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Clinical/Scientific Notes
July 23, 2015
Open Access

Earlier treatment of NMDAR antibody encephalitis in children results in a better outcome

Susan Byrne, PhD, Cathal Walsh, PhD, Yael Hacohen, MRCPCH, Eyal Muscal, MD, Joseph Jankovic, MD, Amber Stocco, MD, Russell C. Dale, PhD, Angela Vincent, MD, MSc, FRCPath, FRS, Ming Lim, PhD, and Mary King, FRCPCHAuthors Info & Affiliations
August 2015 issue
2 (4)
https://doi.org/10.1212/NXI.0000000000000130
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The natural history of NMDA receptor (NMDAR) antibody encephalitis in adults and children is altered by treatment with immunosuppressive therapy or tumor removal.1 In adult cohorts, early initiation of immunotherapy appears to be beneficial.1,2 In the largest series to date, Titulaer et al.1 demonstrated that earlier treatment was associated with a modified Rankin Scale (mRS) score of 2 or less in a cohort of 501 adults and children (univariate analysis p = 0.009, multivariable analysis p < 0.0001). Multivariable analysis on 177 children within the cohort showed that earlier treatment was associated with an mRS score of 2 or less, although this did not reach statistical significance (p = 0.067).1 An mRS score of 2 indicates slight disability and that the patient is unable to carry out all previous activities.
We performed a literature review of all first presentation cases of pediatric NMDAR antibody encephalitis to determine whether early treatment with immunomodulatory therapy is associated with a better outcome (see search criteria in appendix e-1 at Neurology.org/nn).
From 43 articles identified (appendix e-1, figure e-1), information was available on 80 children ≤17 years of age (56 female, median age 8 years, interquartile range [IQR] 4–14 years, range 1.3–17 years) reported across 34 articles with care from at least 34 institutions (table e-1). We dichotomized outcome into complete recovery (pediatric mRS score = 0) or incomplete recovery (mRS score ≥ 1).
Fifty-seven percent (41) received IV steroids as the first agent, 11.3% (9) received IV immunoglobulin (IVIg), 28.7% (23) had IVIg and methylprednisolone simultaneously, 2 children had tumor removal, and 5 children had no treatment (appendix e-1).
At follow-up (median 12 months, IQR 4.5–24 months, range 1.3–54 months), 33 (41%) children had recovered completely (mRS score = 0), whereas 47 (59%) children had an incomplete recovery (mRS score ≥ 1) based on evaluation by their treating physicians and/or families. There was no difference in median time to follow-up or median age at onset between children who recovered fully and those who did not (see table 1). There was no difference in median mRS score at nadir between children who made a full recovery (mRS score 5, IQR 4–5, range 3–5) and children who made an incomplete recovery (mRS score 4, IQR 3–5, range 3–5) (p = 0.2).
Table 1 Comparison of the clinical features between children who recovered completely and those who did not
The important finding from this review is that the median time from symptom onset to initiation of treatment was 15 days (IQR 7–21 days, range 3–182 days) in children who recovered completely (mRS score = 0) and 21 days (IQR 15–40 days, range 5–365 days) in those who had not recovered completely at follow-up (p = 0.014, Wilcoxon Mann-Whitney nonparametric test).
We illustrate the direct correlation between outcome and days to initiation of treatment as a box plot (see figure e-2).

Discussion.

Our retrospective review suggests that earlier treatment of NMDAR antibody encephalitis in children results in better outcomes. This is consistent with a previous report by Titulaer et al.1 In our study, children who recovered completely at follow-up (mRS score = 0) were treated a median of 15 days from symptom onset vs 21 days in children who did not completely recover. The median time of follow-up was 1 year in all patients, and because recovery from NMDAR antibody encephalitis can be very slow and take 18 months or longer,1 some patients may recover further. As such, our data may simply reflect an earlier recovery, which nevertheless may have a large benefit on quality of life and educational attainment. Although NMDAR antibody has been shown to mediate its effect by receptor internalization, which is reversible,3 factors such as the extent of secondary disturbance in synaptogenesis as a result of NMDAR binding by antibodies,4 manifesting as persisting functional and structural advanced MRI changes,5 may exert a larger influence on the developing CNS.
There are limitations to this study. First, selection bias may arise from reporting bias and the subsequent limited author response allowing analysis of only 80 of the potential 300 cases. Single cases are often published because of atypical features, and our study included 23 case reports. Second, 29 of the 80 patients were diagnosed on serum analysis alone, which may yield false-positive results6; however, patients included in this study did have a clinical phenotype compatible with NMDAR encephalitis. Third, the outcome is dichotomous—the mRS was designed to describe outcomes in the context of stroke in adults, focusing primarily on physical deficits, and is not a sensitive marker of cognitive deficits.
Prospective longitudinal studies addressing these limitations will be required to confirm whether earlier treatment results in better measurable outcomes.
Early recognition of the variable symptoms of NMDAR antibody encephalitis and more widespread availability of rapid diagnostic tests7 will facilitate early initiation of optimal therapy, although empiric therapy may be warranted when children have clinical manifestations that are consistent with NMDAR and other autoimmune encephalitis.

Acknowledgments

Acknowledgment: The authors thank Drs. Roberta Biancheri, Blaithnaid McCoy, Sarbani Raha, David Cohen, Sebastian Lebon, Ming-Chi Lai, Darcy Krueger, Johan Penzien, and Mered Parnes for providing additional patient data.

Data Supplement

Files in this Data Supplement:
Table e-1 - Microsoft Word file
Appendix e-1 - Microsoft Word file
Figure e-1 - .tif file
Figure e-2 - .tif file

Footnote

Author contributions: Susan Byrne designed the study, collected the data, analyzed the data, and wrote the manuscript. Cathal Walsh contributed to study design and data analysis and edited the manuscript. Yael Hacohen assisted with data collection and edited the manuscript. Eyal Muscal assisted with data collection and edited the manuscript. Joseph Jankovic assisted with data collection and edited the manuscript. Amber Stocco assisted with data collection and edited the manuscript. Russell C. Dale contributed to data analysis, interpretation, and collection and edited the manuscript. Angela Vincent contributed to data analysis, interpretation, and collection and edited the manuscript. Ming Lim contributed to study design, contributed to data analysis, interpretation, and collection, and wrote the manuscript. Mary King contributed to study design and wrote the manuscript.

Supplementary Material

File (150419_table_e-1_supplemental_data_nmda_byrne.doc)
File (appendix_e-1_final.doc)
File (figure_e-1_byrne.tiff)
File (figure_e-2_byrne.tiff)

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Information & Authors

Information

Published In

Neurology® Neuroimmunology & Neuroinflammation
Volume 2 • Number 4 • August 2015
PubMed: 26236759

Copyright

© 2015 American Academy of Neurology. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Publication History

Received: December 20, 2014
Accepted: April 30, 2015
Published online: July 23, 2015
Published in issue: August 2015

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Funding Information

Study funding: This work was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at Oxford University Hospitals NHS Trust and the University of Oxford.Disclosure: S. Byrne reports no disclosures. C. Walsh received research support from Health Research Board. Y. Hacohen received research support from the NIHR. E. Muscal received research support from Lupus Foundation of America. J. Jankovic is on the scientific advisory board for Allergan Inc, Auspex Pharmaceuticals Inc, Impax Pharmaceuticals, Ipsen Pharmaceuticals Inc, Merz Pharmaceuticals, Teva Pharmaceutical Industries Ltd, UCB Inc, and US World Meds; is on the editorial board for Medlink: Neurology, Expert Review of Neurotherapeutics, Neurology in Clinical Practice, The Botulinum Journal, PeerJ, Therapeutic Advances in Neurological Disorders, Neurotherapeutics, Tremor and Other Hyperkinetic Movements, Journal of Parkinson's Disease, and UpToDate; receives publishing royalties from Cambridge, Elsevier, Hodder Arnold, Lippincott Williams and Wilkins, and Wiley-Blackwell; is employed by Allergan Inc, Ipsen Limited, Michael J. Fox Foundation for Parkinson Research, Merz Pharmaceuticals, Ovation Pharmaceuticals, and Teva; has consulted for Allergan Inc, Auspex Pharmaceuticals Inc, Impax Pharmaceuticals, Ipsen Biopharmaceuticals Inc, Lundbeck Inc, Merz Pharmaceuticals, Teva Pharmaceutical Industries Ltd, UCB Inc, and US World Meds; and received research support from Allergan Inc, Allon Therapeutics, Biotie Therapies Inc, Ceregene Inc, CHDI Foundation, Chelsea Therapeutics, Diana Helis Henry Medical Research Foundation, GE Healthcare, Huntington's Disease Society of America, Huntington Study Group, Impax Pharmaceuticals, Ipsen Limited, Michael J. Fox Foundation for Parkinson Research, Dystonia Medical Research Foundation, Benign Essential Blepharospasm, Lundbeck Inc, Medtronic, Merz Pharmaceuticals, NIH, National Parkinson Foundation, Neurogen, St. Jude Medical, Teva Pharmaceutical Industries Ltd, UCB Inc, and University of Rochester Parkinson Study Group. A. Stocco received travel funding from Bayer. R.C. Dale is on the research advisory committee for Queensland Children's Medical Institute; received honoraria from Biogen Idec and Bristol-Myers-Squibb; is on the editorial board for Multiple Sclerosis and Related Disorders, Neurology: Neuroimmunology & Neuroinflammation, and European Journal of Paediatric Neurology; and received research support from NHMRC and Multiple Sclerosis Research Australia. A. Vincent is on the editorial board for Neurology; was an associate editor for Brain; holds a patent for LGI1/CASPR2 antibodies and for GABAAR antibodies; receives royalties from Athena Diagnostics, Euroimmun AG, Blackwell Publishing, and MacKeith Press; has consulted for Athena Diagnostics; and received research support from NIHR. M. Lim is on the advisory board for SPARKS Charity, received travel funding from Merck Serono, has consulted for CSL Behring, and received research support from NIHR. M. King reports no disclosures. Go to Neurology.org/nn for full disclosure forms. The Article Processing Charge was paid by the authors.

Authors

Affiliations & Disclosures

Susan Byrne, PhD
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Cathal Walsh, PhD
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
Prof Walsh is funded by Health Research Board, RL 2013-4.12079, Research Leader Award, 2013–2018
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Yael Hacohen, MRCPCH
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
This work was supported by the National Institute for Health Research (NIHR) Oxford Biomedical Research Centre based at Oxford University Hospitals NHS Trust and the University of Oxford
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Eyal Muscal, MD
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
(1) Lupus Foundation of America
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Joseph Jankovic, MD
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
Allergan, Inc; Auspex Pharmaceuticals, Inc; Impax Pharmaceuticals; Ipsen Biopharmaceuticals, Inc.; Lundbeck Inc; Merz Pharmaceuticals; Teva Pharmaceutical Industries Ltd; UCB Inc; US World Meds.
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Medlink: Neurology; Expert Review of Neurotherapeutics, Neurology in Clinical Practice; The Botulinum Journal; PeerJ; Therapeutic Advances in Neurological Disorders; Neurotherapeutics; Tremor and Other Hyperkinetic Movements; Journal of Parkinson?s Disease; UpToDate
Patents:
1.
NONE
Publishing Royalties:
1.
Cambridge, Elsevier, Hodder Arnold, Lippincott Williams and Wilkins, Wiley-Blackwell
Employment, Commercial Entity:
1.
Allergan, Inc; Ipsen Limited; Michael J Fox Foundation for Parkinson Research, Merz Pharmaceuticals; Ovation Pharmaceuticals; Teva
Consultancies:
1.
Consultant for Allergan, Inc; Auspex Pharmaceuticals, Inc; Impax Pharmaceuticals; Ipsen Biopharmaceuticals, Inc.; Lundbeck Inc; Merz Pharmaceuticals; Teva Pharmaceutical Industries Ltd; UCB Inc; US World Meds.
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Allergan, Inc; Allon Therapeutics; Biotie Therapies, Inc; Ceregene, Inc; CHDI Foundation; Chelsea Therapeutics; Diana Helis Henry Medical Research Foundation; GE Healthcare; Huntington?s Disease Society of America; Huntington Study Group; Impax Pharmaceuticals; Ipsen Limited.; Lundbeck Inc; Michael J Fox Foundation for Parkinson Research; Medtronic; Merz Pharmaceuticals; National Institutes of Health; National Parkinson Foundation; Neurogen; St. Jude Medical; Teva Pharmaceutical Industries Ltd; UCB Inc; University of Rochester; Parkinson Study Group
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
Michael J Fox Foundation for Parkinson Research, Dystonia Medical Research Foundation, Benign Essential Blepharospasm Research Foundation
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Amber Stocco, MD
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
Baylor College of Medicine - 2019-2014 Integris Baptist 2014-present
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Medtronic paid for travel for Intrathecal Baclofen Pump and Deep Brain Stimulation workshops
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Russell C. Dale, PhD
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
Queensland Children's Medical Institute Research advisory committee. Not for profit.
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
received an honoraria for lecturing from Biogen Idec and Bristol-Myers-Squibb
Editorial Boards:
1.
Editorial advisory board member of MSARD Editorial board member of Neurology: Neuroimmunology and Neuroinflammation Editorial board member of European Journal of Paediatric Neurology
Patents:
1.
NONE
Publishing Royalties:
1.
Biogen Idec honoraria in 2008 and Bristol-Myers-Squibb in 2015
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NHMRC national grant in 2011 national grant for encephalitis study NHMRC practitioner fellowship 2014-8 NHMRC project grant 2015
Research Support, Academic Entities:
1.
Multiple Sclerosis Research Australia 2015
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
View all articles by this author
Angela Vincent, MD, MSc, FRCPath, FRS
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
None in last two years
Editorial Boards:
1.
Advisory Editorial Board Neurology; Associate Editor for Brain ended 2013
Patents:
1.
Hold patent with Oxford University for LGI1/CASPR2 antibodies, licensed to Euroimmun AG, and for GABAAR antibodies, in negotiation with Euroimmun AG.
Publishing Royalties:
1.
Royalties from Athena Diagnostics (MuSK assays). Royalties received from Euroimmun AG (LGI1 and CASPR2 assays) Clinical Neuroimmunology (Blackwell Publishing, 2005) and Inflammatory and Autoimmune Disorders of the Nervous System in Children (Mac Keith Press 2010).
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
Consultancy with Athena Diagnostics for assessing their antibody assays ?5K pa. Ended 2014.
Speakers' Bureaus:
1.
Scientific conference expenses only
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NIHR general support for antibody work
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
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Ming Lim, PhD*
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
1.SPARKS Charity (non-profit)
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
1)Travel grants from Merc Serono for attending meetings (non-profit)
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NONE
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NONE
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NONE
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NONE
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1.
Consultancy for advisory board meeting CSL Behring (non-profit entity)
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NONE
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NONE
Clinical Procedures or Imaging Studies:
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NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
1. National Institute of Health Research (NIHR). A multicentre randomiSed controlled TRial of IntraVEnous immunoglobulin (IVIg) versus standard therapy for the treatment of transverse myelitis in adults and children. HTA 11/129/148 2014-2018 (Chief Investigator) 2. National Institute of Health Research (NIHR). Intravenous immunoglobulin in the management of encephalitis in children (IGNITE). EME 12/212/15, 2015-2020 (Co-applicant)
Research Support, Academic Entities:
1.
NONE
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1.
NONE
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1.
NONE
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NONE
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NONE
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NONE
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NONE
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NONE
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Mary King, FRCPCH*
From Children's Neurosciences (S.B., M.L.), Evelina London Children's Hospital, Kings Health Partners Academic Health Science Center, UK; Department of Pediatric Neurology (S.B., M.K.), Children's University Hospital, Temple Street, Dublin, Ireland; Department of Statistics (C.W.), Trinity College, Dublin, Ireland; Nuffield Department of Clinical Neurosciences (Y.H., A.V., M.L.), John Radcliffe University Hospital, Oxford, England; Texas Children's Hospital (E.M., J.J., A.S.), Baylor College of Medicine, Houston, TX; Neuroimmunology Group (R.C.D.), Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Australia; and TY Nelson Department of Neurology and Neurosurgery (R.C.D.), Children's Hospital at Westmead, Sydney, Australia.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
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Notes

Correspondence to Dr. Byrne: [email protected]
*
These authors acted as joint senior authors.

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