What’s Hot: Immune-mediated neurologic disorders

Immune-mediated neurologic disorders has been a hot and rapidly evolving topic in high income setting such as the US for the past few years. Now there is a burgeoning body of evidence suggesting that immune mediated phenomena deserve more attention in tropical setting as well.  In 2017, Johnson et al. discovered a leiomodin-1 autoantibody in the sera and CSF of patients with nodding syndrome that may be a result of Onchocercal volvulus (OV) infection. OV is the cause of River Blindness and has long been associated with Nodding Syndrome though direct infectious links have been ruled out.1 Also in 2017, Neurology published a report of Post Malaria Neurologic Syndrome (PMNS) in a patient found to have NEUREXIN-3a2 antibodies and another case report of PMNS associated with anti-voltage-gated potassium channel antibodies.3 PMNS has been previously described primarily in adults and involves neuropsychiatric manifestations, confusion or coma, and seizures, but pediatric cases have also been reported.4 In malaria endemic regions, acute febrile pediatric illnesses with seizure and coma for which no underlying etiology can be identified is a not uncommon clinical conundrum. One has to wonder what the full spectrum of PMNS might entail.

  1.  Johnson TP, Tyagi R, Lee PR, et al. Nodding syndrome may be an autoimmune reaction to the parasitic worm Onchocerca volvulus. Sci Transl Med 2017; 9(377).
  2. Costa A, Silva-Pinto A, Alves J, et al. Postmalaria neurologic syndrome associated with neurexin-3alpha antibodies. Neurol Neuroimmunol Neuroinflamm 2017; 4(5): e392.
  3. Sahuguet J, Poulet A, Bou Ali H, Parola P, Kaphan E. Postmalaria Neurologic Syndrome-Autoimmune Encephalitis With Anti-Voltage-Gated Potassium-Channel Antibodies. Ann Intern Med 2017; 167(1): 70-1.
  4. Kernan RJ, Gavin PJ, Butler KM, Leahy TR, Lynch B, Leonard J. Expanding the Spectrum of Post-malaria Neurologic Syndrome in the Pediatric Population. Pediatr Infect Dis J 2018; 37(5): 499-500.

 

Gretchen L. Birbeck, MD, MPH

Gretchen L. Birbeck, MD, MPH

Gretchen Birbeck is a neurologist who divides her time between the US and Africa. Her US academic home is the University of Rochester where she is the Rykenboer Professor of Neurology and Research Director for the Strong Epilepsy Center with adjunct appointments in the Center for Human Experimental Therapeutics and the Department of Public Health. Her additional skills in epidemiology, health services research, and tropical medicine are brought to bear during the 6-months annually she spends in Africa where she serves as Director for the Chikankata Epilepsy Care Team in rural Mazabuka, Zambia, an Honorary Lecturer at the University of Zambia and a consultant for the Paediatric Research Ward at Queen Elizabeth Central Hospital in Blantyre, Malawi. Gretchen’s research programs are aimed at identifying opportunities to prevent or ameliorate the medical and social morbidities of common neurologic conditions in low-income, tropical settings with the ultimate goal of developing successful interventions feasible for scale up and broad implementation. She has been recognized as an Ambassador for Epilepsy by the International League against Epilepsy, a Global Health Research Ambassador by the US Paul Rogers Society, a National Outreach Scholar by the WK Kellogg Foundation and a Leader in Medicine by the American Medical Students Association.

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