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003 Autoimmune encephalitis antibody biomarkers: frequency, age and sex associations
  1. Amy Kunchok1,
  2. Vanda Lennon2,
  3. Christopher Klein2,3,
  4. Eoin Flanagan2,3,
  5. Divyanshu Dubey2,3,
  6. Anastasia Zekeridou2,3,
  7. Andrew McKeon2,3 and
  8. Sean J PIttock2,3
  1. 1Neurology, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Neuroimmunology Laboratory, Mayo Clinic, Rochester, Minnesota, USA
  3. 3Neurology, Mayo Clinic, Rochester, Minnesota, USA


Objective To determine the frequency, age and sex associations for autoimmune encephalitis antibody biomarkers (AE-Abs).

Methods There were 42032 patients tested in the Mayo Clinic Neuroimmunology Laboratory between January 2018-December 2019 for AE-Abs in serum and/or cerebrospinal fluid (CSF) including; NMDA-R-IgG, AMPA-R-IgG, GABAB-R-IgG, CASPR2-IgG, LGI1-IgG, GAD65-IgG, CRMP5-IgG, amphiphysin-IgG, PCA1/2/Tr-IgGs, ANNA1/2/3-IgGs, GFAP-α-IgG, mGluR1-IgG, DPPX-IgG, MOG-IgG1, were examined to determine frequency of antibody positivity. Age and sex associations were examined using multivariable logistic regression.

Results Adult serum analysis (22,472 patients; 56% female) revealed 814 (4%) were positive: NMDA-R-IgG (25%) > GAD65-IgG (22%) > LGI1-IgG (21%) > others. Of children (5,649; 50% female), 250 (4%) were positive: NMDA-R-IgG (53%) > MOG-IgG1 (32%) > GAD65-IgG (7%) > others.

Adult CSF analysis (18,745 patients; 54% female) revealed 709 (4%) were positive; NMDA-R-IgG (45%) > GAD65-IgG (19%) > LGI1-IgG (13%) > others. Of children (5136; 50% female), 276 (5%) were positive: NMDA-R-IgG (90%) > GAD65-IgG (7%) > others.

Age <20 years was associated with NMDA-R-IgG and MOG-IgG1 (OR=8.11 and 7.73 respectively, p<0.001). Age >65 years was associated with GABAB-R-IgG, LGI1-IgG, CASPR2-IgG and ANNA1-IgG (OR=7.33, 14.98, 3.67, 14.53, p<0.001). Women accounted for 60% of NMDA-R-IgG (CSF) and 78% of GAD65-IgG (CSF/serum) cohorts (OR=1.32, p=0.002, OR=2.78, p<0.001, respectively). Men accounted for 62% of the LGI1-IgG cohort (OR=1.87, p <0.001). Age and sex interacted for NMDA-R-IgG, particularly in females <20 years (OR=7.72, p <0.001).

Conclusion The most frequently detected were NMDA-R-IgG, LGI1-IgG, GAD65-IgG and MOG-IgG1. Age and sex associations may suggest paraneoplastic, endocrinological or aging influences on neurological autoimmunity.

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