Primary progressive multiple sclerosis overlapping with anti-GAD and anti-Hu antibodies positive neurological syndromes

Štourač P, Bednářová J, Pavelek Z, Vališ M.

Neurol Neurochir Pol. 2021 Oct 27. doi: 10.5603/PJNNS.a2021.0078. Epub ahead of print. PMID: 34704603.

5 Nov 2021

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Although still rare, there have been reports describing autoimmune demyelinating disorders associated with specific antibodies which overlap with multiple sclerosis (MS) and other demyelinating syndromes in clinical, radiological and immunological features. A relationship between anti-myelin-associated glycoprotein (MOG) syndrome, anti-aquaporin-4 (AQ-4) neuromyelitis optica spectrum disorders, and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis has been described. The opportunity of discovering yet unknown associations is based on the presumption of the co-occurrence of immune mediated diseases [1]. The association of multiple sclerosis with glutamic acid decarboxylase (GAD) neurological syndromes has only been reported in one case [2, 3]. The associated neurological syndromes include stiff-person syndrome (SPS), cerebellar ataxia, epilepsy, and limbic encephalitis. Paraneoplastic origin is rare, and comorbidities include autoimmune thyreoiditis, pernicious anaemia and vitiligo [4]. More than 85% of patients with anti-Hu antibodies harbour small cell lung cancer (SCLC) or, less frequently, other tumours. Anti-Hu antibodies can be found in the sera of 2% of patients without a tumour after five years, but these antibodies are not detected in normal subjects or in other neurological disorders [5].

Key words: anti-Hu, anti-GAD antibodies, primary progressive multiple sclerosis, overlapping syndromes

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