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Abstract Details

Ma2 paraneoplastic limbic encephalitis: Examination of potential prognostic factors and effects of various immunotherapeutic approaches
Autoimmune Neurology
P12 - Poster Session 12 (12:00 PM-1:00 PM)
15-004

To re-examine the prognostic factors for clinical outcome in Ma2 paraneoplastic limbic encephalitis (PNS).

Earlier studies suggested that some factors may be associated with a favorable clinical outcome in Ma-PNS. Those included male gender, younger age, limited CNS involvement, testicular tumors with complete treatment response, and absence of concurrent anti-Ma1 antibodies.  However, several recently published case studies have described poor outcomes despite the presence of some favorable prognostic factors. Furthermore, the effects of immune-suppressive treatments, including systemic corticosteroids, on outcome remain unknown.
We searched PubMed and Google Scholar for case studies on Ma2-PNS published between 2001 and February 2019. We included articles in the English and Japanese languages. We extracted and analyzed several variables in relation to clinical outcome (improved, stabilized or worsened). Variables of interest included age, gender, predominant symptoms, cerebrospinal fluid results, MRI findings, concurrent antibodies, and the use of immune-suppressive treatment. Differences between clinical outcome groups were examined using ANOVA and Fisher’s exact test. A multivariable model was conducted using logistic regression with stepwise BIC selection criteria to examine factors associated with clinical outcome (improved/stabilized vs worsened).

We identified 55 cases of Ma2-PNS (34 [61.8%] male), mean age (SD) of 51.6(18.6) years. Out of 55 patients, 11 had no an associated tumor or co-morbid autoimmune condition. The most common neoplasms identified were testicular (n=17), lung (n=7), breast (n=4), lymphoma (n=3), and gynecologic (n=3). Clinical outcome was not reported for 5 patients and was associated univariately with age (p=0.021) and MRI enhancement (p=0.007). None of the examined variables in our multivariate model predicted the clinical outcome.
Our independent analysis of published cases of Ma2-PNS failed to detect meaningful prognostic factors for clinical outcomes, including immune-suppressive treatments. Future studies of the exact mechanism of CNS damage in MA2-PNS may help identify effective therapeutic targets to improve clinical outcomes.
Authors/Disclosures
Mohammad Aladawi, MD
PRESENTER 		Dr. Aladawi has nothing to disclose.
Amber Salter, PhD (UT Southwestern Medical Center) Dr. Salter has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Gryphon Bio. Dr. Salter has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Abata Therapeutics. Dr. Salter has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sora Neuroscience. Dr. Salter has stock in Owl Therapeutics. The institution of Dr. Salter has received research support from National Multiple Sclerosis Society. The institution of Dr. Salter has received research support from Department of Defense Congressionally Directed Medical Research Program. The institution of Dr. Salter has received research support from Consortium of Multiple Sclerosis Centers.
Michelle Maynard, PharmD (Froedtert Neurosciences Clinic) Dr. Maynard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for TG Therapeutics. Dr. Maynard has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Maynard has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for EMD Serono.
Ahmed Z. Obeidat, MD, PhD (Medical College of Wisconsin) Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Alexion. Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Bristol Myers Squibb. Dr. Obeidat has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Genentech. Dr. Obeidat has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for EMD Serono. Dr. Obeidat has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi/Genzyme . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Horizon pharmaceuticals . Dr. Obeidat has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Sandoz. Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for TG Therapeutics. Dr. Obeidat has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Alexion. Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Biogen. Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Bristol Myers Squibb. Dr. Obeidat has received personal compensation in the range of $100,000-$499,999 for serving on a Speakers Bureau for EMD Serono. Dr. Obeidat has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Banner life sciences . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Sanofi/genzyme. Dr. Obeidat has received personal compensation in the range of $50,000-$99,999 for serving on a Speakers Bureau for Horizon therapeutics . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Amgen. Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for TG Therapeutics . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for AstraZeneca. The institution of Dr. Obeidat has received research support from NIH. The institution of Dr. Obeidat has received research support from NMSS and PCORI. Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Expert opinion and key opinion leader with MJH life sciences . Dr. Obeidat has received personal compensation in the range of $10,000-$49,999 for serving as a Faculty Speaker with CMSC. Dr. Obeidat has a non-compensated relationship as a Board member with CMSC that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Obeidat has a non-compensated relationship as a Editorial Board Member with IJMSC that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Obeidat has a non-compensated relationship as a Reviewer Editor with Frontiers Neurology that is relevant to Â鶹´«Ã½Ó³»­ interests or activities. Dr. Obeidat has a non-compensated relationship as a Board of Trustee Member with National MS Society that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.