Gerstmann-Straüssler-Scheinker disease: novel PRNP mutation and VGKC-complex antibodies.

Abstract

OBJECTIVE:

To describe a unique case of Gerstmann-Straüssler-Scheinker (GSS) disease caused by a novel prion protein (PRNP) gene mutation and associated with strongly positive voltage-gated potassium channel (VGKC)-complex antibodies (Abs).

METHODS:

Clinical data were gathered from retrospective review of the case notes. Postmortem neuropathologic examination was performed, and DNA was extracted from frozen brain tissue for full sequence analysis of the PRNP gene.

RESULTS:

The patient was diagnosed in life with VGKC-complex Ab-associated encephalitis based on strongly positive VGKC-complex Ab titers but no detectable LGI1 or CASPR2 Abs. He died despite 1 year of aggressive immunosuppressive treatment. The neuropathologic diagnosis was GSS disease, and a novel mutation, P84S, in the PRNP gene was found.

CONCLUSION:

VGKC-complex Abs are described in an increasingly broad range of clinical syndromes, including progressive encephalopathies, and may be amenable to treatment with immunosuppression. However, the failure to respond to aggressive immunotherapy warns against VGKC-complex Abs being pathogenic, and their presence does not preclude the possibility of prion disease.

• Authors: Matthew Jones, Sola Odunsi, Daniel du Plessis, Angela Vincent, Matthew Bishop, Mark W Head, James W Ironside, David Gow
• Journal: Neurology (Neurology) Vol. 82 Issue 23 Pg. 2107-11 (Jun 10 2014) ISSN: 1526-632X [Electronic] United States
• PMID: 24814844 (Publication Type: Case Reports, Journal Article)
• Copyright: © 2014 American Academy of Neurology.

Chemical References

• Antibodies
• PRNP protein, human
• Potassium Channels, Voltage-Gated
• Prion Proteins
• Prions

Topics

• Antibodies (adverse effects, blood)
• Encephalitis (drug therapy, genetics, immunology)
• Fatal Outcome
• Gerstmann-Straussler-Scheinker Disease (genetics, immunology)
• Humans
• Male
• Middle Aged
• Mutation (genetics)
• Pedigree
• Potassium Channels, Voltage-Gated (immunology)
• Prion Proteins
• Prions (genetics)