Cortical dysfunction in cerebellar ataxia with antibodies to glutamic acid decarboxylase

Simon, Neil; Vucic, Steve; Joffe, R; Kiernan, Matthew C.

doi:10.1007/s00415-013-7197-3

Cited by 1 publication

(1 citation statement)

References 7 publications

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“…Sub-acute presentations carried a more favourable prognosis than chronic ataxia. Varying induction regimes combining steroids, intravenous immunoglobulins (IVIg) and plasma exchange (PEx) have been utilised, typically relying on clinical status to assess response, although neurophysiological outcome markers may also inform [ 16 ]. While decreases in serum, anti-GAD levels have often tracked effective therapy, for example with rituximab [ 17 ], intrathecal levels may be more reflective of treatment response [ 18 ].…”

Section: Ataxia and Systemic Immunological Disordersmentioning

confidence: 99%

Treatment of Cerebellar Ataxia in the Context of Systemic Diseases

Proudfoot

Wilkins

2017

Curr Treat Options Neurol

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Purpose of review The purpose of this review is to assess the evidence behind treatment regimens for cerebellar ataxias occurring in the context of systemic disease. We will address systemic conditions which are associated with specific involvement of the cerebellum (rather than widespread nervous system involvement) and those conditions for which some degree of evidence of treatment response exists. Recent findings We have divided systemic disorders affecting the cerebellum into systemic immunological disorders, endocrine and metabolic disorders and paraneoplastic. Recent studies have increased understanding of the range of cerebellar disorders associated with a systemic immunological condition. The identification of newer pathogenic antibodies has improved diagnosis in conditions which would have previously been labelled as idiopathic. However, their rarity and phenotypic variability makes defining optimal immunomodulatory treatment regimens challenging. There is some evidence for beneficial effects of immunomodulation, particularly in anti-GAD ataxia and Hashimoto’s encephalopathy, although, at this time, specific treatment regimens cannot be defined. Immune-mediated paraneoplastic cerebellar disorders show response to therapy dependent, to some extent, on the underlying pathogenic antibody. Much is still to be understood concerning treatment regimens for the ataxic manifestations of metabolic disorders, notably alcohol-induced cerebellar injury, which are common and which are associated with significant disability. Summary Despite their rarity, cerebellar ataxias occurring in the context of systemic disease cause significant morbidity and better therapies are required to improve outcomes associated with these conditions.

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Section: Ataxia and Systemic Immunological Disordersmentioning

confidence: 99%