Movement disorders in autoimmune diseases

Abstract

Movement disorders have been known to be associated with a variety of autoimmune diseases, including Sydenham's chorea, pediatric autoimmune neuropsychiatric disorders associated with streptococcus, systemic lupus erythematosus, antiphospholipid syndrome, gluten sensitivity, paraneoplastic and autoimmune encephalopathies. Tremors, dystonia, chorea, ballism, myoclonus, parkinsonism, and ataxia may be the initial and even the only presentation of these autoimmune diseases. Although antibodies directed against various cellular components of the central nervous system have been implicated, the pathogenic mechanisms of these autoimmune movement disorders have not yet been fully elucidated. Clinical recognition of these autoimmune movement disorders is critically important as many improve with immunotherapy or dietary modifications, particularly when diagnosed early. We discuss here the clinical features, pathogenic mechanisms, and treatments of movement disorders associated with autoimmune diseases, based on our own experience and on a systematic review of the literature.

Efficacy of high dose methylprednisolone in a patient with cervical dystonia and blepharospasm and Sjögren’s syndrome

“…Sjogren's syndrome (SS) is an autoimmune disorder characterised by lymphocytic infiltration and destruction of the salivary and lacrymal glands leading to xerostomia and xerophthalmia. Neurological complications have been reported in approximately 1.5-25 % of patients with SS, however, movement disorders like parkinsonism, chorea and dystonia are infrequent [1]. We herein report a patient with blepharospasm and cervical dystonia associated to primary SS.…”

“…As already reported, in SS central nervous system damage could be attributed to vasculitis or direct autoimmune damage to the neural tissue [4]. While proven cases of either primary CNS vasculitis or of CNS vasculitis in the context of systemic vasculitides nearly always result in abnormalities of brain/spinal cord imaging by MRI, antibody-mediated damage may result in CNS dysfunction without apparent morphological abnormalities; this is the case for some systemic lupus erythematosus-related and SS-related neurological complications such as lateralized parkinsonism, chorea or ballism [1].…”

“…A variety of movement disorders have been described in patients with SS but its have been reported very rarely [1]. Only six cases of dystonia associated with SS have been reported in the literature ( Table 1).…”

Gluten chorea

“…Celiac disease (CD) is an autoimmune enteropathy triggered by dietary gluten. Ten percent of these patients will have neurological symptoms [2,3], mainly ataxia and peripheral neuropathy [2,4], even in the absence of intestinal involvement [4]. Chorea has seldom been reported.…”

“…Chorea is a clinical syndrome that comprises several causes [1], including autoimmune disorders such as Sydenham's chorea, systemic lupus erythematosus, antiphospholipid antibody syndrome or paraneoplastic conditions [1,2]. Celiac disease (CD) is an autoimmune enteropathy triggered by dietary gluten.…”