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@ARTICLE{Endres:280055,
      author       = {Endres, Dominique and von Zedtwitz, Katharina and Rau,
                      Alexander and Feige, Bernd and Mast, Hansjörg and Maier,
                      Alexander and Reisert, Marco and Nickel, Kathrin and
                      Brumberg, Joachim and Boettler, Tobias and Glaser, Cornelia
                      and Venhoff, Nils and Urbach, Horst and Baldermann, Juan C
                      and Domschke, Katharina and Tebartz van Elst, Ludger and
                      Hannibal, Luciana and Prüss, Harald and Maier, Simon J},
      title        = {{A}ssociation of {ADHD} symptoms, pain, and tics with
                      anti-thalamus antibodies in cerebrospinal fluid.},
      journal      = {Journal of neuroimmunology},
      volume       = {406},
      issn         = {0165-5728},
      address      = {Amsterdam [u.a.]},
      publisher    = {Elsevier Science},
      reportid     = {DZNE-2025-00892},
      pages        = {578654},
      year         = {2025},
      abstract     = {Complex mixed presentations of severe mental disorders
                      (SMD) with treatment resistance pose major challenges in
                      clinical practice. The role of novel neuronal antibodies in
                      cerebrospinal fluid (CSF) is largely unexamined in this
                      context.A well-studied paradigmatic case of a 36-year-old
                      female patient is reported.She presented with
                      attention-deficit/hyperactivity disorder-like symptoms
                      (including frequent sensory overload), severe pain
                      (pre-diagnosed as fibromyalgia and somatoform pain
                      disorder), and motor tics. In addition, she developed
                      secondary depressive symptoms. Various psychopharmacological
                      treatment attempts were unsuccessful or not tolerated. The
                      diagnostic routine work-up with a wide range of blood tests,
                      electroencephalography (EEG), routine magnetic resonance
                      imaging (MRI), cerebrospinal fluid (CSF) analyses, and
                      [18F]fluorodeoxyglucose positron emission tomography
                      revealed no clear pathological findings. Tissue-based assays
                      using CSF material found strong immunoglobulin G antibody
                      staining specifically directed against a cell population in
                      the thalamus. Neurotransmitter measurements detected low
                      GABA, glutamate and serotonin concentrations as well as high
                      dopamine levels in the CSF. Different MRI-based analyses
                      indicated no neurostructural alterations in the thalamus;
                      however, left mesiotemporal volume loss was identified. The
                      independent component analysis of the EEG showed left
                      temporal theta waves, partly resembling
                      spike-wave-complexes. Immunotherapy using high-dose steroids
                      resulted in a partial improvement with subjectively reduced
                      stimulus overload, intermediate disappearance of pain, and
                      fewer tics. The improvement could not be objectified
                      psychometrically/neuropsychologically. The mesiotemporal
                      volume loss was no longer present. There were no relevant
                      changes in further research MRI measurements of the thalamus
                      including arterial spin labeling, diffusion tensor imaging,
                      and diffusion microstructure imaging from pre to
                      post-immunotherapy.Novel antibodies against strategic brain
                      structures, such as the thalamus, might be associated with
                      some complex SMD. Further immunopsychiatric research in this
                      direction holds promise for a better understanding of
                      similar patients.},
      keywords     = {Humans / Female / Adult / Attention Deficit Disorder with
                      Hyperactivity: cerebrospinal fluid / Attention Deficit
                      Disorder with Hyperactivity: complications / Attention
                      Deficit Disorder with Hyperactivity: immunology / Attention
                      Deficit Disorder with Hyperactivity: diagnostic imaging /
                      Pain: cerebrospinal fluid / Pain: complications / Pain:
                      diagnostic imaging / Pain: immunology / Autoantibodies:
                      cerebrospinal fluid / Thalamus: immunology / Thalamus:
                      diagnostic imaging / Tics: cerebrospinal fluid / Tics:
                      complications / Tics: diagnostic imaging / Tics: immunology
                      / Autoimmune (Other) / Brain (Other) / Immunotherapy (Other)
                      / Inflammation (Other) / Tourette (Other) / Autoantibodies
                      (NLM Chemicals)},
      cin          = {AG Prüß},
      ddc          = {610},
      cid          = {I:(DE-2719)1810003},
      pnm          = {353 - Clinical and Health Care Research (POF4-353)},
      pid          = {G:(DE-HGF)POF4-353},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40617165},
      doi          = {10.1016/j.jneuroim.2025.578654},
      url          = {https://pub.dzne.de/record/280055},
}