P-1029 - Anti basal ganglia autoimmunity: OCD and movement disorder associated with anti neuron specficic enolase and anti pyruvate kynase autoantibodies

Abstract

We describe a case of OCD and movement disorders associated with anti basal ganglia antibodies. A 17 year old patient was referred to our unit in February 2010 because of movement disorder. He denied personal or family history of psychiatric disorders and substance abuse other that occasional cannabis use. His symptoms had began 6 months earlier when he started presenting intrusive thoughts associated with various compulsions such as complex arm and leg movements and bizarre postures: he was treated with Olanzapine and Sertraline which lead to partial improvement of symptoms but he self-discontinuated the medication in january 2010. Upon admittance in february 2010 the patient showed obsessive thoughts associated with bizarre postures and upper limb complex movements. He was treated with 100 mg of Clomipramine which lead to partial regression of symptoms. Autoimmunity screening was performed revealing anti neuron specific enolase and anti pyruvate kynase antibodies. The patient was treated with Desametasone which did not lead to any improvement. Anti neuron specific enolase and anti pyruvate kynase antibodies are directed against antigens specifically expressed in the basal ganglia. According to literature data these autoantibodies can be associated with movement disorders and OCD and we hypothesize that our patient's symtptoms were caused by autoimmunity. Although cortison was not successfull, recents reports in scientific literature have shown that other non psychopharmacological treatment, such as plasmapheresis, or IV immunoglobulins could be effective in similar patients: we are considering this as our next treatment option.