Autoimmune
movement disorders
Autoimmune movement disorders encapsulate a large and diverse group of neurologic disorders occurring either in isolation or accompanying more diffuse autoimmune encephalitic illnesses. Disorders may be ataxic, hypokinetic (parkinsonism), or hyperkinetic (myoclonus, chorea, and other dyskinetic disorders).
Personalized treatment
for each patient
Given the variety of movement phenomena and disorders, treatment protocols should be individualized for each patient and reflect symptom severity, the type of antibody identified, and the presence or absence of cancer. In addition to oncologic therapy (when appropriate), often treatment involves immunotherapy and symptomatic therapy. Often, early-initiated immunotherapy gives patients the best possible outcomes.
53%
46%
of autoimmune cerebellar
ataxia is paraneoplastic.
of autoimmune cerebellar ataxia
patients improve with immunotherapy.
When to consider testing
Consider autoimmune testing for patients presenting with a new-onset movement disorder and one or more
of the following:
- Fluctuating course
- Psychiatric accompaniments (psychosis, hallucinations)
- Headache
- Autoimmune stigmata (e.g., physical signs or personal/ family history of diabetes, thyroid disorder, vitiligo, prematurely gray hair, myasthenia gravis, rheumatoid arthritis, systemic lupus erythematosus)
- History of cancer
- Smoking history (20+ pack years) or other cancer risk factors
- Inflammatory cerebrospinal fluid
- Neuroimages suggesting inflammation (signal abnormality, limbic or extra-temporal)
- Prior treatment with immune checkpoint inhibitors
Patients with autoimmune neurologic disorders may
present with multiple movement phenomena, many
of which can resemble neurodegenerative disorders,
such as Huntington disease. These disorders can
manifest in conjunction with autoimmune encephalitic
diseases, neoplasms, or infections, or they can be
completely idiopathic.
Which test should I order?
One Test, Multiple Targets: Zeroing in on Autoimmune Movement Disorders
A movement disorder like this might be caused by the body’s immune system, which is meant to fight infections, suddenly attacking the brain. Fortunately, an “autoimmune movement disorder” can often be treated—once its cause is discovered.
Antibodies included:
Plasma membrane specificities
Nuclear and cytoplasmic specificities
Webinar - Autoimmune movement disorders
This "Specialty Testing Webinar", presented by Andrew McKeon, M.B, B.Ch., M.D., discusses the spectrum of autoimmune movement disorders and explores diagnosis and treatment.