Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients.

Abstract

OBJECTIVE:

To report the clinical features of 20 newly diagnosed patients with GABAB receptor (GABABR) 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. GABABR antibodies were not detected in serum of 116 patients with SCLC without neurologic symptoms.

CONCLUSION:

Our study confirms GABABR as an autoantigen of paraneoplastic and nonparaneoplastic LE and expands the phenotype of GABABR antibodies to ataxia, OMS, and status epilepticus. The long-term prognosis is dictated by the presence of a tumor. Recognition of syndromes associated with GABABR antibodies is important because they usually respond to treatment.

• Authors: Romana Höftberger, Maarten J Titulaer, Lidia Sabater, Balazs Dome, Anita Rózsás, Balazs Hegedus, Mir Alireza Hoda, Viktoria Laszlo, Hendrik Jan Ankersmit, Lutz Harms, Sabas Boyero, Alicia de Felipe, Albert Saiz, Josep Dalmau, Francesc Graus
• Journal: Neurology (Neurology) Vol. 81 Issue 17 Pg. 1500-6 (Oct 22 2013) ISSN: 1526-632X [Electronic] United States
• PMID: 24068784 (Publication Type: Case Reports, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Review)

Chemical References

• Autoantibodies
• Receptors, GABA-B

Topics

• Adolescent
• Adult
• Aged
• Ataxia (blood, cerebrospinal fluid, immunology)
• Autoantibodies (biosynthesis, blood, cerebrospinal fluid)
• Female
• Follow-Up Studies
• Humans
• Limbic Encephalitis (blood, cerebrospinal fluid, immunology)
• Lung Neoplasms (blood, cerebrospinal fluid, immunology)
• Male
• Middle Aged
• Opsoclonus-Myoclonus Syndrome (blood, cerebrospinal fluid, immunology)
• Prognosis
• Receptors, GABA-B (immunology)
• Retrospective Studies
• Small Cell Lung Carcinoma (blood, cerebrospinal fluid, immunology)
• Status Epilepticus (blood, cerebrospinal fluid, immunology)
• Young Adult