Immunotherapy‐Resistant Neuropathic Pain and Fatigue Predict Quality‐of‐Life in Contactin‐Associated Protein‐Like 2 Antibody Disease
Ceronie B., Strippel C., Uy C., Paneva S., Makuch M., Soleimani B., Turaga S., Binks S., Ramanathan S., Michael S., Varley J., Easton A., Themistocleous A., Dawes J., Bennett DL., Irani A., Handel AE., Irani SR.
The long‐term clinical outcomes and associated prognostic factors in contactin‐associated protein‐like 2 (CASPR2)‐antibody diseases are unknown. A total of 75 participants with CASPR2 antibodies were longitudinally assessed for disability, quality‐of‐life, and chronic pain. Although most symptoms improved within 6 months of treatment, neuropathic pain and fatigue were the most immunotherapy refractory, and persisted for up to 6 years. Furthermore, these two factors—but not CASPR2 antibody levels or subclasses—independently predicted worse disability and quality‐of‐life at 24 months. Quality‐of‐life varied widely for any given modified Rankin Scale score, indicating a divergence between patient and clinician assessed outcomes. Further work should study the relative importance of these measures, and the immunopathogenesis underlying intractable symptoms. ANN NEUROL 2025