Antikörper-Diagnostik bei Verdacht auf autoimmune Hirnentzündungen

 

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Zusammenfassung

Der Nachweis spezifischer gegen Hirngewebe gerichteter Autoantikörper hat zu einer rasanten Weiterentwicklung in der Neurologie und Pädiatrie geführt. Mit ihrer Hilfe können heute bestimmte Symptome zweifelsfrei zugeordnet werden, diagnostische Pfade werden vereinfacht und immunmodulierende Therapien können gezielter eingesetzt werden. Die Krankheitsbilder reichen von Enzephalitiden und Epilepsien bis zu demyelinisierenden Erkrankungen, Psychosen und Demenzen. Angesichts der vielen neuen zugrundeliegenden Autoantikörper gegen Ionen -kanäle und Rezeptoren auf Nervenzellen (zum Beispiel NMDA-, AMPA- und GABA Rezeptoren, LGI1, DPPX) wächst die Schwierigkeit, den Überblick über das variable Erkrankungsspektrum zu behalten. Neben klinischer Untersuchung und MRT-Bild -gebung stehen die Lumbalpunktion und die Bestimmung der Antikörper mit zellbasierten Testverfahren im Vordergrund differenzial -dia gnostischer Entscheidungen und rascher Therapie. Der Nachweis immer neuer Antikörper wird sich in den kommenden Jahren fort-setzen und zu einem besseren Verständnis der Pathomechanismen auch einiger neurologischer Krankheiten führen, die bisher als unheilbar oder psychosomatisch galten.

Summary

Identification of specific auto-antibodies against brain tissue resulted in profound changes in clinical neurology and pediatrics. Antibody detection now allows definite conclusions about the underlying disease mechanisms, streamlines diagnostic pathways, and accelerates initiation of immunotherapy. The disease spectrum is variable and ranges from encephalitis and epilepsy to demyelinating disorders, psychosis, and dementia. Most antibodies target neuronal surface proteins, in particular ion channels and receptors, such as NMDA, AMPA, or GABA receptors, LGI1, and DPPX. Together with clinical examination and MR imaging, cerebrospinal fluid analysis and detection of neuronal surface antibodies in cell-based assays have become the diagnostic mainstay, guiding differential diagnoses and rapid therapy. Further pathogenic auto-antibodies will be detected in future years, thus helping to better understand disease mechanisms even in some of those neurological disorders that until now had to be considered incurable or psychosomatic.

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