Acute encephalitis with intrathecal synthesis of measles antibodies

Journal of Neuroimmunology, 20 (1988) 171-172 Elsevier

171

JNI 00710

Acute encephalitis with intrathecal synthesis of measles antibodies H.-J. Sch~dlich 1, A. K a r e n b e r g a, M. N e k i c 1 a n d K. F e l g e n h a u e r Neurologie Clinic of the University of Cologne, 5000 Ki~ln 41, F.R.G., and 2 Neurologic Clinic of the University of GOttingen, 3400 Gi~ttingen, F.R.G. (Received 4 July 1988) (Revised, received 1 August 1988) (Accepted 1 August 1988)

Key words: Encephafitis; Measles antibody, intrathecal synthesis

Introduction

There are three well-defined inflammatory diseases which are characterized by synthesis of measles antibodies de novo within the central nervous system (CNS): subacute sclerosing panencephalitis (SSPE), a chronic progressive disease of children and young adults with an invariable fatal outcome; acute measles encephalitis, a monophasic disease of childhood that follows systemic measles infection; and multiple sclerosis (MS). The locally synthesized immunoglobulins in SSPE and measles encephalitis consist predominantly of measles antibodies. In MS, however, measles antibodies represent only a minor fraction of the intrathecally synthesized IgG and do not form bands in isoelectric focusing.

Patients

We observed two patients with an inflammatory disease of the CNS (Sch~tdlich et al., 1988) as demonstrated by the detection of intrathecally

Address for correspondence: H.-J. Sch~ldlich, Neurologic Clinic of the University of Cologne, Joseph-Stelzmann-StraBe 9, 5000 K~51n 41, F.R.G.

synthesized immunoglobulins (Felgenhauer, 1982). As determined by an enzyme-linked immunosorbent assay (ELISA; Felgenhauer et al., 1985), both had locally produced measles antibodies in their cerebrospinal fluid (CSF). The patients had suffered from measles infections during childhood and the self-limiting course of the present illness was not consistent with SSPE. Since in both cases measles antibodies were related to oligoclonal bands in the CSF, an acute MS seemed very unlikely. It is assumed that CSF antibodies against measles and other neurotropic viruses are 'bystander reactions' of a general immune stimulation (Rostr~Sm, 1981). In a control series of 47 inflammatory (herpes simplex encephalitis 11, neurosyphilis 10, Central European encephalitis 4, mumps meningitis 2, zoster ganglionitis 2, meningoencephalitis of unknown etology 18) and 429 noninflammatory diseases of the CNS, however, no intrathecal synthesis of measles antibodies was detectable. Conclusions

Our observations demonstrate that there exist acute encephalitis cases with an intrathecal synthesis of measles antibodies not related with a systemic measles infection or SSPE. We are aware

0165-5728/88/$03.50 © 1988 Elsevier Science Publishers B.V. (Biomedical Division)

172 that the detection of measles antigens alone i n the C N S would be conclusive for late-onset measles encephalitis. Therefore, further work is necessary to elucidate the etiology a n d pathogenesis of these diseases,

References Felgenhauer, K. (1982) Differentiation of the humoral immune response in inflammatory diseases of the central nervous system. J. Neurol. 228, 223-237.

Felgenhauer, K., Sch~idlich, H.-J., Nekic, M. and Ackermann, R. (1985) Cerebrospinal fluid virus antibodies - - a diagnostic indicator for multiple sclerosis? J. Neurol. Sci. 71, 291-299. RostrSm, B. (1981) Specificity of antibodies in oligoclonal bands in patients with multiple sclerosis and cerebrovascular disease. Acta Neurol. Scand. 63 (Suppl. 86), 4-84. Sch~idlich, H.-J., Karenberg, A., Nekic, M. and Felgenhauer, K. (1988) Acute encephalitis with intrathecal synthesis of measles antibodies. J. Neurol. 235, 248-251.