A patient presented to the Walton Centre for Neurology and Neurosurgery (WCNN) with non-specific fatigue. A voltage gated potassium channel (VGKC) antibody assay was requested, among other investigations. A titre of 0.151 (normal range: 0–0.1 nmol/l) was detected and subsequent CT) of chest showed a thymoma. This led us to ask the following question: What is the clinical spectrum and incidence of malignancy in positive VGKC antibody patients? We performed a retrospective analysis of patients with positive VGKC antibodies from WCNN between 2001 and 2009 (n=52). Limbic Encephalitis (LE) was seen in 20% (n=10), and Peripheral Nerve Hyperexcitibility (PNH) in 33% (n=17). No cases of Morvan's syndrome were identified. Other associations included Guillain–Barre Syndrome, Chronic Inflammatory Demyelinating Polyneuropathy, Non-Epileptic Attack Disorder, Relapsing Remitting Multiple Sclerosis (RRMS), Primary Lateral Sclerosis, Chronic Regional Pain Syndrome, and an akinetic rigid syndrome. Titres >0.4 nmol/l were detected in 15 patients; PNH (n=5), LE (n=9), RRMS (n=1). Overall five malignancies were detected (10%); thymoma (n=2), small cell carcinoma lung (n=1), astrocytoma (n=1), and prostatic adenocarcinoma (n=1). The clinical spectrum is intriguing, but raises the question of whether testing was appropriate in all cases. This study highlights the importance of correlating clinical context with VGKC antibody testing.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.