Anti-ganglionic acetylcholine receptor antibodies in functional neurological symptom disorder/conversion disorder

Abstract

ObjectiveAutoimmune autonomic ganglionopathy (AAG) is a rare disorder characterized by autonomic failure associated with the presence of anti-ganglionic acetylcholine receptor (gAChR) antibodies; however, several studies have reported that individuals with anti-gAChR antibodies present with central nervous system (CNS) symptoms such as impaired consciousness and seizures. In the present study, we investigated whether the presence of serum anti-gAChR antibodies correlated with autonomic symptoms in patients with functional neurological symptom disorder/conversion disorder (FNSD/CD).MethodsClinical data were collected for 59 patients presenting with neurologically unexplained motor and sensory symptoms at the Department of Neurology and Geriatrics between January 2013 and October 2017 and who were ultimately diagnosed with FNSD/CD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Correlations between serum anti-gAChR antibodies and clinical symptoms and laboratory data were analyzed. Data analysis was conducted in 2021.ResultsOf the 59 patients with FNSD/CD, 52 (88.1%) exhibited autonomic disturbances and 16 (27.1%) were positive for serum anti-gAChR antibodies. Cardiovascular autonomic dysfunction, including orthostatic hypotension, was significantly more prevalent (75.0 vs. 34.9%, P = 0.008), whereas involuntary movements were significantly less prevalent (31.3 vs. 69.8%, P = 0.007), among anti-gAChR antibody-positive compared with -negative patients. Anti-gAChR antibody serostatus did not correlate significantly with the frequency of other autonomic, sensory, or motor symptoms analyzed.ConclusionsAn autoimmune mechanism mediated by anti-gAChR antibodies may be involved in disease etiology in a subgroup of FNSD/CD patients.

C-Reactive Protein: Pathophysiology, Diagnosis, False Test Results and a Novel Diagnostic Algorithm for Clinicians

“…Studies on anti-N-methyl-D-aspartate receptor encephalitis potential relapses are limited and opposed, data on autoimmune autonomic ganglionopathy and myalgic encephalomyelitis/chronic fatigue syndrome are again limited, and so are data on autoimmune hypophysitis—with a case report showing high CRP possibly in relapse [ 749 , 750 , 751 , 752 , 753 ]. Moreover, CRP can be elevated in Guillain–Barré syndrome, in which it can possibly be a risk factor for disease severity, particularly in adults [ 754 , 755 ].…”

Prevalence of Autoimmune Diseases in Functional Neurological Disorder: Influence of Psychiatric Comorbidities and Biological Sex

“…Recent findings suggest that FND is associated with neuroendocrine and immune abnormalities [8]. Specifically, patients with this disorder show blunted morning cortisol secretion [9–11], alterations in peripheral inflammatory markers, such as C-reactive protein, interferon-gamma, interleukin-6, and tumor necrosis factor-alpha [12–14], and presence of anti-ganglionic acetylcholine receptor antibodies associated with autonomic dysfunction [15,16]. Furthermore, a recent hypothesis-free genome-wide epigenetic study identified methylomic changes at the level of multiple immune-related pathways in individuals with FND with and without history of childhood abuse [17].…”

“…Recent findings suggest that FND is associated with neuroendocrine and immune abnormalities [8]. Specifically, patients with this disorder show blunted morning cortisol secretion [9][10][11], alterations in peripheral inflammatory markers, such as C-reactive protein, interferon-gamma, interleukin-6, and tumor necrosis factor-alpha [12][13][14], and presence of antiganglionic acetylcholine receptor antibodies associated with autonomic dysfunction [15,16].…”