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The Peculiar Clinical Symptoms and Treatment of Limbic Encephalitis Associated with AMPA Receptor Antibody

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机构: [a]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China [b]Beijing Key Laboratory of Neuromodulation, Beijing, China [c]Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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关键词: Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor antibody Autonomic instability Cerebellar ataxia Immunotherapy Limb paralysis Limbic encephalitis

摘要:
Alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) antibody-related diseases are very rare in autoimmune neurological diseases. We collected and analyzed the data of 3 patients with peculiar clinical manifestation positive for AMPA2-R antibody in the Department of Neurology, Xuanwu Hospital, Capital Medical University. In our reported case series, 2 patients were male and 1 was female. The initial clinical features of 3 patients were all consistent with an encephalopathy predominantly involving the limbic system. Interestingly, as the disease continues to advance, case 1 presented with limb paralysis, case 2 developed typical cerebellar ataxia, and case 3 had symptoms of autonomic instability. These 3 types of clinical features were very rare in patients with AMPAR-Ab. After immunotherapy, cases 1 and 3 responded well and case 2 was not responsive. During the follow-up, residual memory loss of cases 1 and 3 improved gradually, and they returned to work. To eliminate the influence of the presence of other pathogenic antibodies, we analyzed the available individual clinical information of 37 patients with the single AMPAR-Ab by systematic literature review. A majority of patients had sudden short-term memory loss as the initial symptom and developed limbic encephalitis. Residual memory deficit was the most common symptom after discharge. The combination of at least 2 types of immunotherapy was recommended as the first-line treatment, and patients would benefit from the tumor screening. In addition, compared with the patients positive for single AMPAR-Ab, the patients with both AMPAR-Ab and other antibodies had a higher risk of malignant tumor and might have a poor therapeutic response, which led to a poor prognosis. © 2021 S. Karger AG. All rights reserved.

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出版当年[2020]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 神经科学
最新[2023]版:
大类 | 4 区 医学
小类 | 4 区 临床神经病学 4 区 神经科学
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出版当年[2019]版:
Q4 CLINICAL NEUROLOGY Q4 NEUROSCIENCES
最新[2023]版:
Q3 CLINICAL NEUROLOGY Q3 NEUROSCIENCES

影响因子: 最新[2023版] 最新五年平均 出版当年[2019版] 出版当年五年平均 出版前一年[2018版] 出版后一年[2020版]

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第一作者机构: [a]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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通讯机构: [a]Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China [b]Beijing Key Laboratory of Neuromodulation, Beijing, China [c]Center of Epilepsy, Beijing Institute for Brain Disorders, Capital Medical University, Beijing, China
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