R (28/94, 30%), anti-GABAAR (23/94, 24%), and anti-GlyR (22/94, 23%) autoimmunity. The most frequent clinical syndromes were AE, including limbic and basal ganglia encephalitis (57/94, 61%; GABAAR, D2R, GABABR, AMPAR, amphiphysin, and mGluR5), and isolated epileptic syndromes (15/94, 16%; GlyR, GABAAR). With the limitations imposed by the low number of cases, the main distinctive features of our pediatric literature cohort compared to the respective NSAS in adults included: absent/lower tumor association (exception made for anti-mGluR5 autoimmunity, and most evident in anti-amphiphysin autoimmunity); loss of female preponderance (AMPAR); relatively frequent association with preceding viral encephalitis (GABAAR, D2R). Moreover, while SPS and PERM are the most frequent syndromes in adult anti-GlyR and anti-amphiphysin autoimmunity, in children isolated epileptic syndromes and limbic encephalitis appear predominant, respectively. To our knowledge, this is the first systematic review on rare pediatric NSAS. An improved characterization may aid their recognition in children.
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Affiliation(s)
- Claudio Ancona
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Valentina Masenello
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Matteo Tinnirello
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Luca Mattia Toscano
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Andrea Leo
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Chiara La Piana
- Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Irene Toldo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padova, Padova, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padova, Italy
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