Autoimmune Neurology

Stacey L. Clardy, MD, PhD

In this issue of Seminars in Neurology, the authors and I have tried to focus on the practical issues of management and treatment of the growing number of syndromes encompassed within the specialty of autoimmune neurology. This issue is designed to provide readers with an overview of topics across a broad spectrum of autoimmune and paraneoplastic neurologic disease. In years past, the topic of antibody-mediated neurologic disease was often covered within the neurologic complications of cancer issues, but the rapid discovery of new autoantibodies (some with infrequent cancer association) has necessitated an entire issue dedicated to these disorders. Given the tremendous growth in not only the number of newly identified antibodies, but also the increasing clinical recognition of immune-mediated neurologic disorders and the availability of effective immunotherapy, there are now large numbers of patients who require specialized treatment of these autoimmune neurologic disorders. From this clinical need has arisen the clinical subspecialty of autoimmune neurology—and another generation of physicians and researchers who aspire to continue to advance the field as they stand on the shoulders of so many legendary giants in neuro-oncology and neuroimmunology. I have intentionally asked many young faculty members to be authors for two reasons: (1) to share the modern approach of the practice of autoimmune neurology and (2) to allow each of us to intentionally delve into the vast literature of existing knowledge painstakingly produced by our mentors, so that it can inform our ideas and strategies going forward.

In addition to focused subspecialty overviews, we have highlighted areas of general relevance throughout this issue, including when to suspect an immune-mediated etiology of neurologic symptoms, common disease mimics of these conditions, and several rational diagnostic and treatment approach algorithms. Authors discuss the cancer associations, as relevant, to each syndrome, and also the pathophysiologic and treatment implications of cell surface, synaptic, and intracellular antigen targets. These disorders can be complex and difficult to diagnose, and often will require a collaborative effort between many health care providers. Prompt diagnosis with institution of symptomatic and definitive therapies can positively impact the patient's quality of life and survival.

The goal of this issue is twofold: to provide a comprehensive yet succinct overview of autoimmune neurologic disease, and to outline a practical approach to the diagnosis and treatment of patients with suspected or confirmed immune-mediated neurologic disease. I hope that the readers of this issue of Seminars in Neurology find the chapters beneficial in their scientific work and clinical practice. It is an honor and a pleasure to be the guest editor of this issue of Seminars in Neurology, and I thank the authors for their contributions. I'd also like to thank David M. Greer for inviting me to guest edit this issue of Seminars in Neurology—he is wonderfully supportive, especially of junior faculty. I'd like to also thank my husband, Tom, and our daughters Annamaria and Cecilia. I am also grateful for the ongoing research support of the Transverse Myelitis Association, the Western Institute for Biomedical Research, and Barbara Gural Steinmetz Family.