Movement disorders in autoimmune encephalitis and paraneoplastic neurological syndromes

Abstract

Movement disorders are extremely common and diverse in autoimmune encephalitis (AE) and paraneoplastic neurological syndromes (PNS). They can sometimes represent the main neurological disorder of a given patient, or just be part of a larger neurological syndrome. Early diagnosis of AE or PNS is essential, as the associated abnormal movements can be effectively treated with immunomodulators. Nevertheless, the diagnosis is often delayed because of the large number of differential diagnoses (infections, metabolic disorders, genetic and degenerative diseases) and because the semiology of abnormal movements arising during AE and PNS is often not well known. However, there are highly specific clinical features, depending on the associated autoantibodies, age and gender of the patient, and associated cancers. Such features are likely to rely on specific mechanisms, the knowledge of which could lead to new therapeutic proposals. Also, the growing body of work on AE and PNS provides a better understanding of the links between immunity and neuronal degeneration, and immunity and genetic specificities. Thus, the purpose of this article is to present the current knowledge and different subtypes of movement disorders associated with AE and PNS, as well as the mechanisms that can lead to neuronal dysfunction.

Keywords: Abnormal movement; Auto-anticorps; Autoantibodies; Autoimmune encephalitis; Chorea; Chorée; Dyskinésie oro-faciale; Dystonia; Dystonie; Encéphalite auto-immune; Mouvements anormaux; Neuroimmunologie; Neuroimmunology; Orofacial dyskinesia; Paraneoplastic neurological syndrome; Syndrome neurologique paranéoplasique.