Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-28T02:05:07.737Z Has data issue: false hasContentIssue false
  • English
  • Français

Autoimmune Encephalopathies and Epilepsies in Children and Teenagers

Published online by Cambridge University Press:  02 December 2014

Lily C. Wong-Kisiel ,
Andrew McKeon  and
Elaine C. Wirrell
Lily C. Wong-Kisiel
Affiliation:
Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
Andrew McKeon
Affiliation:
Department of Laboratory Medicine and Pathology, and Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
Elaine C. Wirrell*
Affiliation:
Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota
*
Division of Child and Adolescent Neurology, Department of Neurology, Mayo Clinic College of Medicine; 200 First Street, SW; Rochester, Minnesota, 55905, USA.
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Recognition of autoimmune encephalopathies and epilepsies in children and teenagers with acute or subacute onset of central nervous system dysfunction, through detection of the pertinent antibody on serum or cerebral spinal fluid, or through a response to immunotherapy may lead to an early diagnosis, and thus expedited implementation of immunotherapy and improved neurological outcome. The epidemiology of pediatric autoimmune encephalopathy and epilepsy is not well established, but advances in disease-specific biomarker discovery have lead to identification of disorders with either a cytotoxic T cell mediated pathogenesis or (more recently) possible autoantibody mediated disorders. This review summarizes the clinical presentations and recommended evaluations and treatment of pediatric epileptic encephalopathy suspected to be of autoimmune etiology.

Type
Review Article
Information
Canadian Journal of Neurological Sciences , Volume 39 , Issue 2 , March 2012 , pp. 134 - 144
Copyright
Copyright © The Canadian Journal of Neurological 2012

References

1Albert, ML, Darnell, JC, Bender, A, Francisco, LM, Bhardwaj, N, Darnell, RB.Tumor-specific killer cells in paraneoplastic cerebellar degeneration. Nat Med. 1998;4(11):1321–4.CrossRefGoogle ScholarPubMed
2Ishiura, H, Matsuda, S, Higashihara, M, et al.Response of anti-NMDA receptor encephalitis without tumor to immunotherapy including rituximab. Neurology. 2008;71(23):1921–3.CrossRefGoogle ScholarPubMed
3Lindstrom, JM, Lennon, VA, Seybold, ME, Whittingham, S.Experimental autoimmune myasthenia gravis and myasthenia gravis: biochemical and immunochemical aspects. Ann NY Acad Sci. 1976;274:254–74.CrossRefGoogle ScholarPubMed
4Lennon, VA, Lindstrom, JM, Seybold, ME.Experimental autoimmune myasthenia gravis: cellular and humoral immune responses. Ann N Y Acad Sci. 1976;274:283–99.CrossRefGoogle ScholarPubMed
5Lennon, VA, Ermilov, LG, Szurszewski, JH, Vernino, S.Immunization with neuronal nicotinic acetylcholine receptor induces neurological autoimmune disease. J Clin Invest. 2003; 111(6):907–13.CrossRefGoogle ScholarPubMed
6Vernino, S, Ermilov, LG, Sha, L, Szurszewski, JH, Low, PA, Lennon, VA.Passive transfer of autoimmune autonomic neuropathy to mice. J Neurosci. 2004;24(32):7037–42.CrossRefGoogle ScholarPubMed
7Hughes, EG, Peng, X, Gleichman, AJ, et al.Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010;30(17):5866–75.CrossRefGoogle ScholarPubMed
8Constantin, T, Kalovics, T, Ponyi, A, et al.Prevalence of antiphospholipid and antinuclear antibodies in children with epilepsy. Med Sci Monit. 2009;15(4):CR164–9.Google ScholarPubMed
9Markic, J, Mestrovic, M, Valic, I, Sapunar, A, Bosnjak, N.Frequency of anticardiolipin, antinuclear and anti-beta2 glycoprotein I antibodies in children with epilepsy. Coll Antropol. 2007;31 3: 739–42.Google ScholarPubMed
10Asadi-Pooya, AA, Asadi-Pooya, K.Antinuclear antibodies in children with epilepsy treated by carbamazepine. Epilepsy Res. 2008;80(2–3):229–30.Google ScholarPubMed
11Giordano, L, Valotti, M, Bosetti, A, Accorsi, P, Caimi, L, Imberti, L.Celiac disease-related antibodies in Italian children with epilepsy. Pediatr Neurol. 2009;41(1):34–6.Google ScholarPubMed
12Majoie, HJ, de Baets, M, Renier, W, Lang, B, Vincent, A.Antibodies to voltage-gated potassium and calcium channels in epilepsy. Epilepsy Res. 2006;71(2-3):135–41.CrossRefGoogle ScholarPubMed
13Liimatainen, S, Peltola, M, Sabater, L, et al.Clinical significance of glutamic acid decarboxylase antibodies in patients with epilepsy. Epilepsia. 2010;51(5):760–7.CrossRefGoogle ScholarPubMed
14Pruss, H, Dalmau, J, Harms, L, et al.Retrospective analysis of NMDA receptor antibodies in encephalitis of unknown origin. Neurology. 2010;75(19):1735–9.CrossRefGoogle ScholarPubMed
15Bien, CG, Elger, CE.Limbic encephalitis: a cause of temporal lobe epilepsy with onset in adult life. Epilepsy Behav. 2007;10 4: 529–38.CrossRefGoogle ScholarPubMed
16Irani, SR, Buckley, C, Vincent, A, et al.Immunotherapy-responsive seizure-like episodes with potassium channel antibodies. Neurology. 2008;71(20):1647–8.CrossRefGoogle ScholarPubMed
17Irani, SR, Michell, AW, Lang, B, et al.Faciobrachial dystonic seizures precede Lgi1 antibody limbic encephalitis. Ann Neurol. 2011;69(5):892–900.CrossRefGoogle ScholarPubMed
18Suleiman, J, Brenner, T, Gill, D, et al.VGKC antibodies in pediatric encephalitis presenting with status epilepticus. Neurology. 2011; 76(14):1252–5.CrossRefGoogle ScholarPubMed
19Dhamija, R, Renaud, DL, Pittock, SJ, et al.Neuronal voltage-gated potassium channel complex autoimmunity in children. Pediatr Neurol. 2011;44(4):275–81.CrossRefGoogle ScholarPubMed
20Wainwright, MS, Martin, PL, Morse, RP, et al.Human herpesvirus 6 limbic encephalitis after stem cell transplantation. Ann Neurol. 2001;50(5):612–9.CrossRefGoogle ScholarPubMed
21Duzova, A, Bakkaloglu, A.Central nervous system involvement in pediatric rheumatic diseases: current concepts in treatment. Curr Pharm Des. 2008;14(13):1295–301.Google ScholarPubMed
22Lie, JT.Primary (granulomatous) angiitis of the central nervous system: a clinicopathologic analysis of 15 new cases and a review of the literature. Hum Pathol. 1992;23(2):164–71.CrossRefGoogle Scholar
23Castillo, P, Woodruff, B, Caselli, R, et al.Steroid-responsive encephalopathy associated with autoimmune thyroiditis. Arch Neurol. 2006;63(2):197–202.CrossRefGoogle ScholarPubMed
24Chong, JY, Rowland, LP, Utiger, RD.Hashimoto encephalopathy: syndrome or myth? Arch Neurol. 2003;60(2):164–71.CrossRefGoogle ScholarPubMed
25Nolte, KW, Unbehaun, A, Sieker, H, Kloss, TM, Paulus, W.Hashimoto encephalopathy: a brainstem vasculitis? Neurology. 2000;54 3: 769–70.CrossRefGoogle ScholarPubMed
26Grommes, C, Griffin, C, Downes, KA, Lerner, AJ.Steroid-responsive encephalopathy associated with autoimmune thyroiditis presenting with diffusion MR imaging changes. AJNR Am J Neuroradiol. 2008;29(8):1550–1.CrossRefGoogle ScholarPubMed
27Ferracci, F, Bertiato, G, Moretto, G.Hashimoto’s encephalopathy: epidemiologic data and pathogenetic considerations. J Neurol Sci. 2004;217(2):165–8.Google ScholarPubMed
28Gayatri, NA, Whitehouse, WP.Pilot survey of Hashimoto’s encephalopathy in children. Dev Med Child Neurol. 2005;47 8: 556–8.CrossRefGoogle ScholarPubMed
29Watemberg, N, Greenstein, D, Levine, A.Encephalopathy associated with Hashimoto thyroiditis: Pediatric perspective. J Child Neurol. 2006;21(1):1–5.CrossRefGoogle ScholarPubMed
30Vasconcellos, E, Pina-Garza, JE, Fakhoury, T, Fenichel, GM.Pediatric manifestations of Hashimoto’s encephalopathy. Pediatr Neurol. 1999;20(5):394–8.Google ScholarPubMed
31Maki, M, Mustalahti, K, Kokkonen, J, et al.Prevalence of celiac disease among children in Finland. N Engl JMed. 2003;348 25: 2517–24.CrossRefGoogle ScholarPubMed
32Cook, HB, Burt, MJ, Collett, JA, Whitehead, MR, Frampton, CM, Chapman, BA.Adult coeliac disease: prevalence and clinical significance. J Gastroenterol Hepatol. 2000;15(9):1032–6.CrossRefGoogle ScholarPubMed
33Chapman, RW, Laidlow, JM, Colin-Jones, D, Eade, OE, Smith, CL.Increased prevalence of epilepsy in coeliac disease. Br Med J. 1978;2(6132):250–1.Google ScholarPubMed
34Pengiran Tengah, DSHolmes, GKWills, AJ.The prevalence of epilepsy in patients with celiac disease. Epilepsia. 2004;45 10: 1291–3.CrossRefGoogle ScholarPubMed
35Hanly, JG, Stassen, W, Whelton, M, Callaghan, N.Epilepsy and coeliac disease. J Neurol Neurosurg Psychiatry. 1982;45(8):729–30.CrossRefGoogle ScholarPubMed
36Zelnik, N, Pacht, A, Obeid, R, Lerner, A.Range of neurologic disorders in patients with celiac disease. Pediatrics. 2004;113 6: 1672–6.CrossRefGoogle ScholarPubMed
37Ruggieri, M, Incorpora, G, Polizzi, A, Parano, E, Spina, M, Pavone, P.Low prevalence of neurologic and psychiatric manifestations in children with gluten sensitivity. J Pediatr. 2008;152(2):244–9.CrossRefGoogle ScholarPubMed
38Lionetti, E, Francavilla, R, Pavone, P, et al.The neurology of coeliac disease in childhood: what is the evidence? a systematic review and meta-analysis. Dev Med Child Neurol. 2010;52(8):700–7.CrossRefGoogle ScholarPubMed
39Arroyo, HA, De Rosa, S, Ruggieri, V, de Davila, MT, Fejerman, N.Epilepsy, occipital calcifications, and oligosymptomatic celiac disease in childhood. J Child Neurol. 2002;17(11):800–6.CrossRefGoogle ScholarPubMed
40Gobbi, G.Coeliac disease, epilepsy and cerebral calcifications. Brain Dev. 2005;27(3):189–200.CrossRefGoogle ScholarPubMed
41Benseler, SM, Silverman, ED.Neuropsychiatric involvement in pediatric systemic lupus erythematosus. Lupus. 2007;16 8: 564–71.CrossRefGoogle ScholarPubMed
42Tan, KM, Lennon, VA, Klein, CJ, Boeve, BF, Pittock, SJ.Clinical spectrum of voltage-gated potassium channel autoimmunity. Neurology. 2008;70(20):1883–90.CrossRefGoogle ScholarPubMed
43Vincent, A, Buckley, C, Schott, JM, et al.Potassium channel antibody-associated encephalopathy: a potentially immuno-therapy-responsive form of limbic encephalitis. Brain. 2004;127 (Pt 3):701–12.CrossRefGoogle ScholarPubMed
44Geschwind, MD, Tan, KM, Lennon, VA, et al.Voltage-gated potassium channel autoimmunity mimicking Creutzfeldt-Jakob disease. Arch Neurol. 2008;65(10):1341–6.CrossRefGoogle ScholarPubMed
45Schulte, U, Thumfart, JO, Klocker, N, et al.The epilepsy-linked Lgi1 protein assembles into presynaptic Kv1 channels and inhibits inactivation by Kvbeta1. Neuron. 2006;49(5):697–706.CrossRefGoogle ScholarPubMed
46Ogawa, Y, Oses-Prieto, J, Kim, MY, et al.Adam22, a Kv1 channel-interacting protein, recruits membrane-associated guanylate kinases to juxtaparanodes of myelinated axons. J Neurosci. 2010;30(3):1038–48.CrossRefGoogle ScholarPubMed
47Lai, M, Huijbers, MG, Lancaster, E, et al.Investigation of Lgi1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol. 2010;9(8):776–85.Google ScholarPubMed
48Irani, SR, Alexander, S, Waters, P, 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; 133(9):2734–48.Google ScholarPubMed
49Kroll-Seger, J, Bien, CG, Huppertz, HJ.Non-paraneoplastic limbic encephalitis associated with antibodies to potassium channels leading to bilateral hippocampal sclerosis in a pre-pubertal girl. Epileptic Disord. 2009;11(1):54–9.CrossRefGoogle Scholar
50Haberlandt, E, Bast, T, Ebner, A, et al.Limbic encephalitis in children and adolescents. Arch Dis Child. 2011; 96(2):186–91.CrossRefGoogle ScholarPubMed
51Dalmau, J, Lancaster, E, Martinez-Hernandez, E, Rosenfeld, MR, Balice-Gordon, R.Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011; 10(1):63–74.CrossRefGoogle ScholarPubMed
52Dalmau, J, Gleichman, AJ, Hughes, EG, et al.Anti-NMDA-receptor encephalitis: Case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7(12):1091–8.CrossRefGoogle ScholarPubMed
53Dale, RC, Irani, SR, Brilot, F, et al.N-methyl-d-aspartate receptor antibodies in pediatric dyskinetic encephalitis lethargica. Ann Neurol. 2009;66(5):704–9.CrossRefGoogle ScholarPubMed
54Florance, NR, Davis, RL, Lam, C, et al.Anti-n-methyl-d-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol. 2009;66(1):11–8.CrossRefGoogle ScholarPubMed
55Irani, SR, Bera, K, Waters, P, et al.N-methyl-d-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain. 2010;133(Pt 6):1655–67.CrossRefGoogle Scholar
56Niehusmann, P, Dalmau, J, Rudlowski, C, et al.Diagnostic value of n-methyl-d-aspartate receptor antibodies in women with new-onset epilepsy. Arch Neurol. 2009;66(4):458–64.CrossRefGoogle ScholarPubMed
57Dalmau, J, Tuzun, E, Wu, HY, et al.Paraneoplastic anti-n-methyl-daspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007;61(1):25–36.CrossRefGoogle Scholar
58Lennon, VA, Wingerchuk, DM, Kryzer, TJ, et al.A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet. 2004;364(9451):2106–12.CrossRefGoogle ScholarPubMed
59McKeon, A, Lennon, VA, Lotze, T, et al.CNS aquaporin-4 autoimmunity in children. Neurology. 2008;71(2):93–100.Google ScholarPubMed
60Lotze, TE, Northrop, JL, Hutton, GJ, Ross, B, Schiffman, JS, Hunter, JV.Spectrum of pediatric neuromyelitis optica. Pediatrics. 2008; 122(5):e1039–47.CrossRefGoogle ScholarPubMed
61Lai, M, Hughes, EG, Peng, X, et al.AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol. 2009;65(4):424–34.Google ScholarPubMed
62Lancaster, E, Lai, M, Peng, X, et al.Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol. 2010; 9(1):67–76.Google Scholar
63Graus, F, Keime-Guibert, F, Rene, R, et al.Anti-Hu-associated paraneoplastic encephalomyelitis: analysis of 200 patients. Brain. 2001;124(Pt 6):1138–48.CrossRefGoogle Scholar
64Antunes, NL, Khakoo, Y, Matthay, KK, et al.Antineuronal antibodies in patients with neuroblastoma and paraneoplastic opsoclonus-myoclonus. J Pediatr Hematol Oncol. 2000;22(4):315–20.CrossRefGoogle ScholarPubMed
65Saiz, A, Bruna, J, Stourac, P, et al.Anti-Hu-associated brainstem encephalitis. J Neurol Neurosurg Psychiatry. 2009;80(4):404–7.Google ScholarPubMed
66Voltz, R, Gultekin, SH, Rosenfeld, MR, et al.A serologic marker of paraneoplastic limbic and brain-stem encephalitis in patients with testicular cancer. N Engl J Med. 1999;340(23):1788–95.CrossRefGoogle ScholarPubMed
67Dalmau, J, Gultekin, SH, Voltz, R, et al.Ma1, a novel neuron- and testis-specific protein, is recognized by the serum of patients with paraneoplastic neurological disorders. Brain. 1999;122(Pt 1):27–39.CrossRefGoogle ScholarPubMed
68Pittock, SJ, Yoshikawa, H, Ahlskog, JE, et al.Glutamic acid decarboxylase autoimmunity with brainstem, extrapyramidal, and spinal cord dysfunction. Mayo Clin Proc. 2006;81 9: 1207–14.CrossRefGoogle ScholarPubMed
69Liimatainen, S, Peltola, M, Sabater, L, et al.Clinical significance of glutamic acid decarboxylase antibodies in patients with epilepsy. Epilepsia. 2010;51(5):760–7.CrossRefGoogle ScholarPubMed
70Moersch, FP, Woltman, HW.Progressive fluctuating muscular rigidity and spasm (“stiff-man” syndrome); report of a case and some observations in 13 other cases. Proc Staff Meet Mayo Clin. 1956;31(15):421–7.Google ScholarPubMed
71Saiz, A, Blanco, Y, Sabater, L, et al.Spectrum of neurological syndromes associated with glutamic acid decarboxylase antibodies: diagnostic clues for this association. Brain. 2008;131 (Pt 10):2553–63.CrossRefGoogle ScholarPubMed
72Bingley, PJ, Bonifacio, E, Williams, AJ, Genovese, S, Bottazzo, GF, Gale, EA.Prediction of IDDM in the general population: strategies based on combinations of autoantibody markers. Diabetes. 1997;46(11):1701–10.CrossRefGoogle ScholarPubMed
73Bingley, PJ.Clinical applications of diabetes antibody testing. J Clin Endocrinol Metab. 95(1):25–33.CrossRefGoogle Scholar
74Verrotti, A, Greco, R, Altobelli, E, Latini, G, Morgese, G, Chiarelli, F.Anticardiolipin, glutamic acid decarboxylase, and antinuclear antibodies in epileptic patients. Clin Exp Med. 2003;3(1):32–6.CrossRefGoogle ScholarPubMed
75Peltola, J, Kulmala, P, Isojarvi, J, et al.Autoantibodies to glutamic acid decarboxylase in patients with therapy-resistant epilepsy. Neurology. 2000;55(1):46–50.CrossRefGoogle ScholarPubMed
76McKnight, K, Jiang, Y, Hart, Y, et al.Serum antibodies in epilepsy and seizure-associated disorders. Neurology. 2005;65(11):1730–6.CrossRefGoogle ScholarPubMed
77Errichiello, L, Perruolo, G, Pascarella, A, et al.Autoantibodies to glutamic acid decarboxylase (GAD) in focal and generalized epilepsy: a study on 233 patients. J Neuroimmunol. 2009;211(1–2):120–3.CrossRefGoogle Scholar
78Mata, S, Muscas, GC, Naldi, I, et al.Non-paraneoplastic limbic encephalitis associated with anti-glutamic acid decarboxylase antibodies. J Neuroimmunol. 2008;199(1-2):155–9.CrossRefGoogle ScholarPubMed
79Malter, MP, Helmstaedter, C, Urbach, H, Vincent, A, Bien, CG.Antibodies to glutamic acid decarboxylase define a form of limbic encephalitis. Ann Neurol. 2010;67(4):470–8.CrossRefGoogle ScholarPubMed
80Rasmussen, T, Olszewski, J, Lloydsmith, D.Focal seizures due to chronic localized encephalitis. Neurology. 1958;8(6):435–45.CrossRefGoogle ScholarPubMed
81Rogers, SW, Andrews, PI, Gahring, LC, et al.Autoantibodies to glutamate receptor GluR3 in Rasmussen’s encephalitis. Science. 1994;265(5172):648–51.CrossRefGoogle ScholarPubMed
82Watson, R, Jiang, Y, Bermudez, I, et al.Absence of antibodies to glutamate receptor type 3 (GluR3) in Rasmussen encephalitis. Neurology. 2004;63(1):43–50.Google ScholarPubMed
83Schwab, N, Bien, CG, Waschbisch, A, et al.CD8+ T cell clones dominate brain infiltrates in Rasmussen encephalitis and persist in the periphery. Brain. 2009;132(Pt 5):1236–46.Google ScholarPubMed
84Granata, T, Fusco, L, Gobbi, G, et al.Experience with immunomodulatory treatments in Rasmussen’s encephalitis. Neurology. 2003;61(12):1807–10.CrossRefGoogle ScholarPubMed
85Quek, AML, Britton, J, McKeon, A, et al.Autoimmune epilepsy: retrospective analysis of 26 patients. Neurology 2011; 76:A356.Google Scholar
86McKeon, A, Lennon, VA, Pittock, SJ.Immunotherapy-responsive dementias and encephalopathies. Continuum Lifelong Learning Neurol. 2010;16(2):80–101.CrossRefGoogle ScholarPubMed
87Pittock, SJ, Kryzer, TJ, Lennon, VA.Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome. Ann Neurol. 2004;56(5):715–9.CrossRefGoogle Scholar
88Davidoff, AM.Pediatric oncology. Semin Pediatr Surg. 2010;19 3: 225–33.Google ScholarPubMed
89Murphy, JJ, Tawfeeq, M, Chang, B, Nadel, H.Early experience with PET/CT scan in the evaluation of pediatric abdominal neoplasms. J Pediatr Surg. 2008;43(12):2186–92.Google ScholarPubMed
90McKeon, A, Apiwattanakul, M, Lachance, DH, et al.Positron emission tomography-computed tomography in paraneoplastic neurologic disorders: systematic analysis and review. Arch Neurol. 2010; 67(3):322–9.Google Scholar
91Kuntz, NL, Chabas, D, Weinstock-Guttman, B, et al.Treatment of multiple sclerosis in children and adolescents. Expert Opin Pharmacother. 2010; 11(4):505–20.CrossRefGoogle ScholarPubMed
92Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis: 2001 update. American College of Rheumatology Ad Hoc Committee on glucocorticoid-induced osteoporosis. Arthritis Rheum. 2001;44 7: 1496–503.Google Scholar
93Wagner, CL, Greer, FR.Prevention of rickets and vitamin D deficiency in infants, children, and adolescents. Pediatrics. 2008; 122(5):1142–52.Google ScholarPubMed
94Schimmer, BP, Parker, KL.Adrenocorticotropic hormone; adrenocortical steroid and their synthetic analogs; inhibitors of the synthesis and action of adrenocortical hormones. In: Hardman, JG, Limbird, LE, editors. Goodman and Gilman’s the pharmacological basis of therapeutics 10th Ed. New York: McGraw-Hill; 2001. p. 1657.Google Scholar
95Wong-Kisiel, LC, Ji, T, Renaud, DL, et al.Response to immunotherapy in a 20-month-old boy with anti-NMDA receptor encephalitis. Neurology. 2010;74(19):1550–1.CrossRefGoogle Scholar
96Rosenfeld, MR, Eichen, JG, Wade, DF, Posner, JB, Dalmau, J.Molecular and clinical diversity in paraneoplastic immunity to Ma proteins. Ann Neurol. 2001;50(3):339–48.CrossRefGoogle ScholarPubMed
97Vernino, S, O’Neill, BP, Marks, RS, O’Fallon, JR, Kimmel, DW.Immunomodulatory treatment trial for paraneoplastic neurological disorders. Neuro Oncol. 2004;6(1):55–62.CrossRefGoogle ScholarPubMed
Flanagan, EP, McKeon, A, Lennon, VA, et al.Autoimmune dementia: Clinical course and predictors of immunotherapy response. Mayo Clin Proc. 2010; 85(10):881–97.CrossRefGoogle ScholarPubMed