Autoimmune meningoencephalitis associated with GFAP IgG antibodies.

Fung B et al.  Autoimmune glial fibrillary acidic protein astrocytopathy: a novel meningoencephalomyelitis.  JAMA Neurol 2016; 73: 1297.

Mayo labs has 134 cases out of 100,000 evaluated for autoimmune and paraneoplastic ab's as part of routine care.  Clinical presentation consists of headache, confusion, behavioral changes, lethargy, blurred vision, and trouble walking.  Exam can show papillitis, CN palsies, myelopathy.  CSF can show pleocytosis, highprotein, OCB'sm high IgG index.  MRI can show leptomeningeal enhancement, gyral enhancement.  At least half relapsed despite corticosteroids.  6/16 developed cancers

Steroid sparing therapy in neurosarcoidosis

Neurology 2016; 13:87:2517 Uncontrolled study of 40 patients with neurosarcoidosis, both central and peripheral nerve.  32 got MTX 20 mg per week, 14 got mycophenolate (MMF) at 2 grams per day (median) 6 had both drugs successively.  In MTX group, 15/32 (46 percent) relapsed v. 11/14 (79 %) in MMF group.  Median survival without relapse was 28 months in MTX group, 11 month in MMF group.  Of note steroid dose at initiation was 40 mg po daily in MTX group, and 20 mg in MMF group, a potential confound.  Both groups had high rates of relapse and better steroid sparing drugs are needed.