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Semin Neurol 2014; 34(04): 458-466
DOI: 10.1055/s-0034-1390394
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neuronal Surface Antibody-Mediated Autoimmune Encephalitis

Jenny J. Linnoila
1   Department of Neurology, Massachusetts General Hospital, Boston, Massachussetts
,
Myrna R. Rosenfeld
2   Department of Neurology, Hospital Clínic /Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
3   Centre de Recerca Biomèdica CELLEX, Lab Neuroimmonologia P3A, Barcelona, Spain
4   Department of Neurology, University of Pennsylvania; Philadelphia, Pennsylvania
,
Josep Dalmau
3   Centre de Recerca Biomèdica CELLEX, Lab Neuroimmonologia P3A, Barcelona, Spain
4   Department of Neurology, University of Pennsylvania; Philadelphia, Pennsylvania
5   Institució Catalana de Recerca i Estudis Avançats (ICREA) at Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
› Author Affiliations
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Publication History

Publication Date:
04 November 2014 (online)

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Abstract

In the past few years, many autoimmune encephalitides have been identified, with specific clinical syndromes and associated antibodies against neuronal surface antigens. There is compelling evidence that many of these antibodies are pathogenic and most of these encephalitides are highly responsive to immunotherapies. The clinical spectra of some of these antibody-mediated syndromes, especially those reported in only a few patients, are evolving. Others, such as anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, are well characterized. Diagnosis involves recognizing the specific syndromes and identifying the antibody in a patient's cerebrospinal fluid (CSF) and/or serum. These syndromes are associated with variable abnormalities in CSF, magnetic resonance imaging, and electroencephalography. Treatment is often multidisciplinary and should be focused upon neutralizing the effects of antibodies and eliminating their source. Overlapping disorders have been noted, with some patients having more than one neurologic autoimmune disease. In other patients, viral infections such as herpes simplex virus encephalitis trigger robust antineuronal autoimmune responses.

Keywords

autoimmune - limbic - encephalitis - neuronal antibodies
 

  • References

  • 1 Vora NM, Holman RC, Mehal JM, Steiner CA, Blanton J, Sejvar J. Burden of encephalitis-associated hospitalizations in the United States, 1998-2010. Neurology 2014; 82 (5) 443-451
    CrossrefPubMedGoogle Scholar
  • 2 Prüss H, Dalmau J, Harms L , et al. Retrospective analysis of NMDA receptor antibodies in encephalitis of unknown origin. Neurology 2010; 75 (19) 1735-1739
    CrossrefPubMedGoogle Scholar
  • 3 Wingfield T, McHugh C, Vas A , et al. Autoimmune encephalitis: a case series and comprehensive review of the literature. QJM 2011; 104 (11) 921-931
    CrossrefPubMedGoogle Scholar
  • 4 Lancaster E, Dalmau J. Neuronal autoantigens—pathogenesis, associated disorders and antibody testing. Nat Rev Neurol 2012; 8 (7) 380-390
    CrossrefPubMedGoogle Scholar
  • 5 Lai M, Hughes EG, Peng X , et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Ann Neurol 2009; 65 (4) 424-434
    CrossrefPubMedGoogle Scholar
  • 6 Hughes EG, Peng X, Gleichman AJ , et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci 2010; 30 (17) 5866-5875
    CrossrefPubMedGoogle Scholar
  • 7 Gleichman AJ, Spruce LA, Dalmau J, Seeholzer SH, Lynch DR. Anti-NMDA receptor encephalitis antibody binding is dependent on amino acid identity of a small region within the GluN1 amino terminal domain. J Neurosci 2012; 32 (32) 11082-11094
    CrossrefPubMedGoogle Scholar
  • 8 Mikasova L, De Rossi P, Bouchet D , et al. Disrupted surface cross-talk between NMDA and Ephrin-B2 receptors in anti-NMDA encephalitis. Brain 2012; 135 (Pt 5) 1606-1621
    CrossrefPubMedGoogle Scholar
  • 9 Petit-Pedrol M, Armangue T, Peng X , et al. Encephalitis with refractory seizures, status epilepticus, and antibodies to the GABAA receptor: a case series, characterisation of the antigen, and analysis of the effects of antibodies. Lancet Neurol 2014; 13 (3) 276-286
    CrossrefPubMedGoogle Scholar
  • 10 Moscato EH, Peng X, Jain A, Parsons TD, Dalmau J, Balice-Gordon RJ. Acute mechanisms underlying antibody effects in anti-N-methyl-D-aspartate receptor encephalitis. Ann Neurol 2014; 76 (1) 108-119
    CrossrefPubMedGoogle Scholar
  • 11 Rosenfeld MR, Dalmau JO. Paraneoplastic disorders of the CNS and autoimmune synaptic encephalitis. Continuum (Minneap Minn) 2012; 18 (2) 366-383
    PubMedGoogle Scholar
  • 12 Bien CG, Vincent A, Barnett MH , et al. Immunopathology of autoantibody-associated encephalitides: clues for pathogenesis. Brain 2012; 135 (Pt 5) 1622-1638
    CrossrefPubMedGoogle Scholar
  • 13 Leypoldt F. [Autoimmune encephalitis]. Fortschr Neurol Psychiatr 2013; 81 (9) 523-537, quiz 538
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Dalmau J, Rosenfeld MR. Autoimmune encephalitis update. Neuro-oncol 2014; 16 (6) 771-778
    PubMedGoogle Scholar
  • 15 Dalmau J, Tüzün E, Wu HY , et al. Paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol 2007; 61 (1) 25-36
    Google Scholar
  • 16 Hutchinson M, Waters P, McHugh J , et al. Progressive encephalomyelitis, rigidity, and myoclonus: a novel glycine receptor antibody. Neurology 2008; 71 (16) 1291-1292
    CrossrefPubMedGoogle Scholar
  • 17 Lancaster E, Lai M, Peng X , et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. Lancet Neurol 2010; 9 (1) 67-76
    CrossrefPubMedGoogle Scholar
  • 18 Irani SR, Alexander S, Waters P , et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan's syndrome and acquired neuromyotonia. Brain 2010; 133 (9) 2734-2748
    CrossrefPubMedGoogle Scholar
  • 19 Lai M, Huijbers MGM, Lancaster E , et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. Lancet Neurol 2010; 9 (8) 776-785
    CrossrefPubMedGoogle Scholar
  • 20 Lancaster E, Martinez-Hernandez E, Titulaer MJ , et al. Antibodies to metabotropic glutamate receptor 5 in the Ophelia syndrome. Neurology 2011; 77 (18) 1698-1701
    CrossrefPubMedGoogle Scholar
  • 21 Boronat A, Gelfand JM, Gresa-Arribas N , et al. Encephalitis and antibodies to dipeptidyl-peptidase-like protein-6, a subunit of Kv4.2 potassium channels. Ann Neurol 2013; 73 (1) 120-128
    CrossrefPubMedGoogle Scholar
  • 22 Sabater L, Gaig C, Gelpi E , et al. A novel non-rapid-eye movement and rapid-eye-movement parasomnia with sleep breathing disorder associated with antibodies to IgLON5: a case series, characterisation of the antigen, and post-mortem study. Lancet Neurol 2014; 13 (6) 575-586
    CrossrefPubMedGoogle Scholar
  • 23 Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain 2000; 123 (Pt 7) 1481-1494
    CrossrefPubMedGoogle Scholar
  • 24 Graus F, Delattre JY, Antoine JC , et al. Recommended diagnostic criteria for paraneoplastic neurological syndromes. J Neurol Neurosurg Psychiatry 2004; 75 (8) 1135-1140
    CrossrefPubMedGoogle Scholar
  • 25 Graus F, Ariño H, Dalmau J. Paraneoplastic neurological syndromes in Hodgkin and non-Hodgkin lymphomas. Blood 2014; 123 (21) 3230-3238
    CrossrefPubMedGoogle Scholar
  • 26 Titulaer MJ, McCracken L, Gabilondo I , et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013; 12 (2) 157-165
    CrossrefPubMedGoogle Scholar
  • 27 Poloni M, Rocchelli B, Scelsi R, Pinelli P. Intrathecal IgG synthesis in multiple sclerosis and other neurological diseases: a comparative evaluation by IgG-index and isoelectric focusing. J Neurol 1979; 221 (4) 245-255
    CrossrefPubMedGoogle Scholar
  • 28 Lansberg MG, O'Brien MW, Norbash AM, Moseley ME, Morrell M, Albers GW. MRI abnormalities associated with partial status epilepticus. Neurology 1999; 52 (5) 1021-1027
    Google Scholar
  • 29 Baumgartner A, Rauer S, Mader I, Meyer PT. Cerebral FDG-PET and MRI findings in autoimmune limbic encephalitis: correlation with autoantibody types. J Neurol 2013; 260 (11) 2744-2753
    CrossrefPubMedGoogle Scholar
  • 30 Kaplan PW, Sutter R. Electroencephalography of autoimmune limbic encephalopathy. J Clin Neurophysiol 2013; 30 (5) 490-504
    CrossrefPubMedGoogle Scholar
  • 31 Armangue T, Petit-Pedrol M, Dalmau J. Autoimmune encephalitis in children. J Child Neurol 2012; 27 (11) 1460-1469
    CrossrefPubMedGoogle Scholar
  • 32 Armangue T, Titulaer MJ, Málaga I , et al; Spanish Anti-N-methyl-D-Aspartate Receptor (NMDAR) Encephalitis Work Group. Pediatric anti-N-methyl-D-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients. J Pediatr 2013; 162 (4) 850-856 , e2
    CrossrefPubMedGoogle Scholar
  • 33 Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology 2012; 79 (11) 1094-1100
    CrossrefPubMedGoogle Scholar
  • 34 Graus F, Boronat A, Xifró X , et al. The expanding clinical profile of anti-AMPA receptor encephalitis. Neurology 2010; 74 (10) 857-859
    CrossrefPubMedGoogle Scholar
  • 35 Bataller L, Galiano R, García-Escrig M , et al. Reversible paraneoplastic limbic encephalitis associated with antibodies to the AMPA receptor. Neurology 2010; 74 (3) 265-267
    CrossrefPubMedGoogle Scholar
  • 36 Jeffery OJ, Lennon VA, Pittock SJ, Gregory JK, Britton JW, McKeon A. GABAB receptor autoantibody frequency in service serologic evaluation. Neurology 2013; 81 (10) 882-887
    CrossrefPubMedGoogle Scholar
  • 37 Vincent A, Buckley C, Schott JM , et al. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain 2004; 127 (Pt 3) 701-712
    CrossrefPubMedGoogle Scholar
  • 38 Iranzo A, Graus F, Clover L , et al. Rapid eye movement sleep behavior disorder and potassium channel antibody-associated limbic encephalitis. Ann Neurol 2006; 59 (1) 178-181
    CrossrefPubMedGoogle Scholar
  • 39 Andrade DM, Tai P, Dalmau J, Wennberg R. Tonic seizures: a diagnostic clue of anti-LGI1 encephalitis?. Neurology 2011; 76 (15) 1355-1357
    CrossrefPubMedGoogle Scholar
  • 40 Irani SR, Stagg CJ, Schott JM , et al. Faciobrachial dystonic seizures: the influence of immunotherapy on seizure control and prevention of cognitive impairment in a broadening phenotype. Brain 2013; 136 (Pt 10) 3151-3162
    CrossrefPubMedGoogle Scholar
  • 41 Lancaster E, Huijbers MG, Bar V , et al. Investigations of caspr2, an autoantigen of encephalitis and neuromyotonia. Ann Neurol 2011; 69 (2) 303-311
    CrossrefPubMedGoogle Scholar
  • 42 Irani SR, Pettingill P, Kleopa KA , et al. Morvan syndrome: clinical and serological observations in 29 cases. Ann Neurol 2012; 72 (2) 241-255
    CrossrefPubMedGoogle Scholar
  • 43 Mat A, Adler H, Merwick A , et al. Ophelia syndrome with metabotropic glutamate receptor 5 antibodies in CSF. Neurology 2013; 80 (14) 1349-1350
    CrossrefPubMedGoogle Scholar
  • 44 McKeon A, Martinez-Hernandez E, Lancaster E , et al. Glycine receptor autoimmune spectrum with stiff-man syndrome phenotype. JAMA Neurol 2013; 70 (1) 44-50
    CrossrefPubMedGoogle Scholar
  • 45 Woodhall M, Çoban A, Waters P , et al. Glycine receptor and myelin oligodendrocyte glycoprotein antibodies in Turkish patients with neuromyelitis optica. J Neurol Sci 2013; 335 (1-2) 221-223
    CrossrefPubMedGoogle Scholar
  • 46 Wuerfel E, Bien CG, Vincent A, Woodhall M, Brockmann K. Glycine receptor antibodies in a boy with focal epilepsy and episodic behavioral disorder. J Neurol Sci 2014; 343 (1-2) 180-182
    CrossrefPubMedGoogle Scholar
  • 47 Mas N, Saiz A, Leite MI , et al. Antiglycine-receptor encephalomyelitis with rigidity. J Neurol Neurosurg Psychiatry 2011; 82 (12) 1399-1401
    CrossrefPubMedGoogle Scholar
  • 48 Martinez-Hernandez E, Sepulveda M, Rostasy K , et al. Antibodies to AQP4, MOG and glycine receptor in patients with uni or bilateral, severe, or recurrent isolated optic neuritis. JAMA Neurol, in press
    PubMedGoogle Scholar
  • 49 Balint B, Jarius S, Nagel S , et al. Progressive encephalomyelitis with rigidity and myoclonus: a new variant with DPPX antibodies. Neurology 2014; 82 (17) 1521-1528
    CrossrefPubMedGoogle Scholar
  • 50 Ohkawa T, Satake S, Yokoi N , et al. Identification and characterization of GABA(A) receptor autoantibodies in autoimmune encephalitis. J Neurosci 2014; 34 (24) 8151-8163
    CrossrefPubMedGoogle Scholar
  • 51 Gresa-Arribas N, Titulaer MJ, Torrents A , et al. Antibody titres at diagnosis and during follow-up of anti-NMDA receptor encephalitis: a retrospective study. Lancet Neurol 2014; 13 (2) 167-177
    CrossrefPubMedGoogle Scholar
  • 52 Viaccoz A, Desestret V, Ducray F , et al. Clinical specificities of adult male patients with NMDA receptor antibodies encephalitis. Neurology 2014; 82 (7) 556-563
    CrossrefPubMedGoogle Scholar
  • 53 Saydain G, George L, Raoof S. New therapies: plasmapheresis, intravenous immunoglobulin, and monoclonal antibodies. Crit Care Clin 2002; 18 (4) 957-975
    CrossrefPubMedGoogle Scholar
  • 54 Reff ME, Carner K, Chambers KS , et al. Depletion of B cells in vivo by a chimeric mouse human monoclonal antibody to CD20. Blood 1994; 83 (2) 435-445
    PubMedGoogle Scholar
  • 55 Shapiro-Shelef M, Calame K. Regulation of plasma-cell development. Nat Rev Immunol 2005; 5 (3) 230-242
    CrossrefPubMedGoogle Scholar
  • 56 Kosmidis ML, Dalakas MC. Practical considerations on the use of rituximab in autoimmune neurological disorders. Ther Adv Neurol Disord 2010; 3 (2) 93-105
    CrossrefPubMedGoogle Scholar
  • 57 Brummaier T, Pohanka E, Studnicka-Benke A, Pieringer H. Using cyclophosphamide in inflammatory rheumatic diseases. Eur J Intern Med 2013; 24 (7) 590-596
    CrossrefPubMedGoogle Scholar
  • 58 Rosenfeld MR, Dalmau J. Anti-NMDA-receptor encephalitis and other synaptic autoimmune disorders. Curr Treat Options Neurol 2011; 13 (3) 324-332
    CrossrefPubMedGoogle Scholar
  • 59 Dale RC, Brilot F, Duffy LV , et al. Utility and safety of rituximab in pediatric autoimmune and inflammatory CNS disease. Neurology 2014; 83 (2) 142-150
    CrossrefPubMedGoogle Scholar
  • 60 Pandit AK, Ihtisham K, Garg A, Gulati S, Padma MV, Tripathi M. Autoimmune encephalitis: a potentially reversible cause of status epilepticus, epilepsy, and cognitive decline. Ann Indian Acad Neurol 2013; 16 (4) 577-584
    CrossrefPubMedGoogle Scholar
  • 61 Littman AJ, Jackson LA, White E, Thornquist MD, Gaydos CA, Vaughan TL. Interlaboratory reliability of microimmunofluorescence test for measurement of Chlamydia pneumoniae-specific immunoglobulin A and G antibody titers. Clin Diagn Lab Immunol 2004; 11 (3) 615-617
    PubMedGoogle Scholar
  • 62 Winter O, Dame C, Jundt F, Hiepe F. Pathogenic long-lived plasma cells and their survival niches in autoimmunity, malignancy, and allergy. J Immunol 2012; 189 (11) 5105-5111
    CrossrefPubMedGoogle Scholar
  • 63 Sillevis Smitt P, Kinoshita A, De Leeuw B , et al. Paraneoplastic cerebellar ataxia due to autoantibodies against a glutamate receptor. N Engl J Med 2000; 342 (1) 21-27
    CrossrefPubMedGoogle Scholar
  • 64 Marignier R, Chenevier F, Rogemond V , et al. Metabotropic glutamate receptor type 1 autoantibody-associated cerebellitis: a primary autoimmune disease?. Arch Neurol 2010; 67 (5) 627-630
    PubMedGoogle Scholar
  • 65 Dale RC, Merheb V, Pillai S , et al. Antibodies to surface dopamine-2 receptor in autoimmune movement and psychiatric disorders. Brain 2012; 135 (Pt 11) 3453-3468
    CrossrefPubMedGoogle Scholar
  • 66 De Tiège X, Rozenberg F, Des Portes V , et al. Herpes simplex encephalitis relapses in children: differentiation of two neurologic entities. Neurology 2003; 61 (2) 241-243
    CrossrefPubMedGoogle Scholar
  • 67 Kullnat MW, Morse RP. Choreoathetosis after herpes simplex encephalitis with basal ganglia involvement on MRI. Pediatrics 2008; 121 (4) e1003-e1007
    CrossrefPubMedGoogle Scholar
  • 68 Prüss H, Finke C, Höltje M , et al. N-methyl-D-aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol 2012; 72 (6) 902-911
    CrossrefPubMedGoogle Scholar
  • 69 Leypoldt F, Titulaer MJ, Aguilar E , et al. Herpes simplex virus-1 encephalitis can trigger anti-NMDA receptor encephalitis: case report. Neurology 2013; 81 (18) 1637-1639
    CrossrefPubMedGoogle Scholar
  • 70 Mohammad SS, Sinclair K, Pillai S , et al. Herpes simplex encephalitis relapse with chorea is associated with autoantibodies to N-methyl-D-aspartate receptor or dopamine-2 receptor. Mov Disord 2014; 29 (1) 117-122
    CrossrefPubMedGoogle Scholar
  • 71 Hacohen Y, Deiva K, Pettingill P , et al. N-methyl-D-aspartate receptor antibodies in post-herpes simplex virus encephalitis neurological relapse. Mov Disord 2014; 29 (1) 90-96
    CrossrefPubMedGoogle Scholar
  • 72 Armangue T, Leypoldt F, Málaga I , et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol 2014; 75 (2) 317-323
    CrossrefPubMedGoogle Scholar
  • 73 Titulaer MJ, Höftberger R, Iizuka T , et al. Overlapping demyelinating syndromes and anti–N-methyl-D-aspartate receptor encephalitis. Ann Neurol 2014; 75 (3) 411-428
    CrossrefPubMedGoogle Scholar
  • 74 Cojocaru M, Cojocaru IM, Silosi I. Multiple autoimmune syndrome. Maedica (Buchar) 2010; 5 (2) 132-134
    PubMedGoogle Scholar
  • 75 Díaz-Manera J, Rojas-García R, Gallardo E , et al. Antibodies to AChR, MuSK and VGKC in a patient with myasthenia gravis and Morvan's syndrome. Nat Clin Pract Neurol 2007; 3 (7) 405-410
    PubMedGoogle Scholar
  • 76 Brain L, Jellinek EH, Ball K. Hashimoto's disease and encephalopathy. Lancet 1966; 2 (7462) 512-514
    PubMedGoogle Scholar
  • 77 Castillo P, Woodruff B, Caselli R , et al. Steroid-responsive encephalopathy associated with autoimmune thyroiditis. Arch Neurol 2006; 63 (2) 197-202
    CrossrefPubMedGoogle Scholar
  • 78 Tüzün E, Erdağ E, Durmus H , et al. Autoantibodies to neuronal surface antigens in thyroid antibody-positive and -negative limbic encephalitis. Neurol India 2011; 59 (1) 47-50
    CrossrefPubMedGoogle Scholar
  • 79 Chong JY, Rowland LP, Utiger RD. Hashimoto encephalopathy: syndrome or myth?. Arch Neurol 2003; 60 (2) 164-171
    CrossrefPubMedGoogle Scholar
  • 80 Steup-Beekman G, Steens S, van Buchem M, Huizinga T. Anti-NMDA receptor autoantibodies in patients with systemic lupus erythematosus and their first-degree relatives. Lupus 2007; 16 (5) 329-334
    CrossrefPubMedGoogle Scholar
  • 81 Choe CU, Karamatskos E, Schattling B , et al. A clinical and neurobiological case of IgM NMDA receptor antibody associated encephalitis mimicking bipolar disorder. Psychiatry Res 2013; 208 (2) 194-196
    CrossrefPubMedGoogle Scholar
  • 82 Prüss H, Höltje M, Maier N , et al. IgA NMDA receptor antibodies are markers of synaptic immunity in slow cognitive impairment. Neurology 2012; 78 (22) 1743-1753
    CrossrefPubMedGoogle Scholar
  • 83 Steiner J, Walter M, Glanz W , et al. Increased prevalence of diverse N-methyl-D-aspartate glutamate receptor antibodies in patients with an initial diagnosis of schizophrenia: specific relevance of IgG NR1a antibodies for distinction from N-methyl-D-aspartate glutamate receptor encephalitis. JAMA Psychiatry 2013; 70 (3) 271-278
    CrossrefPubMedGoogle Scholar
  • 84 Hammer C, Stepniak B, Schneider A , et al. Neuropsychiatric disease relevance of circulating anti-NMDA receptor autoantibodies depends on blood-brain barrier integrity. Mol Psychiatry 2013;
    PubMedGoogle Scholar
  • 85 Montojo MT, Petit-Pedrol M, Graus F, Dalmau J. Clinical spectrum and diagnostic value of antibodies against the potassium channel related protein complex. Neurologia 2014;
    PubMedGoogle Scholar
  • 86 Paterson RW, Zandi MS, Armstrong R, Vincent A, Schott JM. Clinical relevance of positive voltage-gated potassium channel (VGKC)-complex antibodies: experience from a tertiary referral centre. J Neurol Neurosurg Psychiatry 2014; 85 (6) 625-630
    CrossrefPubMedGoogle Scholar