This narrative review evaluates the literature pertaining to neural antibody frequency in epilepsy populations, highlights key findings across studies that characterize populations in which antibody positivity is more likely, and identifies gaps and limitations in the literature to clarif
Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune inflammatory conditions that primarily target the optic nerves, spinal cord, brainstem, and occasionally the cerebrum. NMOSD is characterized by recurrent attacks of visual, motor, and/or sensory dysfunction that often…
Reader Response: Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis Thomas Pollak, NIHR Clinical Lecturer, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, UK Harald Prüss, Professor of Neurology, Department of Neurology and Experimental Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany Karl Bechter, Professor of Psychiatry, Department for Psychiatry and Psychotherapy II, Ulm University, Bezirkskrankenhaus Günzburg, Günzburg, Germany Souhel Najjar, Chair of Neurology, Department of Neurology, Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, USA Angela Vincent, Emeritus Professor of Neuroimmunology, Nuffield Department of Clinical Neurosciences, University of Oxford, UK Submitted August 16, 2021 We congratulate Guasp et al. for this study, which includes the complex task of neurologic investigation for patients with psychosis.1 It is encouraging to see neurologists engaging with this important issue. However, some of the authors’ criticisms of the autoimmune psychosis (AP) diagnostic criteria may not reflect the intent of the criteria.2 The authors incorrectly state that 2 of 3 patients with anti-n-methyl-d-aspartate receptor (NMDAR) encephalitis would have been missed. In fact, all 3 patients would have been identified on the basis of dyskinesia and catatonia development, in the case of patient 1; catatonia and cognitive dysfunction or confusion, in the case of patient 2; and in the case of patient 3, cognitive dysfunction including disorientation, inattention, and short-term memory impairment, and echolalia, a verbal-motoric cardinal feature of catatonia included in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5).3 We welcome the authors’ proposal of an alternative diagnostic algorithm for first-episode psychosis (FEP), but question the recommendation of serum antibody testing, MRI, and EEG-based screening for all FEP cases without neurological warning signs. Realistically, access to these investigations is limited in most psychiatric settings—blanket screening, while desirable in the future with improved panel diagnostics and lower prices, would currently be impossible in most hospitals.4 Thus, our possible AP criteria would allow clinicians to focus resources and investigations on those with a greater probability of an autoimmune central nervous system (CNS) process. Disclosure The authors report no relevant disclosures. Contact email@example.com for full disclosures. References Guasp M, Giné-Servén E, Maudes E, et al. Clinical, Neuroimmunologic, and CSF Investigations in First Episode Psychosis. Neurology. 2021;97(1):e61-e75. doi:10.1212/WNL.0000000000012191 Pollak TA, Lennox BR, Müller S, et al. Autoimmune psychosis: an international consensus on an approach to the diagnosis and management of psychosis of suspected autoimmune origin [published correction appears in Lancet Psychiatry. 2019 Dec;6(12):e31]. Lancet Psychiatry. 2020;7(1):93-108. doi:10.1016/S2215-0366(19)30290-1 Walther S, Stegmayer K, Wilson JE, Heckers S. Structure and neural mechanisms of catatonia. Lancet Psychiatry. 2019;6(7):610-619. doi:10.1016/S2215-0366(18)30474-7 Albon E, Tsourapas A, Frew E, et al. Structural neuroimaging in psychosis: a systematic review and economic evaluation. Health Technol Assess. 2008;12(18):iii-163. doi:10.3310/hta12180 NAVIGATE BACK TO ARTICLE
Several novel cancer therapies have been developed, many of which focused on immune
system modulation. These include immune checkpoint inhibitors, modulators, T-cell
therapy, monoclonal antibodies, cytokines, oncolytic viruses, and vaccines.