Herpes simplex encephalitis relapse with chorea is associated with autoantibodies to N‐Methyl‐D‐aspartate receptor or dopamine‐2 receptor
SS Mohammad, K Sinclair, S Pillai… - Movement …, 2014 - Wiley Online Library
Movement Disorders, 2014•Wiley Online Library
Background Movement disorder relapses after herpes simplex virus 1 (HSV1) encephalitis
have been hypothesized to be secondary to postviral autoimmunity. Recently, a proportion
of patients with HSV1 encephalitis (HSE) were shown to produce autoantibodies against N‐
methyl‐D‐aspartate receptor (NMDAR). Methods We measured autoantibodies against
NMDAR and dopamine‐2 receptor (D2R) expressed at the cell surface in the stored acute
serum of 9 children with HSE, 3 of whom had a relapsing course with chorea. Results The 3 …
have been hypothesized to be secondary to postviral autoimmunity. Recently, a proportion
of patients with HSV1 encephalitis (HSE) were shown to produce autoantibodies against N‐
methyl‐D‐aspartate receptor (NMDAR). Methods We measured autoantibodies against
NMDAR and dopamine‐2 receptor (D2R) expressed at the cell surface in the stored acute
serum of 9 children with HSE, 3 of whom had a relapsing course with chorea. Results The 3 …
Background
Movement disorder relapses after herpes simplex virus 1 (HSV1) encephalitis have been hypothesized to be secondary to postviral autoimmunity. Recently, a proportion of patients with HSV1 encephalitis (HSE) were shown to produce autoantibodies against N‐methyl‐D‐aspartate receptor (NMDAR).
Methods
We measured autoantibodies against NMDAR and dopamine‐2 receptor (D2R) expressed at the cell surface in the stored acute serum of 9 children with HSE, 3 of whom had a relapsing course with chorea.
Results
The 3 patients with chorea had elevated autoantibodies against NMDAR (n = 1), D2R (n = 1), or both (n = 1), whereas patients without chorea were negative (n = 6). The prospectively identified patient with chorea and NMDAR autoantibodies improved after early treatment with steroids, intravenous immunoglobulin, and cyclophosphamide, with reduction in serum NMDAR antibody titers.
Conclusions
These autoantibody findings lend support to the autoimmune hypothesis and the early use of immune suppression in post‐HSE chorea. © 2013 International Parkinson and Movement Disorder Society
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