Department of Neurology, Rambam Health Care Campus, Haifa, Israel.
Neuroimmunology Laboratory, Ruth and Bruce Rapaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Front Immunol. 2024 Sep 27;15:1405337. doi: 10.3389/fimmu.2024.1405337. eCollection 2024.
The presence of oligoclonal bands (OCBs) in cerebrospinal fluid (CSF) is a pivotal diagnostic marker for multiple sclerosis (MS). These bands play a crucial role in the diagnosis and understanding of a wide array of immune diseases. In this study, we explore the relationship between the cognitive profile of autoimmune encephalitis (AIE) and the presence of OCBs in CSF, with a particular emphasis on NMDA receptor antibodies.
We studied a cohort of 21 patients across five tertiary centers, segregated into two distinct categories. One group comprised individuals who tested positive only for autoimmune encephalitis antibodies indicative of encephalitis, while the other group included patients whose CSF was positive for both autoimmune encephalitis antibodies and OCBs. Our investigation focused primarily on cognitive functions and behavioral alterations, supplemented by auxiliary diagnostic assessments such as CSF cell count, magnetic resonance imaging (MRI), and electroencephalogram (EEG) results, evaluated for the two patient groups. To validate our findings, we employed statistical analyses such as Fisher's exact test with Benjamini-Hochberg correction.
Our study included 21 patients, comprising 14 who were presented with only autoimmune encephalitis antibodies, and 7 who were dual-positive. Among these patients, we focused on those with NMDA receptor antibodies. Of these, five were dual positive, and nine were positive only for NMDA receptor antibodies. The dual-positive NMDA group, with an average age of 27 ± 16.47 years, exhibited significantly higher CSF cell counts (p=0.0487) and more pronounced language and attention deficits (p= 0.0264). MRI and EEG results did not differ significantly between the groups.
Our results point to OCBs as an additional marker of disease severity in AIE, especially in NMDA receptor-antibody positive patients, possibly indicating a broader inflammatory process, as reflected in elevated CSF lymphocytes. Regular testing for OCBs in cases of suspected AIE may aid in disease prognosis and identification of patients more prone to language and attention disorders, improving diagnosis and targeting treatment for these cognitive aspects.
寡克隆带（OCB）在脑脊液（CSF）中的存在是多发性硬化症（MS）的关键诊断标志物。这些带在诊断和理解广泛的免疫疾病中起着至关重要的作用。在这项研究中，我们探讨了自身免疫性脑炎（AIE）的认知特征与 CSF 中 OCB 存在之间的关系，特别关注 NMDA 受体抗体。
我们在五个三级中心研究了 21 名患者的队列，分为两个不同的类别。一组包括仅检测到表明脑炎的自身免疫性脑炎抗体阳性的个体，另一组包括 CSF 自身免疫性脑炎抗体和 OCB 均阳性的患者。我们的研究主要集中在认知功能和行为改变上，辅助诊断评估包括 CSF 细胞计数、磁共振成像（MRI）和脑电图（EEG）结果，对两组患者进行评估。为了验证我们的发现，我们使用了 Fisher 确切检验和 Benjamini-Hochberg 校正等统计分析。
我们的研究包括 21 名患者，其中 14 名仅表现出自身免疫性脑炎抗体阳性，7 名双阳性。在这些患者中，我们重点关注那些具有 NMDA 受体抗体的患者。其中，5 名双阳性，9 名仅 NMDA 受体抗体阳性。双阳性 NMDA 组平均年龄为 27±16.47 岁，CSF 细胞计数显著升高（p=0.0487），语言和注意力缺陷更为明显（p=0.0264）。两组之间的 MRI 和 EEG 结果没有显著差异。
我们的结果表明，OCB 是 AIE 疾病严重程度的另一个标志物，特别是在 NMDA 受体抗体阳性患者中，可能表明更广泛的炎症过程，反映在 CSF 淋巴细胞升高。在疑似 AIE 的情况下定期检测 OCB 可能有助于疾病预后和识别更易发生语言和注意力障碍的患者，从而改善这些认知方面的诊断和靶向治疗。
