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Antiglycine-receptor encephalomyelitis with rigidity
  1. Natalia Mas1,
  2. Albert Saiz1,
  3. Maria Isabel Leite2,
  4. Patrick Waters2,
  5. Manuel Baron3,
  6. Dolores Castaño4,
  7. Lidia Sabater1,
  8. Angela Vincent2,
  9. Francesc Graus1
  1. 1Service of Neurology, Hospital Clínic and Institut d' Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  2. 2Department of Clinical Neurosciences, Weatheral Institut of Molecular Medicine, John Radcliffe Hospital, Oxford, UK
  3. 3Service of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
  4. 4Service of Neurology, Hospital Sant Joan D'Alacant, Alicante, Spain
  1. Correspondence to Dr Francesc Graus, Servei de Neurologia, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain; fgraus{at}clinic.ub.es

Abstract

Background Glycine receptor antibodies (GlyR-ab) were reported in a patient with progressive encephalomyelitis with rigidity and myoclonus (PERM).

Methods Three additional patients were clinically described. GlyR-ab was detected with a cell-based assay of HEK293 cells transfected with the α1 subunit of the GyR.

Results A 33-year-old woman presented with diplopia, dysphagia and gait ataxia that improved in 5 weeks. Then, she developed a typical stiff-person syndrome (SPS) that resolved with corticosteroids, but relapsed 17 months later with a stiff limb syndrome. After treatment with intravenous immunoglobulins (IVIG), she has been asymptomatic for 8 years. A 60-year-old man developed, dysphagia, diplopia, left facial palsy and right trigeminal hypoaesthesia in a few days, followed by muscular rigidity, corticospinal signs, myoclonic jerks and severe dysautonomia. He developed seizures and suffered a cardiac arrest that left him in a persistent vegetative state. A 48-year-old man presented with leg rigidity and frequent spells of trismus, muscle spasms followed by opisthotonus and diaphoresis. The symptoms were antedated by pruritus of the left scapulae, right arm and T11–T12 dermatome. At the same time he became progressively more aggressive with emotional irritability. He also developed dysgeusia (metallic taste) and severe concurrent behavioural changes and diurnal hypersomnia. Only the rigidity and the spasms improved after therapy.

Conclusions The clinical picture associated with GlyR-ab is wider than the classical view of PERM. GlyR-ab should be examined in patients with core symptoms of muscle rigidity and spasms atypical for SPS.

  • Autoantibodies
  • encephalomyelitis
  • glycine receptor
  • stiff-person syndrome
  • clinical neurology
  • neuroimmunology
  • stiff man syndrome

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Footnotes

  • Funding Supported in part by grants PI030028 Fondo de Investigaciones Sanitarias, Madrid, Spain (FG).

  • Competing interests AV and the Department of Clinical Neurology in Oxford receive royalties and payments for antibody assays.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Hospital Clínic.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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