Biochemical markers of autoimmune diseases of the nervous system.
ABSTRACT Biochemical biomarkers are important candidates for the diagnosis and prognosis of neurological diseases of autoimmune etiology, since they may reflect the presence, nature and intensity of certain immune responses caused by both genetic and environmental processes. Different body fluids such as cerebrospinal fluid (CSF), serum, urine, and tears have been used to identify useful biomarkers. Autoimmune neurological diseases associated with pathology of cell surface structures such as myasthenia gravis, Lambert-Eaton myasthenic syndrome, neuromyotonia, stiff person syndrome, limbic encephalitis, Guillain-Barré syndrome (GBS), and neuromyelitis optica (NMO) are amenable to serum antibody tests which can be used to support the diagnosis. In several of these disorders, new specific autoantibodies have been detected that are directed against proteins complexed with potassium channels in both the central and peripheral nervous system such as contactin-2 associated protein (Caspr2) or the protein leucine-rich, glioma-inactivated 1 (LGI1). Recently, a number of central nervous system disorders like limbic encephalitis and multiple sclerosis (MS) have also been associated with the presence of specific serum autoantibodies. In MS and GBS CSF analysis is still essential to support the diagnosis and to rule out other diseases. We provide an overview over the widening field of autoimmune diseases of the central and peripheral nervous system and discuss the current state of biomarker research and its relevance for clinical practice.
Article: Brain biomarkers and management of uncertainty in predicting outcome of cardiopulmonary resuscitation: a nomogram paints a thousand words.[show abstract] [hide abstract]
ABSTRACT: AIM: Use of brain biomarkers for predicting death after cardiopulmonary resuscitation (CPR) is limited by a research focus on the discriminative ability of each biomarker and ethical/cultural controversy concerning the likelihood of misclassification of potential survivors. We illustrate an approach to address these limitations by creating a dynamic nomogram with four levels of sensitivity (0.8, 0.9, 0.95 and 1.0) selected to represent different degrees of certainty in correct identification of survivors. METHODS: A prolective observational study conducted in a single 850-bed hospital. Admission serum S100beta (S100B) and neuron-specific enolase (NSE) were determined for all adult survivors of non-traumatic out-of-hospital arrest and CPR. RESULTS: 158 patients were included, 126 (80%) died in hospital, 32 (20%) survived. Non-survivors had higher admission biomarker levels than survivors (p≤0.001 for both S100B and NSE). Presenting rhythm (VT/VF vs. other) and logarithmic-transformed S100B and NSE levels were statistically significant in the multivariable model predicting survival. The area under the model ROC curve was 0.868 (95%CI 0.80, 0.936). Plots for predicting survival for each combination of biomarker levels were generated for each sensitivity with and without VT/VF, allowing clinicians to select their option in terms of survival probability. In this modest-sized illustrative study there were no model misclassifications for patients with Cerebral Performance Category 1-2 for sensitivity >0.95. CONCLUSIONS: We demonstrate how brain biomarkers can serve as decision support tools after CPR despite ethical/cultural differences in defining futility. Data from larger and diverse samples are required for stable estimates prior to clinical implementation of such a tool.Resuscitation 02/2013; · 3.60 Impact Factor