Christoph J Schankin1,2, Fabian Kästele1, Lisa Ann Gerdes1,3, Tobias Winkler1, Endy Csanadi1, Tobias Högen1, Hannah Pellkofer4, Walter Paulus5, Tania Kümpfel1,3, Andreas Straube1. 1. Department of Neurology, University of Munich Hospital, Großhadern, Munich, Germany (C.J. Schankin, F. Kästele, L. Ann Gerdes, T. Winkler, E. Csanadi, T. Högen, T. Kümpfel, and A. Straube). 2. Department of Neurology, University Hospital Bern - Inselspital, University of Bern, Bern, Switzerland (C.J. Schankin). 3. Institute of Clinical Neuroimmunology, University of Munich Hospital, Großhadern, Munich, Germany (L.A. Gerdes and T. Kümpfel). 4. Department of Neurology, University Medical Center, University of Göttingen, Göttingen, Germany (H. Pellkofer). 5. Department of Clinical Neurophysiology, University Medical Center, University of Göttingen, Göttingen, Germany (W. Paulus).
Abstract
OBJECTIVE: We tested the hypotheses (i) that autoimmune encephalitis is associated with new-onset headache, and (ii) that the occurrence of headache is associated with the presence of anti-N-methyl-D-aspartate (NMDA)-receptor antibodies. BACKGROUND: Autoimmune encephalitis presents with cognitive dysfunction as well as neuro-psychiatric symptoms. Its pathophysiology might involve antibody-mediated dysfunction of the glutamatergic system as indicated by the presence of anti-NMDA-receptor antibodies in some patients. METHODS: In this cross-sectional study, patients with autoimmune encephalitis were assessed with a standardized interview for previous headache and headache associated with autoimmune encephalitis. Headache was classified according to the International Classification of Headache Disorders, second edition. Clinical and paraclinical findings were correlated with the occurrence of headache. RESULTS: Of 40 patients with autoimmune encephalitis, 19 did not have a history of headache. Of those, nine suffered from encephalitis-associated headache. Seven of these nine had anti-NMDA-receptor antibodies in contrast to only two among the remaining 10 patients without new-onset headache (P = .023, odds ratio: 14, 95% confidence interval: 1.5; 127). In most patients headache occurred in attacks on more than 15 days/month, was severe, and of short duration (less than 4 hours). International Headache Society criteria for migraine were met in three patients. CONCLUSIONS: New-onset headache is a relevant symptom in patients with autoimmune encephalitis who have no history of previous headache, especially in the subgroup with anti-NMDA-receptor antibodies. This indicates a thorough investigation for secondary headaches including anti-NMDA-R antibodies for patients with new-onset headache and neuropsychiatric findings. Glutamatergic dysfunction might be important for the generation of head pain but may only occasionally be sufficient to trigger migraine-like attacks in nonmigraineurs.
OBJECTIVE: We tested the hypotheses (i) that autoimmune encephalitis is associated with new-onset headache, and (ii) that the occurrence of headache is associated with the presence of anti-N-methyl-D-aspartate (NMDA)-receptor antibodies. BACKGROUND:Autoimmune encephalitis presents with cognitive dysfunction as well as neuro-psychiatric symptoms. Its pathophysiology might involve antibody-mediated dysfunction of the glutamatergic system as indicated by the presence of anti-NMDA-receptor antibodies in some patients. METHODS: In this cross-sectional study, patients with autoimmune encephalitis were assessed with a standardized interview for previous headache and headache associated with autoimmune encephalitis. Headache was classified according to the International Classification of Headache Disorders, second edition. Clinical and paraclinical findings were correlated with the occurrence of headache. RESULTS: Of 40 patients with autoimmune encephalitis, 19 did not have a history of headache. Of those, nine suffered from encephalitis-associated headache. Seven of these nine had anti-NMDA-receptor antibodies in contrast to only two among the remaining 10 patients without new-onset headache (P = .023, odds ratio: 14, 95% confidence interval: 1.5; 127). In most patientsheadache occurred in attacks on more than 15 days/month, was severe, and of short duration (less than 4 hours). International Headache Society criteria for migraine were met in three patients. CONCLUSIONS: New-onset headache is a relevant symptom in patients with autoimmune encephalitis who have no history of previous headache, especially in the subgroup with anti-NMDA-receptor antibodies. This indicates a thorough investigation for secondary headaches including anti-NMDA-R antibodies for patients with new-onset headache and neuropsychiatric findings. Glutamatergic dysfunction might be important for the generation of head pain but may only occasionally be sufficient to trigger migraine-like attacks in nonmigraineurs.
Authors: Annette Baumgartner; Sebastian Rauer; Tilman Hottenrott; Frank Leypoldt; Friederike Ufer; Harald Hegen; Harald Prüss; Jan Lewerenz; Florian Deisenhammer; Oliver Stich Journal: J Neurol Date: 2018-11-12 Impact factor: 4.849
Authors: Dominique Endres; Frank Leypoldt; Karl Bechter; Alkomiet Hasan; Johann Steiner; Katharina Domschke; Klaus-Peter Wandinger; Peter Falkai; Volker Arolt; Oliver Stich; Sebastian Rauer; Harald Prüss; Ludger Tebartz van Elst Journal: Eur Arch Psychiatry Clin Neurosci Date: 2020-03-12 Impact factor: 5.270