Anti-ganglionic acetylcholine receptor antibodies in functional neurological symptom disorder/conversion disorder

Ryusei Nagata; Eiji Matsuura; Satoshi Nozuma; Mika Dozono; Yutaka Noguchi; Masahiro Ando; Yu Hiramatsu; Daisuke Kodama; Masakazu Tanaka; Ryuji Kubota; Munekazu Yamakuchi; Yujiro Higuchi; Yusuke Sakiyama; Hitoshi Arata; Keiko Higashi; Teruto Hashiguchi; Shunya Nakane; Hiroshi Takashima

doi:10.3389/fneur.2023.1137958

Anti-ganglionic acetylcholine receptor antibodies in functional neurological symptom disorder/conversion disorder

Front Neurol. 2023 Feb 13:14:1137958. doi: 10.3389/fneur.2023.1137958. eCollection 2023.

Authors

Ryusei Nagata¹, Eiji Matsuura¹, Satoshi Nozuma¹, Mika Dozono¹, Yutaka Noguchi¹, Masahiro Ando¹, Yu Hiramatsu¹, Daisuke Kodama², Masakazu Tanaka², Ryuji Kubota², Munekazu Yamakuchi³, Yujiro Higuchi¹, Yusuke Sakiyama¹, Hitoshi Arata¹, Keiko Higashi¹, Teruto Hashiguchi³, Shunya Nakane⁴, Hiroshi Takashima¹

Affiliations

¹ Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
² Division of Neuroimmunology, Joint Research Center for Human Retrovirus Infection, Kagoshima University, Kagoshima, Japan.
³ Department of Laboratory and Vascular Medicine, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
⁴ Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.

Abstract

Objective: Autoimmune autonomic ganglionopathy (AAG) is a rare disorder characterized by autonomic failure associated with the presence of anti-ganglionic acetylcholine receptor (gAChR) antibodies; however, several studies have reported that individuals with anti-gAChR antibodies present with central nervous system (CNS) symptoms such as impaired consciousness and seizures. In the present study, we investigated whether the presence of serum anti-gAChR antibodies correlated with autonomic symptoms in patients with functional neurological symptom disorder/conversion disorder (FNSD/CD).

Methods: Clinical data were collected for 59 patients presenting with neurologically unexplained motor and sensory symptoms at the Department of Neurology and Geriatrics between January 2013 and October 2017 and who were ultimately diagnosed with FNSD/CD according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Correlations between serum anti-gAChR antibodies and clinical symptoms and laboratory data were analyzed. Data analysis was conducted in 2021.

Results: Of the 59 patients with FNSD/CD, 52 (88.1%) exhibited autonomic disturbances and 16 (27.1%) were positive for serum anti-gAChR antibodies. Cardiovascular autonomic dysfunction, including orthostatic hypotension, was significantly more prevalent (75.0 vs. 34.9%, P = 0.008), whereas involuntary movements were significantly less prevalent (31.3 vs. 69.8%, P = 0.007), among anti-gAChR antibody-positive compared with -negative patients. Anti-gAChR antibody serostatus did not correlate significantly with the frequency of other autonomic, sensory, or motor symptoms analyzed.

Conclusions: An autoimmune mechanism mediated by anti-gAChR antibodies may be involved in disease etiology in a subgroup of FNSD/CD patients.

Keywords: LIPS; antibody; autonomic symptoms; conversion disorder; functional neurological symptom disorder; ganglionic acetylcholine receptor.