Objective: Here we present the unique case of a female patient with GTS, who not only exhibited intrathecal antibody synthesis documented by positive OCBs, but in addition received IVIg for the treatment of an unrelated Guillain-Barré like immune-mediated neuropathy. Based on the hypothesis that positive OCBs might serve as a biomarker not only for an involvement of the immune system in GTS, but also for successful treatment of tics, we were interested in whether her tics might improve after IVIg treatment.

Background: Gilles de la Tourette syndrome (GTS) is a neuropsychiatric disorder characterized by tics. There are several hypotheses as to the cause GTS, one of which suggests that immune system is involved in the pathophysiology of GTS.

Method: Here, we present a 40 years old female patient with a typical history and clinical examination of GTS with tics and psychiatric comorbidities, in whom positive oligoclonal bands (OCB) type 2 in cerebral spinal fluid (CSF) were detected in an earlier study.

Results: In the earlier study, all other investigations were unremarkable (including neurological examination and cMRI), but later, she presented with further neurological symptoms including tetraparesis mostly affecting the left limbs, distal hypesthesia and paresthesia, and dyspnea. Since further examinations (including EMG, MRI, CSF, virological and bacteriological tests as well as autoimmune-encephalitis antibodies) revealed normal results, based on clinical presentation, the diagnosis of Guillain-Barré-like immune-mediated neuropathy was made and treatment with intravenous immunoglobulins (IVIg) (30g/day for 5 days) was initiated. IVIg treatment resulted in a complete remission of immune-mediated neuropathy.
Based on the “immune hypothesis” of GTS, we were interested in whether in this patient positive CSF OCBs might serve as a biomarker for treatment response to IVIg, and therefore assessed tics, premonitory urges and psychiatric comorbidities before and several times after IVIg treatment. However, even though immune-mediated neuropathy resolved after treatment, tics, premonitory urges and comorbidities remained unchanged.

Conclusion: Thus, this case study suggests that treatment with IVIg is partially effective in the treatment of GTS – even in a patient with intrathecal antibody synthesis as expressed by CSF isolated OCBs.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/intravenous-immunoglobulin-treatment-did-not-improve-tics-in-a-patient-with-gilles-de-la-tourette-syndrome-and-intrathecal-antibody-synthesis/