Skip to main content

Surface Antibody-Mediated Autoimmune Encephalitis

  • Chapter
  • First Online:
  • 977 Accesses

Abstract

Autoimmune etiologies are increasingly recognized as a common cause of encephalitis. Many autoimmune encephalitides have been associated with neural autoantibodies, which serve as important biomarkers for these disorders. As the field of autoimmune neurology develops, new autoantibodies, characterized as either intracellular or cell surface, depending on the localization of their antigens, continue to be discovered. As opposed to the classical paraneoplastic syndromes linked with intracellular autoantibodies, neuronal surface antibody syndromes often have a good response to immunotherapy. Despite the growing recognition of autoimmune encephalitides and the increasing availability of commercial autoantibody testing, diagnoses remain challenging, given the variability of neurological presentations and complexity of diagnostic testing and subsequent interpretation. This can have significant clinical implications, as early and adequate immunotherapy ensures the best outcome.

This is a preview of subscription content, log in via an institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Lancaster E, Dalmau J. Neuronal autoantigens—pathogenesis, associated disorders and antibody testing. Nat Rev Neurol. 2012 Jul;8(7):380–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Linnoila JJ, Rosenfeld MR, Dalmau J. Neuronal surface antibody-mediated autoimmune encephalitis. Semin Neurol. 2014 Sep;34(4):458–66.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Lancaster E, Martinez-Hernandez E, Dalmau J. Encephalitis and antibodies to synaptic and neuronal cell surface proteins. Neurology. 2011 Jul;77(2):179–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ramanathan S, Mohammad SS, Brilot F, Dale RC. Autoimmune encephalitis: recent updates and emerging challenges. J Clin Neurosci. 2014 May;21(5):722–30.

    Article  CAS  PubMed  Google Scholar 

  5. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010 Apr;30(17):5866–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu H, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol. 2009 Apr;65(4):424–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Gleichman AJ, Spruce LA, Dalmau J, Seeholzer SH, Lynch DR. Anti-NMDA receptor encephalitis antibody binding is dependent on amino acid identity of a small region within the glun1 amino terminal domain. J Neurosci. 2012 Aug;32(32):11082–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Gleichman AJ, Panzer JA, Baumann BH, Dalmau J, Lynch DR. Antigenic and mechanistic characterization of anti-AMPA receptor encephalitis. Ann Clin Transl Neurol. 2014 Mar;1(3):180–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Moscato EH, Peng X, Jain A, Parsons TD, Dalmau J, Balice-Gordon RJ. Acute mechanisms underlying antibody effects in anti-N-methyl-D-aspartate receptor encephalitis. Ann Neurol. 2014 Jul;76(1):108–19.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Gresa-Arribas N, Planagumà J, Petit-Pedrol M, Kawachi I, Katada S, Glaser CA, et al. Human neurexin-3α antibodies associate with encephalitis and alter synapse development. Neurology. 2016 Jun;86(24):2235–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Petit-Pedrol M, Armangue T, Peng X, Bataller L, Cellucci T, Davis R, et al. Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: a case series, characterisation of the antigen, and analysis of the effects of antibodies. Lancet Neurol. 2014 Mar;13(3):276–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Rousseau A, Benyahia B, Dalmau J, Connan F, Guillet JG, Delattre JY, et al. T cell response to Hu-D peptides in patients with anti-Hu syndrome. J Neuro-Oncol. 2005 Feb;71(3):231–6.

    Article  CAS  Google Scholar 

  13. Plonquet A, Gherardi RK, Créange A, Antoine JC, Benyahia B, Grisold W, et al. Oligoclonal T-cells in blood and target tissues of patients with anti-Hu syndrome. J Neuroimmunol. 2002 Jan;122(1–2):100–5.

    Article  CAS  PubMed  Google Scholar 

  14. Greenlee JE, Clawson SA, Hill KE, Wood B, Clardy SL, Tsunoda I, et al. Neuronal uptake of anti-Hu antibody, but not anti-Ri antibody, leads to cell death in brain slice cultures. J Neuroinflammation. 2014;11:160.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Armangue T, Leypoldt F, Málaga I, Raspall-Chaure M, Marti I, Nichter C, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol. 2014 Feb;75(2):317–23.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Morris NA, Kaplan TB, Linnoila J, Cho T. HSV encephalitis-induced anti-NMDAR encephalitis in a 67-year-old woman: report of a case and review of the literature. J Neurovirol. 2016 Feb;22(1):33–7.

    Article  PubMed  Google Scholar 

  17. Linnoila JJ, Binnicker MJ, Majed M, Klein CJ, McKeon A. CSF herpes virus and autoantibody profiles in the evaluation of encephalitis. Neurol Neuroimmunol Neuroinflamm. 2016 Aug;3(4):e245.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ang CW, Jacobs BC, Laman JD. The Guillain-Barré syndrome: a true case of molecular mimicry. Trends Immunol. 2004 Feb;25(2):61–6.

    Article  CAS  PubMed  Google Scholar 

  19. Kirvan CA, Swedo SE, Heuser JS, Cunningham MW. Mimicry and autoantibody-mediated neuronal cell signaling in Sydenham chorea. Nat Med. 2003 Jul;9(7):914–20.

    Article  CAS  PubMed  Google Scholar 

  20. Schäbitz WR, Rogalewski A, Hagemeister C, Bien CG. VZV brainstem encephalitis triggers NMDA receptor immunoreaction. Neurology. 2014 Dec;83(24):2309–11.

    Article  PubMed  Google Scholar 

  21. Gable MS, Sheriff H, Dalmau J, Tilley DH, Glaser CA. The frequency of autoimmune N-methyl-D-aspartate receptor encephalitis surpasses that of individual viral etiologies in young individuals enrolled in the California encephalitis project. Clin Infect Dis. 2012 Apr;54(7):899–904.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Prüss H, Dalmau J, Harms L, Höltje M, Ahnert-Hilger G, Borowski K, et al. Retrospective analysis of NMDA receptor antibodies in encephalitis of unknown origin. Neurology. 2010 Nov;75(19):1735–9.

    Article  PubMed  CAS  Google Scholar 

  23. Dalmau J, Tüzün E, Wu HY, Masjuan J, Rossi JE, Voloschin A, et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007 Jan;61(1):25–36.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Irani SR, Alexander S, Waters P, Kleopa KA, Pettingill P, Zuliani L, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan’s syndrome and acquired neuromyotonia. Brain. 2010 Sep;133(9):2734–48.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, Raizer J, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol. 2010 Jan;9(1):67–76.

    Article  CAS  PubMed  Google Scholar 

  26. Lancaster E, Martinez-Hernandez E, Titulaer MJ, Boulos M, Weaver S, Antoine JC, et al. Antibodies to metabotropic glutamate receptor 5 in the Ophelia syndrome. Neurology. 2011 Nov;77(18):1698–701.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Carvajal-González A, Leite MI, Waters P, Woodhall M, Coutinho E, Balint B, et al. Glycine receptor antibodies in perm and related syndromes: characteristics, clinical features and outcomes. Brain. 2014 Aug;137(Pt 8):2178–92.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Boronat A, Gelfand JM, Gresa-Arribas N, Jeong HY, Walsh M, Roberts K, et al. Encephalitis and antibodies to dipeptidyl-peptidase-like protein-6, a subunit of Kv4.2 potassium channels. Ann Neurol. 2013 Jan;73(1):120–8.

    Article  CAS  PubMed  Google Scholar 

  29. Sabater L, Gaig C, Gelpi E, Bataller L, Lewerenz J, Torres-Vega E, et al. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study. Lancet Neurol. 2014 Jun;13(6):575–86.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Linnoila J, Pittock SJ. Autoantibody-associated central nervous system neurologic disorders. Semin Neurol. 2016 Aug;36(4):382–96.

    Article  PubMed  Google Scholar 

  31. Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Ann N Y Acad Sci. 2015 Mar;1338:94–114.

    Article  CAS  PubMed  Google Scholar 

  32. Probasco JC, Solnes L, Nalluri A, Cohen J, Jones KM, Zan E, et al. Abnormal brain metabolism on FDG-PET/CT is a common early finding in autoimmune encephalitis. Neurol Neuroimmunol Neuroinflamm. 2017 Jul;4(4):e352.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Gresa-Arribas N, Titulaer MJ, Torrents A, Aguilar E, McCracken L, Leypoldt F, et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol. 2014 Feb;13(2):167–77.

    Article  CAS  PubMed  Google Scholar 

  34. Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013 Feb;12(2):157–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Rosenfeld MR, Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn). 2012 Apr;18(2):366–83.

    Google Scholar 

  36. Rosenfeld MR, Dalmau J. Diagnosis and management of paraneoplastic neurologic disorders. Curr Treat Options in Oncol. 2013 Dec;14(4):528–38.

    Article  Google Scholar 

  37. McKeon A, Apiwattanakul M, Lachance DH, Lennon VA, Mandrekar JN, Boeve BF, et al. Positron emission tomography-computed tomography in paraneoplastic neurologic disorders: systematic analysis and review. Arch Neurol. 2010 Mar;67(3):322–9.

    Article  PubMed  Google Scholar 

  38. Leypoldt F, Buchert R, Kleiter I, Marienhagen J, Gelderblom M, Magnus T, et al. Fluorodeoxyglucose positron emission tomography in anti-N-methyl-D-aspartate receptor encephalitis: distinct pattern of disease. J Neurol Neurosurg Psychiatry. 2012 Jul;83(7):681–6.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Flanagan EP, Kotsenas AL, Britton JW, McKeon A, Watson RE, Klein CJ, et al. Basal ganglia T1 hyperintensity in LGI1-autoantibody faciobrachial dystonic seizures. Neurol Neuroimmunol Neuroinflamm. 2015 Dec;2(6):e161.

    Article  PubMed  PubMed Central  Google Scholar 

  40. van Sonderen A, Ariño H, Petit-Pedrol M, Leypoldt F, Körtvélyessy P, Wandinger KP, et al. The clinical spectrum of Caspr2 antibody-associated disease. Neurology. 2016 Jul;87(5):521–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Tobin WO, Lennon VA, Komorowski L, Probst C, Clardy SL, Aksamit AJ, et al. DPPX potassium channel antibody: frequency, clinical accompaniments, and outcomes in 20 patients. Neurology. 2014 Nov;83(20):1797–803.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Höftberger R, Titulaer MJ, Sabater L, Dome B, Rózsás A, Hegedus B, et al. Encephalitis and GABAB receptor antibodies: novel findings in a new case series of 20 patients. Neurology. 2013 Oct;81(17):1500–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  43. Hutchinson M, Waters P, McHugh J, Gorman G, O’Riordan S, Connolly S, et al. Progressive encephalomyelitis, rigidity, and myoclonus: a novel glycine receptor antibody. Neurology. 2008 Oct;71(16):1291–2.

    Article  CAS  PubMed  Google Scholar 

  44. Carr I. The Ophelia syndrome: memory loss in Hodgkin’s disease. Lancet. 1982 Apr;1(8276):844–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jenny J. Linnoila .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Piquet, A.L., Linnoila, J.J. (2019). Surface Antibody-Mediated Autoimmune Encephalitis. In: Cho, T., Bhattacharyya, S., Helfgott, S. (eds) Neurorheumatology. Springer, Cham. https://doi.org/10.1007/978-3-030-16928-2_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-16928-2_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-16927-5

  • Online ISBN: 978-3-030-16928-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics