Article Information
Accepted for Publication: September 22, 2022.
Published Online: November 28, 2022. doi:10.1001/jamaneurol.2022.4251
Open Access: This is an open access article distributed under the terms of the
CC-BY License. © 2022 Flanagan EP et al.
JAMA Neurology.
Author Contributions: Dr Flanagan had full access to all of the data in the study and takes responsibility
for the integrity of the data and the accuracy of the data analysis. These authors
contributed equally: Drs Geschwind, Irani, and Vernino.
Concept and design: Flanagan, Lopez Chiriboga, Blackburn, Gelfand.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Flanagan, Lopez Chiriboga, Rodenbeck, Solomon, Irani.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Flanagan.
Administrative, technical, or material support: Lopez Chiriboga, Blackburn, Binks, Zitser, Vernino, Irani.
Supervision: Flanagan, Geschwind, Vernino, Irani.
Conflict of Interest Disclosures: Dr Flanagan has served on advisory boards for Alexion, Genentech, UCB, and Horizon
Therapeutics outside the submitted work; has a patent for DACH1-IgG as a biomarker
of paraneoplastic autoimmunity pending; has received speaker honoraria from Pharmacy
Times; has received royalties from UpToDate; was a site primary investigator in a
randomized clinical trial on inebilizumab in neuromyelitis optica spectrum disorder
run by Medimmune/Viela-Bio/Horizon Therapeutics; has received funding from the National
Institutes of Health (grant R01NS113828); is a member of the medical advisory board
of the MOG project; and is an editorial board member of the Journal of the Neurological
Sciences and Neuroimmunology Reports. Dr Geschwind reported grants from the National
Institute on Aging (grants R01 AG031189, R56 AG055619, and R01 AG062562) and research
support from Michael J. Homer Family Fund during the conduct of the study; personal
fees from MedConnect Pro LLC Medical Legal, Clarion, Blade Therapeutics, Clearview
Healthcare Partners, LifeSci Capital LLC, Ascel Health LLC, Teledoc Health Inc, Microvention
Terumo, Reata Pharmaceuticals, Wolters Kluwer, Maupin Cox, Wallace & Milsap LLC, Trinity
Partners LLC, Anderson Boutwell Traylor, and Adept Field; nonfinancial support from
Ionis Pharmaceuticals; has consulted for Best Doctors Inc, Biohaven Pharma Inc, Bioscience
Pharma Partners, LLC, First Thought Consulting, Grand Rounds Inc/UCSF Second Opinion
Inc, Quest Diagnostics, and Smith & Hennessey LLC; has received speaking honoraria
from Oakstone Publishing; has received research support from Alliance Biosecure, CurePSP,
the Tau Consortium, Quest Diagnostics, and the National Institutes of Health; and
serves on the board of directors for San Francisco Bay Area Physicians for Social
Responsibility and on the editorial board of Dementia & Neuropsychologia. Dr Lopez-Chiriboga
has served on advisory boards for Genentech and Horizon Therapeutics. Dr Blackburn
reported personal fees from Genentech, grants from Siegel Rare Neuroimmune Association
outside the submitted work. Dr Binks reported grants from Wellcome Trust during the
conduct of the study and had a patent for Ref. JA94536P.GBA pending (diagnostic strategy
to improve specificity of CASPR2 antibody detection). Dr Gelfand reported grants from
Genentech/Roche for research support to University of California, San Francisco for
clinical trials; service on trial steering committees and grants from Vigil Neuroscience
for research support to University of California, San Francisco for clinical research
study; and personal fees from Biogen for consulting outside the submitted work. Dr
Day reported grants from National Institute on Aging (grant K23AG064029) during the
conduct of the study; personal fees from PeerView Media, Continuing Education, DynaMed,
and Parabon Nanolabs outside the submitted work; is co–principal investigator of the
ExTINGUISH Trial (1U01NS120901); owns stock (>$10 000) in ANI Pharmaceuticals; and
is the clinical director of the Anti-NMDA Receptor Encephalitis Foundation (uncompensated).
Dr Clardy reported being site investigator for an Alexion clinical trial; grants from
National Institute of Neurological Disorders and Stroke for the ExTINGUISH Trial,
Western Institute for Veteran Research, and Sumaira Foundation for NMO; research support
from Siegel Rare Neuroimmune Association Funding and Barbara Gural Steinmetz Foundation
Funding; personal fees from American Academy of Neurology (section editor, Neurology
Podcast and Neurology Minute), from Alexion, VielaBio/Horizon, Genentech/Roche, Guidepoint,
ExpertConnect, and Clarion Healthcare (majority fees to University of Utah); and funding
from Viela Bio/Horizon and Alexion/AstraZeneca outside the submitted work. Dr Solomon
reported research funding from Bristol Myers Squibb; consulting and nonpromotional
speaking for EMD Serono; personal fees from Genentech, Biogen, Alexion, Celgene, Greenwich
Bioscience, and Octave Biosciences; expert witness testimony for Jacob D. Fuchsberg
Law Firm and Koskoff, Koskoff, and Bieder; served on advisory board of Genentech,
Biogen, Alexion, Celgene, Greenwich Biosciences, and TG Therapeutics; and conducted
contract research for Sanofi, Biogen, Novartis, Actelion, and Genetech outside the
submitted work. Dr Pittock reported grants, personal fees, and nonfinancial support
from Alexion and MedImmune/Viela Bio/Horizon (all compensation is paid directly to
the Mayo Clinic); grants from the National Institutes of Health, Grifols, NovelMed,
and F. Hoffmann-LaRoche/Roche/Genentech (all compensation is paid directly to Mayo
Clinic); consulting for Astellas (compensation to Mayo Clinic and personal compensation);
personal fees from Sage Therapeutics, UCB, and F. Hoffmann-LaRoche/Roche/Genentech;
and had patent #8,889,102 issued, patent #9,891,219B2 issued, and a patent for GFAP-IgG;
Septin-5-IgG; MAP1B-IgG; Kelch-like protein 11; PDE10A pending. Dr McKeon reported
grants from the National Institutes of Health (grants RO1NS126227 and U01NS120901)
during the conduct of the study; consulting fees from Janssen and Roche (all paid
to Mayo Clinic) outside the submitted work; and had a patent for MAP1B antibody issued,
a patent for Septins 5, 7, GFAP, PDE10A, KLCHL11 antibodies pending, a patent for
Septin antibodies licensed, and a patent for MAP1B antibodies with royalties paid.
Dr Dubey reported a patent for KLHL11 pending, a patent for LUZP4 pending, and a patent
for CAVIN4 pending; and has consulted for UCB, Astellas, Argenx, Immunovant and Arialys
pharmaceuticals (all compensation paid directly to Mayo Clinic). Dr Zekeridou reported
grants from Roche/Genentech outside the submitted work and had a patent for DACH1-IgG
as biomarker of neurological autoimmunity pending and a patent for PDE10A-IgG as biomarker
of neurological autoimmunity pending. Dr Vernino has served as a consultant for Alterity,
Argenx, Catalyst, Genentech, and Sage Therapeutics and has received research support
from Dysautonomia International, BioHaven, Grifols, and Quest Diagnostics (through
a licensing contract). Dr Irani reported grants from UCB, CSL Behring, and ONO Pharmaceuticals
outside the submitted work; had a patent for LGI1/Caspr2 antibodies with royalties
paid from EIAG, a patent for Autoantibody diagnostics issued, and a patent for Relapse
predictions pending; and honoraria/research support from UCB, Immunovant, MedImmun,
Roche, Janssen, Cerebral therapeutics, ADC therapeutics, Brain, CSL Behring, and ONO
Pharmaceuticals. No other disclosures were reported.
Funding/Support: Dr Binks is supported by the
Wellcome Trust, has had salary support from the
National Institute for Health Research (
NIHR), and holds grants from
PetSavers (03.20) and
Petplan Charitable Trust (grant S20-924-963). Dr Geschwind was supported by the
National Institute on Aging (grants R01 AG AG031189; R01AG062562; R56 AG055619) and the
Michael J. Homer Family Fund. Dr Irani is supported by a
Medical Research Council Fellowship (MR/V007173/1),
Wellcome Trust (grant 104079/Z/14/Z),
BMA Research Grants- Vera Down grant (2013) and
Margaret Temple (2017),
Epilepsy Research UK (P1201), the
Fulbright UK-US commission (MS-Society research award) and by the NIHR
Oxford Biomedical Research Centre.
Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management,
analysis, and interpretation of the data; preparation, review, or approval of the
manuscript; and decision to submit the manuscript for publication.
Disclaimer: The views expressed are those of the author(s) and not necessarily those of the National
Health Service, the National Institute for Health and Care Research, or the Department
of Health.
Additional Contributions: We thank Jessica Sagen, MA (Mayo Clinic, Rochester, Minnesota), and Michael Terranova,
MS (University of California San Francisco), for their administrative assistance;
compensation was not received.