les ataxies cerebelleuses autoimmunes · les ataxies cerebelleuses autoimmunes pr j. honnorat des...
TRANSCRIPT
![Page 1: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/1.jpg)
LES ATAXIES CEREBELLEUSES AUTOIMMUNES
PR J. HONNORAT
DES NEUROLOGIE Clermont-Ferrand Mars 2012
NEURO-ONCOLOGIE HOPITAL NEUROLOGIQUE
LYON, FRANCE
![Page 2: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/2.jpg)
LES ATAXIES CEREBELLEUSES SPORADIQUES
- Génétiques récessives (Freidreich, AOA, mitochondries…) - Dégénératives idiopathiques (MSA…) - Tumorales - vasculaires - infectieuses (VZV, CMV, EBV, Herpes, Prions, HIV, LEMP) - Toxiques (alcool, Phénytoines, Lithium, Cytarabine, Mercure,
Toluène, Plomb, CO, Bromure, Thallium...) - métaboliques (carences vitaminiques : E, B1, Folique, A ;
Hypothyroidie ; dégénérescence Hépato-cérébrale ) - Auto-immunes (SEP, LED, Wegener, Behcet, maladie coeliaque,
paranéoplasiques, autres auto-Ac…) - Autres (Hémosidérose marginée du névraxe ; Hyperthermie maligne) - inconnues +++
CAUSES MULTIPLES :
![Page 3: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/3.jpg)
AUTOIMMUNE HYPOTHESIS IN PARANEOPLASTIC NEUROLOGICAL SYNDROMES
CSF : pleocytosis elevated protein levels increased IgG concentration oligoclonal bands
Brain : T lymphocytes infiltration
Anti-neuronal autoantibodies : - specificity 100 % - sensitivity 50 % - determine: tumor types neurological signs
![Page 4: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/4.jpg)
specificity 99 % ; sensitivity 50 % ; intra-cellular antigens
![Page 5: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/5.jpg)
Giometto et al, Arch Neurol, 2010;67:330-335
PNS with onconeural antibodies are rare Only 979 patients with definite PNS collected
By the PNS Euronetwork consortium between 2000 and 2008 (11 countries, 22 centers)
![Page 6: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/6.jpg)
979 patients with definite PNS collected By the PNS Euronetwork consortium between 2000 and 2008
Giometto et al, Arch Neurol, 2010;67:330-335
Cerebellar ataxia and sensory neuronopathy are the most frequent PNS
![Page 7: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/7.jpg)
Caractéristiques des patients présentant une ataxie cérébelleuse dans la base de données PNS-Euronetwork 2000-2008
![Page 8: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/8.jpg)
Anti-YO ICC on rat cerebellum WB on Purkinje cells
- -
62
34
Tumoral expression : yes
![Page 9: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/9.jpg)
Peterson et al, Neurology 1992;42:1931-1937. Rojas et al, Neurology 2000;55:713-715.
Anti-Yo
Associated tumours : - Breast - Ovary
Neurological disorders : - subacute cerebellar ataxia
Median age : 61 years (98 % female)
Evolution : - median survival : 100 months (breast cancer) 22 months (gynecologic cancer)
- Cancer was cause of death in 52 % of patients
![Page 10: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/10.jpg)
PARANEOPLASTIC NEUROLOGICAL SYNDROMES
Miss M…, 63 years old, subacute cerebellar ataxia for 1 month, anti-Yo antibodies, ovarian carcinoma.
![Page 11: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/11.jpg)
PARANEOPLASTIC NEUROLOGICAL SYNDROMES
Miss M…, 67 years old, subacute cerebellar ataxia for 1 month, anti-Yo antibodies, ovarian carcinoma for 1 year.
![Page 12: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/12.jpg)
![Page 13: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/13.jpg)
Anti-CV2 / Anti-CRMP 5
Associated tumours : - Thoracic : 83 % ° SCLC 58 % ; Thymoma 15 % - Extrathoracic : 17 %(Prostate, uterus sarcoma…)
Neurological disorders : - neuropathy : 74 % - cerebellar ataxia : 61 % - optic neuropathy : 17 % - chorea : 10 %
Median survival : - 52 months Can be associated with anti-Hu
Honnorat et al, J Neurol Neurosurg Psy 1996;61:270-278 Rogemond et Honnorat, Clin Rev All Immunol 2000;19:48-57. Honnorat et al, J Neurol Neurosurg Psy 2009;80:412-416
Median age : 61,5 years (male 72 %)
![Page 14: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/14.jpg)
Mr P…, 55 years old, subacute cerebellar ataxia (1 month) anti-CV2 antibodies, SCLC (found 23 months after neurological signs)
Anti-CV2
![Page 15: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/15.jpg)
Pathophysiology of PNS with onconeural antibodies is unclear Example of anti-Yo antibodies
Miss M…, 63 years old subacute cerebellar ataxia for 1 month, anti-Yo antibodies, ovarian carcinoma.
Auto-antibodies
Yo selectively expressed by Purkinje cells
Selective loss of Purkinje cells No animal model
Albert et al, Ann Neurol, 2000;47:9-17
Cellular immunity seems to play a major role
T8 cells (arrows) around neuron
Intra-cellular antigen. Antibody access ???
![Page 16: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/16.jpg)
New concepts in auto-immune encephalitis
° OLD CONCEPT :
Paraneoplastic Anti-Hu Anti-CV2 Anti-Ma2 Anti-NMDAR Anti-neuropile
Non paraneoplastic Anti-VGKC Anti-VGCC But 20 to 60% of cancer
° NEW CONCEPT :
Intra-cellular antigens Anti-Hu Anti-CV2 Anti-Ma2…. Markers, no direct role
Membrane antigens Anti-NMDA-R Anti-VGKC Anti-AMPAr Anti-GABABr Anti-neuropile… Markers and direct role
All of them paraneoplastic or not
![Page 17: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/17.jpg)
![Page 18: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/18.jpg)
Graus et al, J Neuroimmunol 1997;74:55-61!Graus et al, Neurology 2003;!
![Page 19: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/19.jpg)
Anti-Tr
38 years old. November 11th 2003 diagnosis of Hodgkin lymphoma November 13th 2003 dysarthria November 14th 2003 gait ataxia, Tr antibodies positive November 24th 2003 beddriden, onset of chemotherapy October 2004, alive, cerebellar ataxia, cancer remission, Tr negative
![Page 20: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/20.jpg)
Anti-mGluR1 4 cas décrits depuis 2000
Doute sur origine paranéoplasique ; Hodgkin ?? Effet direct de l’IgG sur le récepteur (Sillevis-Smitt et al, N Engl J Med 2000)
Marignier et al, Arch Neurol 2010
![Page 21: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/21.jpg)
GLUTAMATE
GABA
GAD
Neurotransmetteur inhibiteur
Neurotransmetteur excitateur
GAD = Glutamate Acide Décarboxylase enzyme
Anti-GAD et ataxies cérébelleuses
![Page 22: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/22.jpg)
![Page 23: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/23.jpg)
ANTI-GAD ANTIBODIES AND NEUROLOGICAL DISORDERS
but three specific syndromes have been described :
- Stiff-person syndrome
- Late onset cerebellar ataxia
- epilepsia and encephalitis
This association seems to be very rare
![Page 24: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/24.jpg)
- axial muscles and proximal limbs - most patients respond to GABAergic drugs - 90 % are associated with anti-GAD - 30 % develop IDDM - 40 % have at least one auto-immune disease
(thyroiditis, myasthenia gravis, pernicious anemia….)
- 10 % develop generalized epilepsia
- Few paraneoplastic cases with amphiphysin antibodies
![Page 25: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/25.jpg)
Anti-GAD et ataxies cérébelleuses
![Page 26: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/26.jpg)
Between 1995 and 1999 : 6 new cases have been published
- Giometto et al, J Neurol Sci 1996;143:57-59.
- Saiz et al, Neurology 1997;49:1026-1030.
- Abele et al, Neurology 1999;52:857-859.
- Ishida et al, Ann Neurol 1999;46:263-267.
![Page 27: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/27.jpg)
European study :
- 5 centers : Lyon - 9000 tested sera Barcelona St Etienne Padova Oxford
- 36 anti-GAD sera - 22 Stiff-person syndrome - 14 cerebellar ataxia
![Page 28: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/28.jpg)
![Page 29: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/29.jpg)
1 = monoclonal anti-GAD65 antibody 2 à 15 = patients sera with cerebellar ataxia (dilution 1/20 000 à 1/5000) 16-17 = control patients
![Page 30: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/30.jpg)
Patients ’ clinical presentation :
- 13 female / 1 male - median age : 55 years (20 to 74 years) - insidious and progressive signs 93% - truncal ataxia +++ (100%) Rankin score > 2 (71%) - limb ataxia + (85%) - Nystagmus 85% ; Dysarthria 64 % - Stiff-limb syndrome (2 cases) - Myasthenia gravis (1 case) - Neuropathy (1 case)
![Page 31: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/31.jpg)
CSF and MRI studies :
CSF : - 4 patients : normal - 100% normal protein levels - High level IgG Index : 3 cases - oligoclonal Bands : 71%
IRM : - Cerebellar atrophy (50%) - Brainstem atrophy (0%)
![Page 32: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/32.jpg)
Family and patients histories :
Family : - Cerebellar ataxia (0%) - Auto-immune diseases (43%)
patients : - particular IDDM (71%) median age : 47 years (28-66) - auto-immune thyroiditis (57%) - pernicious anemia (2 cases) - Psoriasis (1 cases) - Coeliac disease (1 cases) - Malignant Thymoma (2 cases) - other organ specific autoantibodies (79%)
![Page 33: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/33.jpg)
74 years old woman, progressive ataxia for three years
![Page 34: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/34.jpg)
Female patient, 74 years old, with progressive cerebellar ataxia, anti-GAD antibodies and periodic alternating nystagmus
Without treatment 15 days with Baclofen 15 mg/d
![Page 35: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/35.jpg)
- Frequence of family and personal histories of auto-immune diseases - CSF synthesis of anti-GAD antibodies (6 cases /7) - IgG oligoclonal bands in the CSF - Particular MHC II : DR3 in 71 % (versus 11% in controls) - relationship with stiff-person syndrome
° Similar type and titers of anti-GAD antibodies ° 2 patients with stiff-person syndrome
![Page 36: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/36.jpg)
Anti-GAD antibodies of patients with cerebellar ataxia produce, in vitro, selective suppression of GABAergic transmission
(Ishida et al, Ann Neurol 1999;46:263-267) (Mitoma et al, J Neurol Sci 2000;175:40-44)
(Takenoshita et al, J Neurol Neurosurg Psychiatr 2001;70:386-389)
![Page 37: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/37.jpg)
Manto et al, Ann Neurol, 2007
![Page 38: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/38.jpg)
- anti-GAD can be used as diagnostic and prognostic markers
- association : anti-GAD and stiff-person syndromes subtype of cerebellar ataxia
Is now well established
- understanding of GAD immunity could help us to develop specific treatments
- As IDDM is frequent anti-GAD can lead to misdiagnosis In case of atypical neurological syndromes
![Page 39: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/39.jpg)
Autres autoanticorps associés aux ataxies
Anti-Gliadine (Gluten Ataxia - Sheffield) Anti-CASPR2 (Angela Vincent – Oxford)
![Page 40: LES ATAXIES CEREBELLEUSES AUTOIMMUNES · les ataxies cerebelleuses autoimmunes pr j. honnorat des neurologie clermont-ferrand mars 2012 neuro-oncologie hopital neurologique lyon,](https://reader031.vdocuments.mx/reader031/viewer/2022041711/5e47d404f8198301975b7aa6/html5/thumbnails/40.jpg)
CONCLUSIONS :
- Les ataxies auto-immunes sont en cours de description, Mais elles sont manifestement rares
- Formes paranéoplasiques clairement auto-immunes, mais mécanisme inconnu…
- Formes avec anti-GAD, effet direct de l’IgG suspectée. Diagnostic sur un faisceau d’arguments
- Anti-Gliadine et anti-CASPR2 doivent être précisés