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. 2020 Aug 12;10(1):279.
doi: 10.1038/s41398-020-00967-3.

Cerebrospinal fluid, antineuronal autoantibody, EEG, and MRI findings from 992 patients with schizophreniform and affective psychosis

Dominique Endres #  1   2 , Sophie Meixensberger #  3   4 , Rick Dersch  5 , Bernd Feige  3   4 , Oliver Stich  5   6 , Nils Venhoff  7 , Miriam Matysik  3   4 , Simon J Maier  3   4 , Maike Michel  4 , Kimon Runge  3   4 , Kathrin Nickel  3   4 , Horst Urbach  8 , Katharina Domschke  4   9 , Harald Prüss #  10   11 , Ludger Tebartz van Elst #  3   4
Affiliations

Cerebrospinal fluid, antineuronal autoantibody, EEG, and MRI findings from 992 patients with schizophreniform and affective psychosis

Dominique Endres et al. Transl Psychiatry. .

Abstract

The central role played by cerebrospinal-fluid (CSF) examinations including antineuronal autoantibody (Ab) testing is increasingly recognized in psychiatry. The rationale of this study was to present a multimodally investigated group of patients. In total, 992 patients were analyzed for CSF alterations: 456 patients with schizophreniform and 536 with affective syndromes. Ab measurement included testing for established antineuronal IgG-Abs against intracellular antigens in serum (Yo/Hu/Ri/cv2[CRMP5]/Ma1/Ma2/SOX1/TR[DNER]/Zic4/amphiphysin/GAD65) and for cell surface antigens in the CSF (NMDAR/AMPA-1/2-R/GABA-B-R/LGI1/CASPR2/DPPX). In 30 patients with "red flags" for autoimmune psychosis, "tissue tests" were performed. Additional diagnostics included MRI and EEG analyses. CSF white-blood-cell counts were increased in 4% and IgG indices in 2%; CSF-specific oligoclonal bands were detected in 4%; overall, 8% displayed signs of neuroinflammation. In addition, 18% revealed increased albumin quotients. Antineuronal Abs against intracellular antigens were detected in serum in 0.6%. Antineuronal Abs against established cell surface antigens were detected in serum of 1% and in the CSF of 0.3% (CSF samples were only questionably positive). Abnormal IgG binding in "tissue tests" was detected in serum of 23% and in CSF of 27%. In total, 92% of the Ab-positive patients demonstrated at least one sign of brain involvement in additional diagnostics using CSF, MRI, EEG, and FDG-PET. In summary, CSF basic analyses revealed signs of blood-brain-barrier dysfunction and neuroinflammation in relevant subgroups of patients. Established antineuronal IgG-Abs were rare in serum and even rarer in the CSF. "Tissue tests" revealed frequent occurrences of Ab-binding; therefore, novel antineuronal Abs could play a relevant role in psychiatry.

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Conflict of interest statement

D.E.: None. S.M.: None. B.F.: None. R.D.: Lecture fees from Roche and travel grants from Biogen. O.S.: None. N.V.: Advisory boards, lectures, and travel grants from Roche. S.M.: None. M.Ma.: None. M.Mi.: None. K.R.: None. K.N.: None. H.U.: Shareholder of the Veobrain: K.D.: Steering Committee Neurosciences, Janssen. H.P.: None. L.T.v.E.: Advisory boards, lectures, or travel grants within the last three years: Roche, Eli Lilly, Janssen-Cilag, Novartis, Shire, UCB, GSK, Servier, Janssen, and Cyberonics.

Figures

Fig. 1
Fig. 1. Average number of lumbar punctures per month over the years.
If patients have been treated several times as inpatients or have had repeated lumbar punctures, only the first lumbar puncture appears here.
See this image and copyright information in PMC

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