Autoimmune GFAP astrocytopathy: Prospective evaluation of 90 patients in 1 year

In this prospective evaluation of serum and CSF samples, all but two CSF GFAP alpha-lgG positive patients had autoimmune meningoencephalomyelitis while serum GFAP alpha-IgG positivity alone was less specific. Phenotypes were diverse among patients that were serum positive only. Adult and pediatric clinical presentations were similar. Most patients were immunotherapy responsive. Co-existing NMDA-R-IgG and cancer were associated with lack of response to first-line immunotherapy. Among patients with follow-up information, 18% had relapses. This study demonstrates CSF GFAP alpha-IgG is a specific autoimmune meningoencephalomyelitis biomarker, with favorable corticosteroid response. Lack of response should prompt evaluation for co-existing NMDA-R-IgG or malignancy.