Prevalence of serum anti-neuronal autoantibodies in patients admitted to acute psychiatric care

Schou, Morten Brix; Sæther, Sverre Georg; Borowski, Kathrin; Teegen, Bianca; Kondziella, Daniel; Stoecker, Winfried; Vaaler, Arne; Reitan, Solveig Merete Klæbo

doi:10.1017/s0033291716002038

Cited by 43 publications

(53 citation statements)

References 43 publications

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“…Of the seven positive studies, four used a commercially available fixed cell-based assay (CBA) [10-12, 16], two used a live CBA [13, 15], and one used both, as well as a single molecule-based imaging method, for the sake of comparing approaches [14]. The majority of negative studies also used the same aforementioned commercially available CBA (or a modification of it) [17-22, 24-29], and four of these studies also included immunohistochemistry for further testing [19, 26-28]. Two negative studies, including one previously referenced study that also used the commercial CBA kit for testing some of its sample, used in-house CBAs [22, 23].…”

Section: Resultsmentioning

confidence: 99%

“…A number of studies have also found immunoglobulin A (IgA) or immunoglobulin M (IgM) antibodies in a small proportion of patients (2.3–6.6%) [10-13, 24]; a finding of unknown clinical significance. These antibodies were also found in a small proportion of healthy controls (0.4–6.3%) in all but one of the studies that included a control group [10-12], further complicating interpretation of the results.…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, in each of the two positive studies, antibodies were found in only one patient (<1% of the samples) [11, 24], and the only study that included a healthy control group also found antibodies in 0.2% of controls [11]. Notably, of these two studies, only Schou et al [24] specified testing for antibodies of the IgG isotype.…”

Section: Resultsmentioning

confidence: 99%

“…A number of studies that tested for IgG, IgA, or IgM anti-CASPR2 antibodies found seropositivity in a small percentage (2.5% or less) of patients [11, 15, 24, 29, 36], although numerous other studies were negative [16, 18, 20, 26, 28]. Of note, all of the positive studies that included a healthy control group, however, also found antibodies in a small number of controls (up to 2.9%), and no group differences were found [11, 15, 36].…”

Section: Resultsmentioning

confidence: 99%

“…Only three studies found anti-LGI1 antibodies in a small subset of schizophrenia spectrum disorder patients (2.0% or less) [11, 15, 36], whereas six studies were negative [16, 18, 20, 24, 26, 29]. All of the positive studies included a healthy control group for comparison, two of which found anti-LGI1 antibodies in a small number of healthy controls (2% and <0.1%, respectively), and no group differences were found [11, 36].…”

Section: Resultsmentioning

confidence: 99%

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Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Colijn

Ismail

2019

Neuropsychobiology

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Schizophrenia is a phenotypically heterogeneous and poorly understood disorder. While its etiology is likely multifactorial, immune system dysfunction has increasingly been implicated in its development. As hallucinations and delusions occur frequently and prominently in autoimmune encephalitis (AE), numerous studies have sought to determine whether a small subset of individuals diagnosed with schizophrenia possess anti-neuronal antibodies implicated in AE. Exploring this possibility is of clinical relevance, as identifying individuals with AE who have been misdiagnosed as having a primary psychotic disorder may allow for the implementation of appropriate immune-related therapies as early as possible in the course of the illness, in order to optimize outcomes, reduce illness chronicity, and minimize adverse events. This qualitative review serves to provide an overview of the existing literature on this topic, as well as to update previously published reviews. Although there is some evidence to suggest that in rare cases AE may be misdiagnosed as a primary psychotic disorder, particularly early in the course of the illness, numerous methodological differences between studies likely account for the highly variable findings, and interpretation of the results is particularly limited by a paucity of cerebrospinal fluid data. Moreover, the prevalence of misdiagnosis in chronic and treatment-resistant populations remains understudied. This is particularly problematic, as treatment resistance may represent an enriched population with respect to the presence of anti-neuronal antibodies, and given that such patients have few evidence-based treatment options available to them beyond clozapine.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Colijn

Ismail

2019

Neuropsychobiology

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Psychiatric features in NMDAR and LGI1 antibody–associated autoimmune encephalitis

et al. 2023

Eur Arch Psychiatry Clin Neurosci

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Patient characteristics and outcome associations in AMPA receptor encephalitis

et al. 2018

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Antibody-mediated encephalitis defines a class of diseases wherein antibodies directed at cellsurface receptors are associated with behavioral and cognitive disturbances. One such recently described encephalitis is due to antibodies directed at alpha-amino-3-hydroxy-5methyl-4isoxazolepropionic acid receptors (AMPAR). This entity is exceptionally rare and its clinical phenotype incompletely described. We present findings from two cases of AMPAR encephalitis that exemplify variability in the disease spectrum, and summarize findings in published cases derived from a systematic literature review. When all patients are considered together, the presence of psychiatric symptoms at presentation portended a poor outcome and was associated with the presence of a tumor. Furthermore, we provide evidence to suggest that the topography of magnetic resonance imaging abnormalities in reported cases mirrors the distribution of AMPARs in the human brain. The potential for neurological improvement following immunomodulatory therapy together with the favorable outcome reported in most cases emphasizes the importance of testing for autoantibodies against neuronal cell-surface proteins, including AMPAR, in patients with clinical and neuroimaging findings suggestive of autoimmune encephalitis. Close attention to the clinical phenotype may inform the presence of malignancy and long-term prognosis.

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Prevalence of serum anti-neuronal autoantibodies in patients admitted to acute psychiatric care

Cited by 43 publications

References 43 publications

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Clinically Relevant Anti-Neuronal Cell Surface Antibodies in Schizophrenia Spectrum Disorders

Psychiatric features in NMDAR and LGI1 antibody–associated autoimmune encephalitis

Patient characteristics and outcome associations in AMPA receptor encephalitis

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