Tenascin-R autoimmunity: isolated tremor reversed with immunotherapy.

Autoimmune movement disorders are increasingly recognized but isolated tremor is extremely rare. We describe a 70-year-old male with rapidly progressive, severe, postural and intention tremor and weight loss. His CSF was inflammatory and harbored a neural-tissue-restricted antibody. The autoantigen was identified by immunoprecipitation and mass-spectrometry and confirmed by antigen-specific assays to be specific for tenascin-R. He was investigated for cancer and diagnosed with follicular lymphoma that expresses tenascin-R suggesting a paraneoplastic origin; cancer treatment and immunotherapy led to complete recovery. With this individualized patient approach and antibody discovery, we expand the spectrum of antibodies accompanying autoimmune hyperkinetic movement disorders. This article is protected by copyright. All rights reserved.