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  • 1
    In: Acta Neuropsychiatrica, Cambridge University Press (CUP), Vol. 25, No. 3 ( 2013-06), p. 128-136
    Kurzfassung: Autoimmune encephalitis associated with autoantibodies against the N ‐methyl‐ d ‐aspartate receptor (NMDAR) often presents with behavioural change. Our objective was to describe in detail the psychiatric presentation and pathways to care in order to aid the early diagnosis of NMDAR encephalitis. Methods Sera and cerebrospinal fluid (CSF) from patients with suspected NMDAR encephalitis were tested on HEK 293 cells transfected with the NR1 subunit of the NMDAR. Clinical information was obtained from the referring psychiatrists and neurologists and by review of the clinical records. Results Samples from 15 patients (13 female, 2 male, mean age 24 years, range 5–56 years) tested anti‐NMDAR positive. Twelve of the 15 patients (80%) presented with prominent psychiatric symptoms and 8 were initially referred to a psychiatric service. The most prominent initial psychiatric symptoms were anxiety in seven (47%), behavioural change (often bizarre) in six (40%) and agitation in five (33%). All patients developed psychiatric symptoms in the first 6 weeks of illness. Thirteen patients received psychotropic medications: antipsychotics in 12 and benzodiazepines in 11. Treating physicians considered the psychotropic medication not effective in 11 patients resulting in many drug switches. At nadir, all patients were in a very poor condition. However, eight patients (53%) recovered (almost) completely. Outcome tended to be better in patients who had received early immunotherapy or tumour removal. Conclusions Autoimmune encephalitis and anti‐NMDAR testing in serum and CSF should be considered in patients, especially young females, presenting with atypical psychiatric phenomena. Early diagnosis and treatment will likely improve the prognosis of NMDAR encephalitis.
    Materialart: Online-Ressource
    ISSN: 0924-2708 , 1601-5215
    Sprache: Englisch
    Verlag: Cambridge University Press (CUP)
    Publikationsdatum: 2013
    ZDB Id: 2077830-2
    Standort Signatur Einschränkungen Verfügbarkeit
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  • 2
    Online-Ressource
    Online-Ressource
    American Association for Cancer Research (AACR) ; 2012
    In:  Cancer Research Vol. 72, No. 8_Supplement ( 2012-04-15), p. 4822-4822
    In: Cancer Research, American Association for Cancer Research (AACR), Vol. 72, No. 8_Supplement ( 2012-04-15), p. 4822-4822
    Kurzfassung: Introduction: Paraneoplastic cerebellar degeneration (PCD) is characterized by subacute cerebellar ataxia which coincides with the presence of specific tumour types and antineuronal antibodies. One particular form of PCD is associated with Hodgkin Lymphoma (HL) and the presence of antibodies against cerebellar Purkinje cells in several of these patients’ sera. These later called anti-Tr antibodies recognize a specific punctuate immunoreactivity in the large dendritic tree as well as the soma of the Purkinje cells, but not in the axons. Although this characteristic immunoreactive pattern is considered to be a good hallmark for the presence of anti-Tr antibodies, further diagnosis is elaborate. In order to aid this diagnosis, and to understand the pathogenic nature of the PCD we aimed to identify the antigen recognized by anti-Tr antibodies. Objective: We aimed to identify the long sought antigen recognized by anti-Tr antibodies. Methods: To identify the antigen we performed immunoprecipitation using four anti-Tr positive sera on total rat brain extract followed by mass spectrometry. By Western blotting and cell-based assays we subsequently determined the region of the epitope recognized by the anti-Tr antibodies. Deletion and mutant constructs were generated to further map the antigenic region. Results: We identified Delta/Notch-like epidermal growth factor (EGF)-related Receptor (DNER) as the Tr antigen. In a cell-based screening assay 191 control samples were negative, whereas all of the 12 anti-Tr positive sera stained HA-tagged-DNER expressing cells. Using deletion constructs we pinpointed the main epitope to the extracellular domain. Glycosylation inhibitor tunicamycin and N-glycosylation mutations in DNER abolished the anti-Tr staining, indicating that DNER must be glycosylated to be recognized by anti-Tr antibodies. Conclusion: Anti-Tr positive sera recognize DNER. Using the cell based assay, presence of anti-Tr antibodies in patients with PCD and HL can now be screened both quickly and reliably. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4822. doi:1538-7445.AM2012-4822
    Materialart: Online-Ressource
    ISSN: 0008-5472 , 1538-7445
    RVK:
    RVK:
    Sprache: Englisch
    Verlag: American Association for Cancer Research (AACR)
    Publikationsdatum: 2012
    ZDB Id: 2036785-5
    ZDB Id: 1432-1
    ZDB Id: 410466-3
    Standort Signatur Einschränkungen Verfügbarkeit
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