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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},
}