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Autoimmune encephalitis encompasses a spectrum of neurological disorders characterized by an autoimmune response directed against neurons and glia. Around two-thirds of cases exhibit autoantibodies targeting neuronal or glial antigens in the cerebrospinal fluid and/or serum. The diagnosis is based on specific criteria combining a subacute clinical presentation and complementary test results. However, approximately one-quarter of patients do not present any paraclinical abnormalities, making the diagnosis complex. Testing for anti-antibodies is pivotal for diagnosis, and their interpretation should be contextual. Best practices for anti-neural antibody detection involve appropriate sample collection and confirmation of positive results in relation to the clinical picture., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Aging in multiple sclerosis (MS) leads to altered clinical manifestations, where the pathophysiology shifts towards compartmentalized inflammation that drives clinical progression independent of relapse activity. Consequently, the effectiveness of disease-modifying therapies (DMTs) diminishes in older patients, coinciding with an elevated risk of adverse events. This raises the question of whether MS therapies should be discontinued after a certain age, which is often proposed for patients over 55 years. Studies on treatment discontinuation have shown a slight increase in disease activity, yet without significant disability progression. This suggests that the decision to stop DMTs should be discussed with older patients, considering existing comorbidities. Following the cessation of therapy, meticulous monitoring is essential., Competing Interests: Le Dr R. Bernard-Valnet a reçu un soutien pour des congrès et des honoraires pour des présentations de la part de Roche et Novartis et des fonds de recherche de la part de la fondation Novartis (en dehors des sujets traités ici). Le Pr P. Lalive a reçu des honoraires pour des conférences et/ou des frais de déplacement de Biogen, Merck, Novartis et Roche, des honoraires de consultation de Biogen, GeNeuro, Merck, Novartis et Roche, un soutien à la recherche de Roche et Novartis. Aucun n’était lié à ce travail. La Dre M. Théaudin a reçu un soutien pour des congrès et des honoraires pour des présentations et participation à des conseils consultatifs de la part de Biogen, Roche, Sanofi et Novartis. La Pre C. Pot a reçu des honoraires pour des conférences et/ou des frais de déplacement de Biogen, Merck, Novartis et Roche, tous versés au CHUV. Aucun n’était lié à ce travail. Le Pr R. Du Pasquier rapporte que le CHUV a reçu un soutien pour des congrès et des honoraires pour des présentations et participation à des conseils consultatifs de la part de Biogen, Genzyme, Merck, Novartis, Roche et Sanofi. Le Dr G. Breville n’a déclaré aucun conflit d’intérêts en relation avec cet article.

The management of multiple sclerosis (MS) has undergone a veritable revolution in recent years, with the arrival of highly effective treatments. In some cases, therapeutic discussions even precede the first clinical signs of the disease. The aim of this review is to present the therapeutic arsenal of progression-preventing treatments available in 2024 for MS, with anti-CD20 antibodies taking pride of place, also available for certain progressive forms of MS. The use of these immunosuppressants requires in-depth knowledge of their mechanisms of action, in order to understand their risks, such as the occurrence of opportunistic infections., Competing Interests: La Pre C. Pot a reçu des honoraires pour des conférences et/ou des frais de déplacement de Biogen, Merck, Novartis et Roche, tous versés au CHUV. Aucun n’était lié à ce travail. Le Pr R. Du Pasquier rapporte que le CHUV a reçu un soutien pour des congrès et des honoraires pour des présentations et participation à des conseils consultatifs de la part de Biogen, Genzyme, Merck, Novartis, Roche et Sanofi. Le Pr P. Lalive a reçu des honoraires pour des conférences et/ou des frais de déplacement de Biogen, Merck, Novartis et Roche, des honoraires de consultation de Biogen, GeNeuro, Merck, Novartis et Roche, un soutien à la recherche de Roche et Novartis. Aucun n’était lié à ce travail. Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Myasthenia gravis (MG) is an autoimmune disease characterized by fluctuating weakness of skeletal muscles. Despite current treatments, a significant percentage of patients remain symptomatic. This review explores new immunosuppressive therapies and ongoing clinical trials in MG, including depletion of B lymphocytes with agents such as rituximab and inebilizumab, as well as the use of eculizumab, efgartigimod, satralizumab, tocilizumab, and CAR-T (Chimeric Antigen Receptor-T) cell therapy. These advancements aim to improve disease control and patients' quality of life., Competing Interests: La Dre Marie Théaudin a reçu des honoraires pour sa participation à des advisory boards d’Alexion, Argenx et UCB ainsi que des frais de déplacement de la part d’Alexion. La Dre Agustina M. Lascano a reçu des honoraires de ADC therapeutics et d’Alexion pour sa participation à un advisory board et de Sanofi pour une présentation. Le Pr Patrice H. Lalive a reçu des honoraires pour des conférences et/ou des frais de déplacement de Biogen, Merck, Novartis et Roche, des honoraires de consultation de Biogen, GeNeuro, Merck, Novartis et Roche, et un soutien à la recherche de Roche et Novartis. Aucun n’était lié à ce travail. Les autres auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common chronic autoimmune neuropathy. Its management has considerably evolved over the last decade. In 2021, the diagnostic guidelines for CIDP were updated and the diagnostic criteria simplified. They enable better characterization of the electro-clinical phenotype of the disease, and emphasize supportive criteria, in particular neuro-muscular imaging. In terms of pathophysiology, the discovery of antibodies directed against antigens in the nodal and paranodal regions has given rise to the concept of autoimmune nodopathy. Finally, the preliminary results of the ADHERE study on efgartigimod have rekindled hopes of a new, effective therapy for CIDP., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Myelin Oligodendrocyte Glycoprotein Antibody Associated Disease (MOGAD) is an autoimmune disease responsible for demyelination of the central nervous system that can occur in adults or children. Overlapping phenotypes between MOGAD, multiple sclerosis (MS) and neuromyelitis optica spectrum disease (NMOSD) have been described. The diagnostic criteria for MOGAD were proposed by a panel of international experts and published in 2023. Defining clinical, biological and imaging characteristics specific to this entity helps to improve diagnostic specificity. In this article, we present the clinical characteristics suggestive of MOGAD and discuss the importance of the antibody detection method and therapeutic management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Acute encephalopathy is one of the most frequent neurological complication in patients hospitalized for COVID-19. Electrolyte imbalance, drugs, and hypoxemia can all affect brain homeostasis, leading to acute cognitive dysfunction and direct implications of the SARS-CoV-2 are not completely understood. Neurological complications of SARS-CoV-2 infection are poorly understood: an inflammatory insult to the endothelium affecting the blood-brain barrier may explain the clinical presentation, but other hypotheses including direct viral damage or an immune-mediated reaction are also suggested. Among these various potential mechanisms, often combined, the controversy remains., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Small fiber neuropathy (SFN) causes damage to small-calibre nerve fibers (unmyelinated C fibers and myelinated A-delta fibers). The symptoms of SFN usually are sensitive including paresthesia, dysesthesia or burning pain, and protopathic deficits, sometimes associated with dysautonomia. The causes of SFN can be classified in six main groups: idiopathic, toxic, metabolic, immunological, infectious and hereditary. In this article, we present the diagnostic approach to SFN, the most common autoimmune aetiologies, as well as elements of their therapeutic management., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Autoimmune neurological diseases involve a broad spectrum of diseases that may affect the central or peripheral nervous system, the neuromuscular junction and the muscle. The risk of vaccinating a patient with an autoimmune neurological disease frequently arises in view of fears, often scientifically unfounded, to reactivate the immune system and cause or aggravate the disease. The questions should also include the risks of not vaccinating a patient, and particularly the risk of the disease getting worse in case of infection that could have been potentially prevented by vaccination. Finally, the danger of not vaccinating an immunosuppressed patient must also be taken into account (increased infectious risk)., Competing Interests: L’auteurs n’a déclaré aucun conflit d’intérêts en relation avec cet article.

Paraneoplastic neurological syndromes are a group of neurological syndromes secondary to an underlying malignancy. Associated autoantibodies can be classified according to the cellular localization of the antigen target. Onconeuronal autoantibodies (targeting intracellular antigens) strongly associate with cancer and the response to immunotherapy is often disappointing. Identifying and treating the underlying malignancy is a high priority. However, immunomodulation can provide a favourable outcome for neurological symptoms associated with autoantibodies specific for cell membrane antigens. An early recognition of these disorders following the triad "clinical neurological syndrome--specific autoantibodies--tumour research" is important so that patients can benefit from appropriate targeted treatments.

In Switzerland, medical cannabinoids can be prescribed under compassionate use after special authorization in justified indications such as refractory pain. Evidence of efficacy in pain is limited and the clinical benefit seems to be modest. Their drug-drug interactions (DDI) profile is poorly documented. Cytochromes P450 (CYP) 2C9 and 3A4 are involved in the metabolism of tetrahydrocannabinol and cannabidiol, which implies possible DDI with CYP450 inhibitor and inducer, such as anticonvulsivants and HIV protease inhibitors, which may be prescribed in patients with neuropathic pain.

"What are you doing today? I'm suffering." So expressed himself Alphonse Daudet the French writer. The pain he had gave him the spirit when he wrote a text entitled "La Doulou" a word from the South of France meaning "The pain". Speaking about pain requires listening to suffering patients. Many of them can be good observers and describe pain deeply and subtly. This paper covers the clinical approach of pain in MS patients. Can pain be the first sign of MS, are they frequent, what are their specific properties, how do we classify them, how do we recognize them to alleviate the burden of pain. These are the daily questions we ask as neurologists, while running neurological examination and listening to each patient. Gathered information will hopefully help you to find an appropriate answer for each patient.

Myasthenia gravis (MG) is an autoimmune disease of the neuromuscular junction, due to the binding of autoantibodies to the nicotinic acetylcholine receptor (AChR), or more rarely to a muscle specific kinase (MuSK). It affects most of the time young women and old patients, with a tendency toward increasing incidence and prevalence. Clinical presentation, with fluctuating weakness of ocular, facial and bulbar muscles has a wide range of severity. Evolution is characterized by remissions and exacerbations. The goal of treatment is a complete remission, which implies a sustained collaboration between the general practitioner and the specialized centre and the use of symptomatic treatment (anticholinesterasic) in association with immunomodulators/suppressors (prednisone and azathioprine); although other treatments are available.