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NEUROLOGY 1994;44:2145
© 1994 American Academy of Neurology

Intrathecal synthesis of the anti-Hu antibody in patients with paraneoplastic encephalomyelitis or sensory neuronopathy

Clinical-immunologic correlation

F. Vega, MD, F. Graus, MD, Q. M. Chen, MD, M. Poisson, MD, E. Schuller, MD and J. Y. Delattre, MD

Neurology Service (Drs. Vega, Chen, Poisson, and Delattre) and the Laboratory of Neuro-Immunology (Dr. Schuller), Hopital de la Salpetriere, Paris, France; and the Neurology Service (Dr. Graus), Hospital Clinic i Provincial, Barcelona, Spain.

We studied the intrathecal synthesis of the anti-Hu antibody (also called type 1 antineuronal nuclear autoantibody) in 14 patients with isolated paraneoplastic subacute sensory neuronopathy (SSN) and 16 with paraneoplastic encephalomyelitis (PEM). Patients with PEM had higher anti-Hu titers in the CSF (p = 0.003) but not in the serum than those with SSN. Only one patient (7%) with SSN had a positive intrathecal anti-Hu antibody synthesis whereas this was present in 14 (88%) of the 16 patients with PEM (p < 0.0001). The correlation between the intrathecal production of anti-Hu antibodies and PEM supports the role of autoimmune mechanisms in the pathogenesis of PEM. The absent intrathecal synthesis of anti-Hu antibodies in patients with SSN suggests easier accessibility of the systemic immune reaction to the sensory neurons probably due to the partial absence of blood-nerve barrier in the dorsal root ganglia.

Address correspondence and reprint requests to Dr. Francesc Graus, Neurology Service, Hospital Clínic i Provincial, Villarroel 170, 08036 Barcelona, Spain.

Supported in part by grant FIS 92/0010, Madrid, Spain.

Received February 16, 1994. Accepted in final form May 12, 1994.




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