Neurology Central

Autoantibodies in neurological disorders – a review from Judith Greer

Autoantibodies occur in many different nervous system disorders, and are increasingly being found in disorders not traditionally associated with the immune system. Determining if the autoantibodies play a functional or pathogenic role is critical in selecting the most appropriate treatment options.

Association of autoantibodies with disorders of the nervous system

Some diseases affecting the nervous system have a long history of association with autoantibodies. For example, the presence of oligoclonal bands of immunoglobulin in the cerebrospinal fluid (CSF) has been used for nearly 50 years in the diagnosis of multiple sclerosis (MS) [1], and the presence of antibodies that bind to muscle in serum of patients with myasthenia gravis (MG) was described even earlier [2]. More recently, it has become clear that autoantibodies are also found in various types of encephalitis, and in some patients with movement or psychiatric disorders or epilepsy [3–7]. Then there are autoantibodies associated with neoplasms (e.g., anti-Hu antibodies in small cell lung cancer with paraneoplastic sensory neuropathy [8]) or with other autoimmune diseases that may cross-react with neural components to cause CNS disease (e.g., cases of patients with type 1 diabetes developing stiff person syndrome, or vice versa, presumably due to immune attack against glutamic acid decarboxylase (GAD), which is present in both the pancreas and the nervous system [9]). What remains to be elucidated in many cases is whether these autoantibodies are merely a biomarker of the disease process, or whether they are pathogenic [10].

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