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2018 ; 141
(1
): 13-36
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Movement disorders with neuronal antibodies: syndromic approach, genetic
parallels and pathophysiology
#MMPMID29053777
Balint B
; Vincent A
; Meinck HM
; Irani SR
; Bhatia KP
Brain
2018[Jan]; 141
(1
): 13-36
PMID29053777
show ga
Movement disorders are a prominent and common feature in many
autoantibody-associated neurological diseases, a group of potentially treatable
conditions that can mimic infectious, metabolic or neurodegenerative disease.
Certain movement disorders are likely to associate with certain autoantibodies;
for example, the characteristic dyskinesias, chorea and dystonia associated with
NMDAR antibodies, stiff person spectrum disorders with GAD, glycine receptor,
amphiphysin or DPPX antibodies, specific paroxysmal dystonias with LGI1
antibodies, and cerebellar ataxia with various anti-neuronal antibodies. There
are also less-recognized movement disorder presentations of antibody-related
disease, and a considerable overlap between the clinical phenotypes and the
associated antibody spectra. In this review, we first describe the antibodies
associated with each syndrome, highlight distinctive clinical or radiological
'red flags', and suggest a syndromic approach based on the predominant movement
disorder presentation, age, and associated features. We then examine the
underlying immunopathophysiology, which may guide treatment decisions in these
neuroimmunological disorders, and highlight the exceptional interface between
neuronal antibodies and neurodegeneration, such as the tauopathy associated with
IgLON5 antibodies. Moreover, we elaborate the emerging pathophysiological
parallels between genetic movement disorders and immunological conditions, with
proteins being either affected by mutations or targeted by autoantibodies.
Hereditary hyperekplexia, for example, is caused by mutations of the alpha
subunit of the glycine receptor leading to an infantile-onset disorder with
exaggerated startle and stiffness, whereas antibodies targeting glycine receptors
can induce acquired hyperekplexia. The spectrum of such immunological and genetic
analogies also includes cerebellar ataxias and some encephalopathies. Lastly, we
discuss how these pathophysiological considerations could reflect on possible
future directions regarding antigen-specific immunotherapies or targeting the
pathophysiological cascades downstream of the antibody effects.