Autoimmune Encephalitis

Česká verzia

Authors: D. Krýsl ¹; M. Elišák ²
Authors place of work: Klinisk Neurofysiologi, Sahlgrenska Universitetssjukhuset, Göteborg ¹; Neurologická klinika 2. LF UK a FN v Motole, Praha ²
Published in the journal: Cesk Slov Neurol N 2015; 78/111(1): 7-23
Category: Minimonography
doi: https://doi.org/10.14735/amcsnn20151

Summary

Autoimmune encephalitis is a term used to describe a group of acute or subacute monophasic or progressive inflammatory CNS disorders with autoimmune pathogenesis (i.e. induced by pathogenic autoantibodies or autoreactive effector cells). This group includes such diverse conditions as paraneoplastic CNS syndromes, limbic encephalitis, anti-NMDAR encephalitis, Morvan’s syndrome, Rasmussen encephalitis, stiff-person syndrome spectrum disorders including progressive encephalomyelitis with rigidity and myoclonus, autoimmune movement disorders, encephalitis lethargica, neurological syndromes with increased sensitivity to gluten, etc. This area of neuroimmunology has evolved dynamically during the past 10 years. Many new syndromes have been described, understanding of pathogenesis of the already known syndromes has improved and new antibodies were identified. This review aims to provide an overview of current knowledge in the field of autoimmune encephalitis in order to help clinicians navigate the rough waters of this exciting area of neurology.

Key words:
autoimmune diseases – autoantibodies – encephalitis – paraneoplastic syndromes –limbic encephalitis – anti-N-methyl-D-aspartate receptor encephalitis – epilepsy

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

Zdroje

Literatura doporučená ke studiu je označena hvězdičkou

1.* Bien CG, Vincent A, Barnett MH, Becker AJ, Blumcke I, Graus F et al. Immunopathology of autoantibody‑associated encephalitides: clues for pathogenesis. Brain 2012; 135(5): 1622– 1638. doi: 10.1093/ brain/ aws082.

2. Albert ML, Austin LM, Darnell RB. Detection and treatment of activated T cells in the cerebrospinal fluid of patients with paraneoplastic cerebellar degeneration. Ann Neurol 2000; 47(1): 9– 17.

3.* Darnell RB. The importance of defining the paraneoplastic neurologic disorders. N Engl J Med 1999; 340(23): 1831– 1833.

4. Kishitani T, Matsunaga A, Yoneda M. The biomarker and treatment in Hashimoto‘s encephalopahty. Nihon Rinsho 2013; 71(5): 893– 897.

5.* Saiz A, Blanco Y, Sabater L, Gonzalez F, Bataller L, Casamitjana R et al. Spectrum of neurological syndromes associated with glutamic acid decarboxylase antibodies: diagnostic clues for this association. Brain 2008; 131(10): 2553– 2563. doi: 10.1093/ brain/ awn183.

6. Kohler W, Ehrlich S, Dohmen C, Haubitz M, Hoffmann F, Schmidt S et al. Tryptophan immunoadsorption for the treatment of autoimmune encephalitis. Eur J Neurol 2014. doi: 10.1111/ ene.12389.

7. Antozzi C, Granata T, Aurisano N, Zardini G, Confalonieri P, Airaghi G et al. Long‑term selective IgG immuno‑ adsorption improves Rasmussen‘s encephalitis. Neurology 1998; 51(1): 302– 305.

8. Hayashi A, Nakamagoe K, Ohkoshi N, Hoshino S, Shoji S. Double filtration plasma exchange and immunoadsorption therapy in a case of stiff‑ man syndrome with negative anti‑GAD antibody. J Med 1999; 30(5– 6): 321– 327.

9. 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. The Lancet Neurol 2013; 12(2): 157– 165. doi: 10.1016/ S1474‑ 4422(12)70310‑ 1.

10.* Graus F, Delattre JY, Antoine JC, Dalmau J, Giometto B, Grisold W et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 2004; 75(8): 1135– 1140.

11.* Dalmau J, Rosenfeld MR. Paraneoplastic syndromes of the CNS. Lancet Neurol 2008; 7(4): 327– 340. doi: 10.1016/ S1474‑ 4422(08)70060‑ 7.

12.* Šťourač P, Ambler Z. Paraneoplastické neurologické syndromy – základní charakteristika, klasifikace, etiopatogeneze a diagnostika. Neurol Prax 2013; 14(1): 9– 12.

13.* Titulaer MJ, Soffietti R, Dalmau J, Gilhus NE, Giometto B, Graus F et al. Screening for tumours in paraneoplastic syndromes: report of an EFNS Task Force. Eur J Neurol 2011; 18(1): 19. doi: 10.1111/ j.1468‑ 1331.2010.03220.x.

14. Mathew RM, Vandenberghe R, Garcia‑ Merino A, Yamamoto T, Landolfi JC, Rosenfeld MR et al. Orchiectomy for suspected microscopic tumor in patients with anti‑Ma2‑associated encephalitis. Neurology 2007; 68(12): 900– 905.

15. Buckley C, Oger J, Clover L, Tuzun E, Carpenter K, Jackson M et al. Potassium channel antibodies in two patients with reversible limbic encephalitis. Ann Neurol 2001; 50(1): 73– 78.

16.* Lai M, Huijbers MG, Lancaster E, Graus F, Bataller L, Balice‑ Gordon R 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– 785. doi: 10.1016/ S1474‑ 4422(10)70137‑ X.

17. Dalmau J, Graus F, Villarejo A, Posner JB, Blumenthal D, Thiessen B et al. Clinical analysis of anti‑Ma2‑associated encephalitis. Brain 2004; 127(8): 1831– 1844.

18. Overeem S, Dalmau J, Bataller L, Nishino S, Mignot E, Verschuuren J et al. Hypocretin‑1 CSF levels in anti‑Ma2 associated encephalitis. Neurology 2004; 62(1): 138– 140.

19.* Bien CG, Elger CE. Limbic encephalitis: a cause of temporal lobe epilepsy with onset in adult life. Epilepsy Behav 2007; 10(4): 529– 538.

20. Haberlandt E, Bast T, Ebner A, Holthausen H, Kluger G, Kravljanac R et al. Limbic encephalitis in children and adolescents. Arch Dis Child 2011; 96(2): 186– 191. doi: 10.1136/ adc.2010.183897.

21. 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; 9(1): 67– 76. doi: 10.1016/ S1474‑ 4422(09)70324‑ 2.

22. Boronat A, Sabater L, Saiz A, Dalmau J, Graus F. GABA(B) receptor antibodies in limbic encephalitis and anti‑GAD‑associated neurologic disorders. Neurology 2011; 76(9): 795– 800. doi: 10.1212/ WNL.0b013e31820e7b8d.

23. 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; 65(4): 424– 434. doi: 10.1002/ ana.21589.

24. Najjar S, Pearlman D, Najjar A, Ghiasian V, Zagzag D, Devinsky O. Extralimbic autoimmune encephalitis associated with glutamic acid decarboxylase antibodies: an underdiagnosed entity? Epilepsy Behav 2011; 21(3): 306– 313. doi: 10.1016/ j.yebeh.2011.03.038.

25. Lopez‑ Sublet M, Bihan H, Reach G, Dupont S, Didelot A, Mourad JJ et al. Limbic encephalitis and type 1 diabetes with glutamic acid decarboxylase 65 (GAD65) autoimmunity: improvement with high‑dose intravenous immunoglobulin therapy. Diabetes Metab 2012; 38(3): 273– 275. doi: 10.1016/ j.diabet.2012.02.005.

26. Dalakas MC. The role of IVIg in the treatment of patients with stiff person syndrome and other neurological diseases associated with anti‑GAD antibodies. J Neurol 2005; 252 (Suppl 1): I19– I25.

27. Thompson PD. The stiff‑ man syndrome and related disorders. Parkinsonism Relat Disord 2001; 8(2): 147– 153.

28. Josephs KA, Silber MH, Fealey RD, Nippoldt TB, Auger RG, Vernino S. Neurophysiologic studies in Morvan syndrome. J Clin Neurophysiol 2004; 21(6): 440– 445.

29.* Irani SR, Pettingill P, Kleopa KA, Schiza N, Waters P, Mazia C et al. Morvan syndrome: clinical and serological observations in 29 cases. Ann Neurol 2012; 72(2): 241– 255. doi: 10.1002/ ana.23577.

30. Dalmau J, Tuzun 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; 61(1): 25– 36.

31.* Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population‑based prospective study. Lancet Infect Dis 2010; 10(12): 835– 844. doi: 10.1016/ S1473‑ 3099(10)70222‑ X.

32.* Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M et al. Anti‑NMDA‑ receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008; 7(12): 1091– 1098. doi: 10.1016/ S1474‑ 4422(08)70224‑ 2.

33. Ito Y, Abe T, Tomioka R, Komori T, Araki N. Anti‑NMDA receptor encephalitis during pregnancy. Rinsho Shinkeigaku 2010; 50(2): 103– 107.

34. Hacohen Y, Wright S, Waters P, Agrawal S, Carr L, Cross H et al. Paediatric autoimmune encephalopathies: clinical features, laboratory investigations and outcomes in patients with or without antibodies to known central nervous system autoantigens. J Neurol Neurosurg Psychiatry 2013; 84(7): 748– 755. doi: 10.1136/ jnnp‑ 2012‑ 303807.

35. Irani SR, Vincent A. NMDA receptor antibody encephalitis. Curr Neurol Neurosci Rep 2011; 11(3): 298– 304. doi: 10.1007/ s11910‑ 011‑ 0186‑ y.

36. Agrawal S, Vincent A, Jacobson L, Milford D, Gupta R, Wassmer E. Successful treatment of antiN‑ methyl‑ d‑ aspartate receptor limbic encephalitis in a 22– monthold child with plasmapheresis and pharmacological immunomodulation. Arch Dis Child 2010; 95(4): 312. doi: 10.1136/ adc.2009.164889.

37. Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S et al. Anti‑N‑ methyl‑ D‑ aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol 2009; 66(1): 11– 18. doi: 10.1002/ ana.21756.

38. Irani SR, Bera K, Waters P, Zuliani L, Maxwell S, Zandi MS 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(6): 1655– 1667. doi: 10.1093/ brain/ awq113.

39. Le Foll J, Pelletier A. Psychiatric symptoms of a paraneoplastic anti‑N‑ methyl‑ D‑ aspartate receptor encephalitis: a case report. Encephale 2010; 36(2): 166– 171. doi: 10.1016/ j.encep.2009.06.008.

40. Consoli A, Raffin M, Laurent C, Bodeau N, Campion D, Amoura Z et al. Medical and developmental risk factors of catatonia in children and adolescents: a prospective case‑ control study. Schizophr Res 2012; 137(1– 3): 151– 158. doi: 10.1016/ j.schres.2012.02.012.

41. Casanova‑ Gracia N, Banzo‑ Arguis C, Sanz‑ Asin P, Zapata‑ Usabel M, Jordana‑ Vilanova N, Cortina‑ Lacambra MT. Encephalitis associated to anti‑NMDA receptor antibodies: a description of two cases in the child/ youth population. Rev Neurol 2012; 54(8): 475– 478.

42. Borlot F, Santos ML, Bandeira M, Liberalesso PB, Kok F, Lohr A jr et al. Anti‑N‑ methyl D‑ aspartate receptor encephalitis in childhood. J Pediatr (Rio J) 2012; 88(3): 275– 278. doi:10.2223/ JPED.2172.

43. Uchino A, Iizuka T, Urano Y, Arai M, Hara A, Hamada J et al. Pseudo‑ piano playing motions and nocturnal hypoventilation in anti‑NMDA receptor encephalitis: response to prompt tumor removal and immunotherapy. Intern Med 2011; 50(6): 627– 630.

44. Chia PL, Tan K, Foo D. Profound Sinus Node Dysfunction in anti‑N‑ methyl‑ D‑ aspartate receptor limbic encephalitis. Pacing Clin Electrophysiol 2011; 36(3): e90– e92. doi: 10.1111/ j.1540‑ 8159.2011.03154.x.

45. Nazif TM, Vazquez J, Honig LS, Dizon JM. Anti‑N‑ methyl‑ D‑ aspartate receptor encephalitis: an emerging cause of centrally mediated sinus node dysfunction. Europace 2012; 14(8): 1188– 1194. doi: 10.1093/ europace/ eus014.

46. Liba Z, Sebronova V, Komarek V, Sediva A, Sedlacek P. Prevalence and treatment of anti‑NMDA receptor encephalitis. Lancet Neurol 2013; 12(5): 424– 425. doi: 10.1016/ S1474‑ 4422(13)70070‑ X.

47. Sadalage G, Karim A, Jacob S. Autoimmune encephalitis screen – a review of rapid diagnostic screening in 600 patients over 5 years. J Neurol Neurosurg Psychiatry 2013; 84(11): e2.

48. Fujita K, Yuasa T, Takahashi Y, Tanaka K, Sako W, Koizumi H et al. Antibodies to N‑ methyl‑ D‑ aspartate glutamate receptors in Creutzfeldt‑ Jakob disease patients. J Neuroimmunol 2012; 251(1– 2): 90– 93. doi: 10.1016/ j.jneuroim.2012.06.010.

49. Prüss H, Finke C, Holtje M, Hofmann J, Klingbeil C, Probst C et al. N‑ methyl‑ D‑ aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol 2012; 72(6): 902– 911. doi: 10.1002/ ana.23689.

50. Leypoldt F, Titulaer MJ, Aguilar E, Walther J, Bonstrup M, Havemeister S et al. Herpes simplex virus‑ 1 encephalitis can trigger anti‑NMDA receptor encephalitis: case report. Neurology 2013; 81(18): 1637– 1639. doi: 10.1212/ WNL.0b013e3182a9f531.

51. Kirkpatrick MP, Clarke CD, Sonmezturk HH, Abou‑ Khalil B. Rhythmic delta activity represents a form of nonconvulsive status epilepticus in anti‑NMDA receptor antibody encephalitis. Epilepsy Behav 2011; 20(2): 392– 394. doi: 10.1016/ j.yebeh.2010.11.020.

52. Johnson N, Henry C, Fessler AJ, Dalmau J. Anti‑NMDA receptor encephalitis causing prolonged nonconvulsive status epilepticus. Neurology 2010; 75(16): 1480– 1482. doi: 10.1212/ WNL.0b013e3181f8831a.

53. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti‑NMDA receptor encephalitis. Neurology 2012; 79 (11): 1094– 1100. doi: 10.1212/ WNL.0b013e3182698cd8.

54. Chanson JB, Diaconu M, Honnorat J, Martin T, De Seze J, Namer IJ et al. PET follow‑up in a case of anti‑NMDAR encephalitis: arguments for cingulate limbic encephalitis. Epileptic Disord 2012; 14 (1): 90– 93. doi: 10.1684/ epd.2012.0486.

55.* Dalmau 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. doi: 10.1016/ S1474‑ 4422(10)70253‑ 2.

56. Eker A, Saka E, Dalmau J, Kurne A, Bilen C, Ozen H et al. Testicular teratoma and anti‑N‑ methyl‑ D‑ aspartate receptor‑associated encephalitis. J Neurol Neurosurg Psychiatry 2008; 79(9): 1082– 1083. doi: 10.1136/ jnnp.2008.147611.

57. Ishiura H, Matsuda S, Higashihara M, Hasegawa M, Hida A, Hanajima R et al. Response of anti‑NMDA receptor encephalitis without tumor to immunotherapy including rituximab. Neurology 2008; 71(23): 1921– 1923. doi: 10.1212/ 01.wnl.0000336648.43562.59.

58. Tumbi A, Gilani A, Scarff JR, Kaur G, Lippmann S. Anti‑N‑ methyl‑ D Encephalitis. Innov Clin Neurosci 2011; 8(9): 24– 25.

59. Finke C, Kopp UA, Pruss H, Dalmau J, Wandinger KP, Ploner CJ. Cognitive deficits following anti‑NMDA receptor encephalitis. J Neurol Neurosurg Psychiatry 2012; 83(2): 195– 198.

60. Dalmau J. Limbic encephalitis and variants related to neuronal cell membrane autoantigens. Rinsho Shinkeigaku 2008; 48(11): 871– 874.

61. Cantiniaux S, Azulay JP, Boucraut J, Pouget J, Attarian S. Stiff man syndrome: clinical forms, treatment and clinical course. Rev Neurol (Paris) 2006; 162(8– 9): 832– 839.

62. Barker RA, Revesz T, Thom M, Marsden CD, Brown P. Review of 23 patients affected by the stiff man syndrome: clinical subdivision into stiff trunk (man) syndrome, stiff limb syndrome, and progressive encephalomyelitis with rigidity. J Neurol Neurosurg Psychiatry 1998; 65(5): 633– 640.

63. Espay AJ, Chen R. Rigidity and spasms from autoimmune encephalomyelopathies: stiff‑ person syndrome. Muscle Nerve 2006; 34(6): 677– 690.

64. Spitz M, Ferraz HB, Barsottini OG, Gabbai AA. Progressive encephalomyelitis with rigidity: a paraneoplastic presentation of oat cell carcinoma of the lung. Case report. Arq Neuropsiquiatr 2004; 62(2B): 547– 549.

65. Gouider‑ Khouja N, Mekaouar A, Larnaout A, Miladi N, Ben Khelifa F, Hentati F. Progressive encephalomyelitis with rigidity presenting as a stiff‑ person syndrome. Parkinsonism Relat Disord 2002; 8(4): 285– 258.

66. Gazulla Abio J, Benavente Aguilar I, Capablo Liesa JL. Progressive encephalomyelitis with rigidity. Clinical and electrophysiological aspects. Neurologia 2001; 16(2): 85– 88.

67. Cooke WT and Smith WT. Neurological disorders associated with adult coeliac disease. Brain 1966; 89(4): 683– 722.

68. Hadjivassiliou M, Davies‑ Jones GA, Sanders DS, Grunewald RA. Dietary treatment of gluten ataxia. J Neurol Neurosurg Psychiatry 2003; 74(9): 1221– 1224.

69. Rasmussen T, Olszewski J, Lloydsmith D. Focal seizures due to chronic localized encephalitis. Neurology 1958; 8(6): 435– 445.

70. Rasmussen T. Further observations on the syndrome of chronic encephalitis and epilepsy. Appl Neurophysiol 1978; 41(1– 4): 1– 12.

71. Dulac O. Rasmussen‘s syndrome. Curr Opin Neurol 1996; 9(2): 75– 77.

72. Bauer J, Elger CE, Hans VH, Schramm J, Urbach H, Lassmann H et al. Astrocytes are a specific immunological target in Rasmussen‘s encephalitis. Ann Neurol 2007; 62(1): 67– 80.

73.* Bien CG and Elger CE. Epilepsia partialis continua: semiology and differential diagnoses. Epileptic Disord 2008; 10(1): 3– 7. doi: 10.1684/ epd.2008.0161.

74. Terra‑ Bustamante VC, Machado HR, dos Santos Oliveira R, Serafini LN, Souza‑ Oliveira C, Escorsi‑ Rosset Set al. Rasmussen encephalitis: long‑term outcome after surgery. Childs Nerv Syst 2009; 25(5): 583– 589. doi: 10.1007/ s00381‑ 008‑ 0795‑ 1.

75. Nabbout R. Autoimmune and inflammatory epilepsies. Epilepsia 2012; 53 (Suppl 4): 58– 62. doi: 10.1111/ j.1528‑ 1167.2012.03614.x.

76. Armangue T, Petit‑ Pedrol M, Dalmau J. Autoimmune Encephalitis in Children. J Child Neurol 2012; 27(11): 1460– 1469. doi: 10.1177/ 0883073812448838.

77. Caraballo RH, Fortini S, Cersosimo R, Monges S, Pasteris MC, Gomez M et al. Rasmussen syndrome: an argentinean experience in 32 patients. Seizure 2013; 22(5): 360– 367. doi: 10.1016/ j.seizure.2013.02.003.

78. Feasby T, Banwell B, Benstead T, Bril V, Brouwers M, Freedman M et al. Guidelines on the use of intravenous immune globulin for neurologic conditions. Transfus Med Rev 2007; 21 (Suppl 1): S57– S107.

79. Bien CG, Tiemeier H, Sassen R, Kuczaty S, Urbach H, von Lehe M et al. Rasmussen encephalitis: incidence and course under randomized therapy with tacrolimus or intravenous immunoglobulins. Epilepsia 2013; 54(3): 543– 550. doi: 10.1111/ epi.12042.

80. Andrews PI, Dichter MA, Berkovic SF, Newton MR, McNamara JO. Plasmapheresis in Rasmussen‘s encephalitis. Neurology 1996; 46(1): 242– 246.

81. Leach JP, Chadwick DW, Miles JB, Hart IK. Improvement in adult‑ onset Rasmussen‘s encephalitis with long‑term immunomodulatory therapy. Neurology 1999; 52(4): 738– 742.

82.* van Baalen A, Hausler M, Plecko‑Startinig B, Strautmanis J, Vlaho S, Gebhardt B et al. Febrile infection‑related epilepsy syndrome without detectable autoantibodies and response to immunotherapy: a case series and discussion of epileptogenesis in FIRES. Neuropediatrics 2012; 43(4): 209– 216. doi: 10.1055/ s‑ 0032‑ 1323848.

83.* Dale RC, Church AJ, Surtees RA, Lees AJ, Adcock JE, Harding B et al. Encephalitis lethargica syndrome: 20 new cases and evidence of basal ganglia autoimmunity. Brain 2004; 127(1): 21– 33.

84. Dale RC, Merheb V, Pillai S, Wang D, Cantrill L, Murphy TKet al. Antibodies to surface dopamine‑ 2 receptor in autoimmune movement and psychiatric disorders. Brain 2012; 135(11): 3453– 3468. doi: 10.1093/ brain/ aws256.

85. 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; 61(1): 25– 36.

86. 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; 13(3): 276– 286.

87. Corsellis JA, Goldberg GJ,Norton AR. „Limbic encephalitis“ and its association with carcinoma. Brain 1968; 91(3): 481– 496.

88. Buckley C, Oger J, Clover L, Tuzun E, Carpenter K, Jackson M et al. Potassium channel antibodies in two patients with reversible limbic encephalitis. Ann Neurol 2001; 50(1): 73– 78.

89. 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; 133(9): 2734– 2748. doi: 10.1093/ brain/ awq213.

90. 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; 9(1): 67– 76. doi: 10.1016/ S1474‑ 4422(09)70324‑ 2.

91. Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu Het al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol 2009; 65(4): 424– 434. doi: 10.1002/ ana.21589.

92. Giometto B, Nicolao P, Macucci M, Tavolato B, Foxon R,Bottazzo GF. Temporal‑ lobe epilepsy associated with glutamic‑ acid‑ decarboxylase autoantibodies. Lancet 1998; 352(9126): 457.

93. Turner MR, Irani SR, Leite MI, Nithi K, Vincent A, Ansorge O. Progressive encephalomyelitis with rigidity and myoclonus: glycine and NMDA receptor antibodies. Neurology 2011; 77(5): 439– 443. doi: 10.1212/ WNL.0b013e318227b176.

94. Moersch 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– 427.

95. 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; 73(1): 120– 128. doi: 10.1002/ ana.23756.

96. Rasmussen T, Olszewski J, Lloydsmith D. Focal seizures due to chronic localized encephalitis. Neurology 1958; 8(6): 435– 445.

97. Aron AM, Freeman JM, Carter S. The natural history of Sydenham‘s chorea. Review of the literature and long‑term evaluation with emphasis on cardiac sequelae. Am J Med 1965; 38: 83– 95.

98. Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S et al. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: clinical description of the first 50 cases. Am J Psychiatry 1998; 155(2): 264– 271.

99. Dale RC, Brilot F. Autoimmune basal ganglia disorders. J Child Neurol 2012; 27(11): 1470– 1481. doi: 10.1177/ 0883073812451327.

100. Dale RC, Church AJ, Surtees RA, Lees AJ, Adcock JE, Harding B et al. Encephalitis lethargica syndrome: 20 new cases and evidence of basal ganglia autoimmunity. Brain 2004; 127(1): 21– 33.

101. Cooke WT, Smith WT. Neurological disorders associated with adult coeliac disease. Brain 1966; 89(4): 683– 722.