Skip to main content
Advertisement
  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Neurology: Neuroimmunology & Neuroinflammation COVID-19 Article Hub
    • Diversity, Equity, & Inclusion (DEI)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit New Manuscript
    • Submit Revised Manuscript
    • Author Center

Advanced Search

Main menu

  • Neurology.org
  • Journals
    • Neurology
    • Clinical Practice
    • Education
    • Genetics
    • Neuroimmunology & Neuroinflammation
  • Online Sections
    • Neurology Video Journal Club
    • Neurology: Neuroimmunology & Neuroinflammation COVID-19 Article Hub
    • Diversity, Equity, & Inclusion (DEI)
    • Innovations in Care Delivery
    • Practice Buzz
    • Practice Current
    • Residents & Fellows
    • Without Borders
  • Collections
    • COVID-19
    • Disputes & Debates
    • Health Disparities
    • Infographics
    • Null Hypothesis
    • Patient Pages
    • Topics A-Z
    • Translations
  • Podcast
  • CME
  • About
    • About the Journals
    • Contact Us
    • Editorial Board
  • Authors
    • Submit New Manuscript
    • Submit Revised Manuscript
    • Author Center
  • Home
  • Articles
  • Issues
  • COVID-19 Article Hub
  • Infographics & Video Summaries

User menu

  • My Alerts
  • Log in

Search

  • Advanced search
Neurology Neuroimmunology & Neuroinflammation
Home
A peer-reviewed clinical and translational neurology open access journal
  • My Alerts
  • Log in
Site Logo
  • Home
  • Articles
  • Issues
  • COVID-19 Article Hub
  • Infographics & Video Summaries

Author response: Increased frequency of anti-Ma2 encephalitis associated with immune checkpoint inhibitors

  • Alberto Vogrig, Neurologist, French refererence center on paraneoplastic neurological diseases and autoimmune encephalitis
  • Marine Fouret, Neurologist, French refererence center on paraneoplastic neurological diseases and autoimmune encephalitis
  • Sergio Muñiz-Castrillo, Neurologist, French refererence center on paraneoplastic neurological diseases and autoimmune encephalitis
  • Jérôme Honnorat, Professor of Neurology, French refererence center on paraneoplastic neurological diseases and autoimmune encephalitis
Submitted September 14, 2019

We appreciate Dr. Obeidat’s comment regarding our recent article1 that identified a higher frequency of anti-Ma2-associated paraneoplastic neurologic syndrome after immune checkpoint inhibitors (ICIs) implementation in France. We agree that it could be hypothesized that all 6 cases had pre-ICI subclinical anti-Ma2 seropositivity and, on this matter, we have suggested testing for onconeural antibodies all patients with lung adenocarcinoma before starting ICI therapy. Similarly, anti-Hu antibodies were present before initiation of programmed cell death 1 (PD-1) inhibitors in 2 recently reported cases of limbic encephalitis.2,3 The patients were neurologically asymptomatic at the time of ICI introduction. Moreover, the median delay between ICI initiation and onset of the neurologic syndrome in our series was 4 months. Therefore, we do not believe that ICI treatment aggravated a pre-existing anti-Ma2 paraneoplastic neurological syndrome (PNS). To the contrary, we favor a “two-hit hypothesis,” in which the presence of antibodies is not sufficient per se to induce a PNS but requires a T-cell activation as permitted by the use of ICIs.1 As Dr. Obeidat correctly states, anti-Ma2 syndrome can present with unusual neurologic symptoms, including motor neuron syndrome, myeloradiculopathy, and narcolepsy-cataplexy. Therefore, physicians must be aware of this rare diagnosis.4,5

References

  1. Vogrig A, Fouret M, Joubert B, et al. Increased frequency of anti-Ma2 encephalitis associated with immune checkpoint inhibitors. Neurol Neuroimmunol Neuroinflamm 2019;6:e604.
  2. Matsuoka H, Kimura H, Koba H, et al. Nivolumab-induced Limbic Encephalitis with Anti-Hu Antibody in a Patient With Advanced Pleomorphic Carcinoma of the Lung. Clin Lung Cancer 2018;19:e597–e599.
  3. Papadopoulos KP, Romero RS, Gonzalez G, Dix JE, Lowy I, Fury M. Anti-Hu-Associated Autoimmune Limbic Encephalitis in a Patient with PD-1 Inhibitor-Responsive Myxoid Chondrosarcoma. Oncologist 2018;23:118–120.
  4. Vogrig A, Joubert B, Maureille A, et al. Motor neuron involvement in anti-Ma2-associated paraneoplastic neurological syndrome. J Neurol 2019;266:398–410.
  5. Vogrig A, Ferrari S, Tinazzi M, Manganotti P, Vattemi G, Monaco S. Anti-Ma-associated encephalomyeloradiculopathy in a patient with pleural mesothelioma. J Neurol Sci 2015;350:105–106. 

Navigate back to article

Neurology - Neuroimmunology Neuroinflammation: 10 (3)

Articles

  • Articles
  • Issues
  • Popular Articles

About

  • About the Journals
  • Ethics Policies
  • Editors & Editorial Board
  • Contact Us
  • Advertise

Submit

  • Author Center
  • Submit a Manuscript
  • Information for Reviewers
  • AAN Guidelines
  • Permissions

Subscribers

  • Subscribe
  • Sign up for eAlerts
  • RSS Feed
Site Logo
  • Visit neurology Template on Facebook
  • Follow neurology Template on Twitter
  • Visit Neurology on YouTube
  • Neurology
  • Neurology: Clinical Practice
  • Neurology: Education
  • Neurology: Genetics
  • Neurology: Neuroimmunology & Neuroinflammation
  • AAN.com
  • AANnews
  • Continuum
  • Brain & Life
  • Neurology Today

Wolters Kluwer Logo

Neurology: Neuroimmunology & Neuroinflammation
Online ISSN: 2332-7812

© 2023 American Academy of Neurology

  • Privacy Policy
  • Feedback
  • Advertise