Clinical manifestations and outcomes of the treatment of patients with GABAB encephalitis

Kim, Tae Joon; Shin, Jai Moo; Moon, Jangsup; Lim, Joo Hyun; Byun, Jung Ick; Shin, Yeong-Gil; Lee, Keon Joo; Jung, Kwangyun; Kim, Young Soo; Park, Kyung‐Il; Chu, Kon; Lee, Sang Kun

doi:10.1016/j.jneuroim.2014.02.011

Cited by 86 publications

(107 citation statements)

References 25 publications

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“…The patient with cortical hypometabolism showed normal MRI. 7 Our case is different from previous report. First, the brain has a mixed metabolic pattern characterized by pronounced medial temporal hypermetabolism with gross hypometabolism in the rest of the brain.…”

Section: Figurecontrasting

confidence: 98%

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18F-FDG PET/CT and MRI Findings in a Patient With Anti-GABAB Receptor Encephalitis

Tian

2015

Clinical Nuclear Medicine

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Autoimmune synaptic encephalitis can occur as paraneoplastic neurological syndromes, which are dysfunctions of the nervous system in cancer patients. One such rare but treatable form is associated with GABAB (γ-aminobutyric acid-B) receptor antibody. We report a 55-year-old man with small cell lung cancer who presented with 3 weeks of progressive seizures, memory impairment, and behavioral disorder. His cerebrospinal fluid anti-GABAB receptor antibody titer was elevated. F-FDG PET/CT revealed pronounced medial temporal hypermetabolism with gross hypometabolism in the rest of the brain. There were no associated abnormalities on MRI. He showed improvement after immunotherapy and chemoradiotherapy.

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Section: Figurecontrasting

confidence: 98%

“…3,7 To our knowledge, there is only 1 report (5 cases) of correlated MRI and 18 F-FDG PET patterns in anti-GABA B receptor encephalitis. 7 In that study, 3 patients showed abnormalities on PET, including 2 temporal hypermetabolism and 1 cortical hypometabolism. The 2 temporal hypermetabolism patients had corresponding signal changes on MRI.…”

Section: Figurementioning

confidence: 99%

18F-FDG PET/CT and MRI Findings in a Patient With Anti-GABAB Receptor Encephalitis

Tian

2015

Clinical Nuclear Medicine

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“…Then, a cell-based immunocytochemistry method (Euroimmune Ag, Lübeck, Germany) was applied to test autoimmune-synaptic antibodies for AE, including N-methyl-D-aspartate-receptor (NMDA-R), leucine-rich glioma-inactivated 1, contactinassociated protein-like 2, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic-acid-receptor 1, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic-acid-receptor 2, γ-aminobutyric acid receptor B, and amphiphysin [4]. Autoantibodies associated with classic paraneoplastic neurologic syndromes, including Hu, Yo, Ri, Ma2, CV2/CRMP5, and recoverin, were also investigated using the immunoblotting method (Euroimmune Ag) [25][26][27]. Once the autoantibody screening test result was positive, a definite diagnosis of AE was made.…”

Section: Study Populationmentioning

confidence: 99%

Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study

et al. 2016

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A considerable portion of autoimmune encephalitis (AE) does not respond to conventional immunotherapies and subsequently has poor outcomes. We aimed to determine the efficacy of tocilizumab, an anti-interleukin-6 antibody, in rituximab-refractory AE compared with other treatment options. From an institutional cohort of AE, 91 patients with inadequate clinical response to first-line immunotherapy and following rituximab were retrospectively reviewed. Patients were grouped according to their further immunotherapy strategies. Thirty (33.0 %) patients were included in the tocilizumab group, 31 (34.0 %) in the additional rituximab group, and 30 (33.0 %) in the observation group. Outcomes were defined as the favorable modified Rankin Scale scores (≤2) at 1 and 2 months from the initiation of each treatment strategy and at the last follow-up. Favorable clinical response (improvement of the modified Rankin Scale scores by ≥ 2 points or achievement of the mRS scores ≤ 2) at the last follow-up was also analyzed. The tocilizumab group showed more frequent favorable mRS scores at 2 months from treatment initiation and at the last follow-up compared with those at the relevant time points of the remaining groups. The majority (89.5 %) of the patients with clinical improvement at 1 month from tocilizumab treatment maintained a long-term favorable clinical response. No serious adverse effects of rituximab or tocilizumab were reported. Therefore, we suggest that tocilizumab might be a good treatment strategy for treating AE refractory to conventional immunotherapies and rituximab. The tocilizumab-mediated clinical improvement manifests as early at 1 month after treatment initiation.

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“…8B). 49–51 On rare occasions, brainstem abnormalities were found in anti-GABAB Ab encephalitis with brainstem involvement 52,53…”

Section: Mrimentioning

confidence: 99%

The Laboratory Diagnosis of Autoimmune Encephalitis

Lee

2016

J Epilepsy Res

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Autoimmune encephalitis is a group of encephalitis syndromes that cause altered mentality, memory decline, or seizures in association with the presence of serum and cerebrospinal fluid (CSF) autoantibodies (auto-Abs). An early diagnosis enables early treatments. The detection of auto-Abs is a confirmatory diagnosis. Tissue-based assay, cell-based immunoassay, and immunoblotting are used to detect various autoantibodies. The CSF test for the presence of antibodies is important because it is more sensitive and reflects disease activity in many autoimmune encephalitis, although antibody tests can be negative even in the presence of autoimmune encephalitis. EEG is often abnormal, but nonspecific. A unilateral or bilateral medial temporal T2 high signal is a common finding in MRI. Fludeoxyglucose-positron emission tomography is sometimes useful for diagnosis in patients with normal MRI.

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Clinical manifestations and outcomes of the treatment of patients with GABAB encephalitis

Cited by 86 publications

References 25 publications

18F-FDG PET/CT and MRI Findings in a Patient With Anti-GABAB Receptor Encephalitis

18F-FDG PET/CT and MRI Findings in a Patient With Anti-GABAB Receptor Encephalitis

Tocilizumab in Autoimmune Encephalitis Refractory to Rituximab: An Institutional Cohort Study

The Laboratory Diagnosis of Autoimmune Encephalitis

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