Objective: Determine the prevalence of systemic and anti-neuronal antibodies in Movement Disorders patients from a third-level neurological hospital.

Background: Autoimmunity is a common cause of neurological disease identification of Movement Disorders (MovDis) related to auto-antibodies is growing fast. Systemic Autoimmune (SA) diseases with CNS involvement and Autoimmune Encephalitis (AE) can manifest with MovDis, which could be the key manifestation of these potentially treatable conditions. The early recognition of these entities is essential to prompt treatment in order to avoid neurological disability.

Methods: We identified a series of patients referred to the National Neurology and Neurosurgery Institute in Mexico evaluated by a MovDis specialist from 2014 to 2018. Highly-suspicious cases were considered if they have had a sub-acute onset, rapidly progressive course, and combined movement disorders. All patients were videotaped and classified according to the main MovDis. Severity was assessed with clinical scales. A brain MRI, whole-body FDG-PET scan, and serum and CSF immunological panel where requested as necessary. A descriptive analysis was performed using IBM SPSS v.22.

Results: 837 patients with MovDis were evaluated from 2014 to 2018. An autoimmune specific disorder or a marker of autoimmunity was found in 5.9% (50 pts). Women were more affected, ataxia and orolingual dyskinesias were the most prevalent clinical presentation. 40% had positive AE Abs; 10% were diagnosed with an​ SA disease after MovDis developed, and 10% neither had an SA disease nor an AE but some had autoimmune Abs. Almost all patients showed an abnormal brain MRI and FDG-PET, neoplasia was detected in 6 patients. More than 90% of cases received an immunomodulatory therapy. Six patients died during follow-up, 3 with a paraneoplastic disorder, 2 with Anti-NMDARc encephalitis, 1 with SLE, and 1 without a specific immunological disorder.

Conclusions: An autoimmune etiology should be investigated in MovDis patients with a subacute onset, rapidly progressive course, and when combined MovDis developed. We present a series of autoimmune cases from a cohort of consecutive MovDis patients referred to a neurological center. Our clinical approach was oriented to find a potentially treatable condition using imaging, CSF, and serum markers in order to begin early treatment and avoid neurological disability.

References: Baizabal J, Jankovic J. Movement Disorders in Autoimmune Diseases. Movement disorders 2012; 27 (8): 935-946. Poewe W, Djamshidian A. MovementDisorders in SystemicDiseases. NeurolClin 2015; 33: 269-297.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/auto-antibodies-and-clinical-imaging-associations-in-patients-with-movements-disorders-from-a-neurological-institute-in-mexico/