Encephalitis with mGluR5 antibodies Symptoms and antibody effects
Por:
Spatola M, Sabater L, Planagumà J, Martínez-Hernandez E, Armangue-Salvador T, Prüss H, Iizuka T, Caparó Oblitas RL, Antoine JC, Li R, Heaney N, Tubridy N, Munteis Olivas E, Rosenfeld MR, Graus F and Dalmau J
Publicada:
29 may 2018
Ahead of Print:
27 abr 2018
Categoría:
Neurology (clinical)
Resumen:
Objective
To report the clinical features of 11 patients with metabotropic glutamate receptor 5 (mGluR5) antibody-associated encephalitis, immunoglobulin G (IgG) subclass, and effects of the antibodies on neuronal mGluR5 clusters.
Methods
Clinical information was retrospectively obtained from referring physicians. Antibodies to mGluR5 and IgG subclasses were determined with brain immunohistochemistry and cell-based assays. The effects of the antibodies were examined on rat hippocampal neurons with reported techniques.
Results
From January 2005 to May 2017, 11 patients (median age 29 years, range 6-75 years, 5 female) were identified. The main clinical features were psychiatric (10), cognitive (10), movement disorders (7), sleep dysfunction (7), and seizures (6). Median modified Rankin Scale score at the peak of the disease was 4; 4 patients required intensive care. Five patients had Hodgkin lymphoma, and 1 had small cell lung cancer. CSF showed pleocytosis (median white blood cell count 22 mm(3)) in all patients; brain MRI was abnormal in 5, involving limbic (1) or extralimbic (4) regions. Treatments included immunotherapy and/or oncologic therapy; at the last followup (median 48 months), 6 patients had complete and 5 had partial recovery. Neurologic relapse occurred in 2 patients. Antibodies were IgG1 alone (4 of 9) or in combination with IgG2 (1 of 9), IgG3 (3 of 9), or both (1). Patients' IgG caused a significant and specific decrease of cell-surface synaptic and extrasynaptic mGluR5 without altering the levels of postsynaptic density protein 95.
Conclusions
Anti-mGluR5 encephalitis associates with a complex neuropsychiatric syndrome, not restricted to limbic encephalitis, and can occur without tumor. Patients respond to treatment, but relapses can occur. The antibodies have pathogenic effects altering the levels of cell-surface mGluR5.
Filiaciones:
Spatola M:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Sabater L:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Planagumà J:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Martínez-Hernandez E:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Armangue-Salvador T:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Prüss H:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Iizuka T:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Caparó Oblitas RL:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Antoine JC:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Li R:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Heaney N:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Tubridy N:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Munteis Olivas E:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Rosenfeld MR:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Graus F:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain
Dalmau J:
From the Institut d'Investigacions Biomèdiques August Pi i Sunyer (M.S., L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.) and Hospital Clínic, University of Barcelona, Spain
Department of Clinical Neuroscience (M.S.), University of Lausanne, Switzerland
Centro de Investigación Biomédica en Red de Enfermedades Raras (L.S., J.P., E.M.-H., T.A., M.R.R., F.G., J.D.), Valencia
ICFO-Institut de Ciències Fotòniques (J.P.)
Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain
Charité Universitätsmedizin Berlin (H.P.), Experimentelle Neurologie und Klinik und Poliklinik für Neurologie
German Center for Neurodegenerative Diseases (H.P.), Berlin, Germany
Department of Neurology (T.I.), Kitasato University School of Medicine, Sagamihara, Japan
Hospital Nacional Edgardo Rebagliati Martins (R.L.C.O.), Lima, Peru
Department of Neurology (J.-C.A.), University Hospital, Saint-Etienne, France
Pamela Youde Nethersole Eastern Hospital (R.L.), Hong Kong
Beatson West of Scotland Cancer Centre (N.H.), Glasgow, UK
Department of Neurology (N.T.), St. Vincent's University Hospital, Dublin, Ireland
Service of Neurology (E.M.O.), Hospital del Mar, IMIM, Barcelona, Spain
Department of Neurology (M.R.R., J.D.), University of Pennsylvania, Philadelphia
and Catalan Institution for Research and Advanced Studies (J.D.), Barcelona, Spain.
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