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CSF IgA NMDAR antibodies are potential biomarkers for teratomas in anti-NMDAR encephalitis

V. Desestret A. Chefdeville A. Viaccoz C. Bost F. Ducray G. Picard V. Rogemond M. O. Chaffois C. Blanc Claire Bardel 1 I. Treilleux O. Pascual J. C. Antoine J. y. Delattre J. Honnorat 
1 Biostatistiques santé
Département biostatistiques et modélisation pour la santé et l'environnement [LBBE]
Abstract : Objective: To evaluate the presence of immunoglobulin A (IgA) subtype of anti-NMDA receptor (NMDAR) antibodies (IgA-NMDAR-Abs) in the CSF of patients with immunoglobulin G (IgG)-NMDAR-Ab encephalitis and to describe the potential association with a specific clinical pattern. Methods: The retrospective analysis for the presence of IgA-NMDAR-Abs in 94 CSF samples from patients with anti-NMDAR encephalitis diagnosed between October 2007 and February 2014 was conducted at the French Reference Centre on Paraneoplastic Neurological Syndrome. This observational study compared 39 patients with both IgA-and IgG-NMDAR-Abs to 55 patients with only IgG-NMDAR-Abs. Results: In the retrospective cohort, 41% of the patients with NMDAR-Ab encephalitis had both CSF IgG-and IgA-NMDAR-Abs. Approximately half of the IgA-NMDAR-Ab-positive patients (18/38, 49%) definitively possessed associated tumors, primarily ovarian teratomas (17/18, 94%), compared with only 5% (3/55) of the patients in the IgA-NMDAR-Ab-negative group (p < 0.001). In the adult female population at risk for ovarian teratoma, the detection of CSF IgA-NMDAR-Ab positivity showed 85% sensitivity, 70% specificity, a 57% positive predictive value, and a 90% negative predictive value for the diagnosis of ovarian teratoma. No other specific clinical features or clinical outcome were associated with CSF IgA-NMDAR-Ab positivity. Conclusion: These results suggest that in patients with IgG-NMDAR-Ab encephalitis, CSF IgA-NMDAR-Abs could be used as a biological marker for the presence of an ovarian teratoma.
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Submitted on : Thursday, February 21, 2019 - 5:02:09 PM
Last modification on : Wednesday, February 16, 2022 - 2:31:21 PM

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V. Desestret, A. Chefdeville, A. Viaccoz, C. Bost, F. Ducray, et al.. CSF IgA NMDAR antibodies are potential biomarkers for teratomas in anti-NMDAR encephalitis. Neurology Neuroimmunology & Neuroinflammation, American Academy of neurology, 2015, 2 (6), pp.e166. ⟨10.1212/NXI.0000000000000166⟩. ⟨hal-02044951⟩

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