Journal
NEUROLOGY
Volume 81, Issue 17, Pages 1500-1506Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1212/WNL.0b013e3182a9585f
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Funding
- Fondo de Investigaciones Sanitarias, Madrid, Spain [PI12/00611]
- NIH [RO1NS077851, RO1CA89054]
- McKnight Neuroscience of Brain Disorders award
- Fondo de Investigaciones Sanitarias (FIS, Spain) [11/01780]
- Fundacio la Marato de TV3
- Euroimmun
- Fonds zur Forderung der wissenschaftlichen Forschung, Austria [J3230]
- ErasmusMC fellowship
- European Union
- State of Hungary
- European Social Fund [TAMOP 4.2.4 A/-11-1-2012-0001]
- OTKA MOB [80325]
- KTIA-AIK [12-1-2013-0041]
- OTKA [K109626, K108465]
- Hans und Blanca Moser Foundation
- Austrian Science Fund (FWF) [J3230] Funding Source: Austrian Science Fund (FWF)
- ICREA Funding Source: Custom
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Objective: To report the clinical features of 20 newly diagnosed patients with GABA(B) receptor (GABA(B)R) antibodies and determine the frequency of associated tumors and concurrent neuronal autoantibodies. Methods: Clinical data were retrospectively obtained and evaluated. Serum and CSF samples were examined for additional antibodies using methods previously reported. Results: Seventeen patients presented with seizures, memory loss, and confusion, compatible with limbic encephalitis (LE), one patient presented with ataxia, one patient presented with status epilepticus, and one patient presented with opsoclonus-myoclonus syndrome (OMS). Nineteen (95%) patients eventually developed LE during the course of the disease. Small-cell lung cancer (SCLC) was identified in 10 (50%) patients, all with LE. Treatment and outcome was available from 19 patients: 15 showed complete (n = 7) or partial (n = 8) neurologic improvement after steroids, IV immunoglobulins, or plasma exchange and oncologic treatment when indicated; 1 patient died of tumor progression shortly after the first cycle of immunotherapy, and 3 were not treated. Five patients with SCLC had additional onconeuronal antibodies (Ri, amphiphysin, or SOX1), and 2 without tumor had GAD65 and NMDAR antibodies, respectively. GABA(B)R antibodies were not detected in serum of 116 patients with SCLC without neurologic symptoms. Conclusion: Our study confirms GABA(B)R as an autoantigen of paraneoplastic and nonparaneoplastic LE and expands the phenotype of GABA(B)R antibodies to ataxia, OMS, and status epilepticus. The long-term prognosis is dictated by the presence of a tumor. Recognition of syndromes associated with GABA(B)R antibodies is important because they usually respond to treatment.
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