Seronegative autoimmune autonomic neuropathy: a distinct clinical entity

Elisabeth P. Golden, Meredith A. Bryarly, Steven Vernino

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Purpose: Autoimmune autonomic ganglionopathy (AAG) is associated with ganglionic acetylcholine receptor (gAChR) antibodies. We describe a similar but distinct series of patients with autoimmune autonomic failure lacking this antibody. Methods: Retrospective chart review. Results: Six patients presented with subacute autonomic failure, seronegative for gAChR antibodies. Orthostatic hypotension and gastrointestinal complaints were common. Autonomic testing revealed predominant sympathetic failure and no premature pupillary redilation. All patients had sensory symptoms and/or pain, which was severe in three. Immunotherapy with plasma exchange, intravenous immunoglobulin, and rituximab was ineffective. Three patients responded to intravenous steroids. Conclusion: In these cases of autoimmune autonomic failure, key differences from seropositive AAG emerge. Testing showed prominent sympathetic (rather than cholinergic) failure, specific pupillary findings of AAG were absent, and sensory symptoms were prominent. AAG responds to antibody-targeted immunotherapy, while these patients responded best to steroids. This seronegative autoimmune autonomic neuropathy is a distinct clinical entity requiring a different treatment approach from AAG.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalClinical Autonomic Research
DOIs
StateAccepted/In press - Dec 26 2017

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Antibodies
Cholinergic Receptors
Immunotherapy
Steroids
Orthostatic Hypotension
Plasma Exchange
Intravenous Immunoglobulins
Cholinergic Agents
Pain
Therapeutics
Rituximab

Keywords

  • Autoimmune autonomic ganglionopathy
  • Autonomic neuropathy
  • Autonomic testing
  • Immunotherapy
  • Orthostatic hypotension

ASJC Scopus subject areas

  • Endocrine and Autonomic Systems
  • Clinical Neurology

Cite this

Seronegative autoimmune autonomic neuropathy : a distinct clinical entity. / Golden, Elisabeth P.; Bryarly, Meredith A.; Vernino, Steven.

In: Clinical Autonomic Research, 26.12.2017, p. 1-9.

Research output: Contribution to journalArticle

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