Clinical Features, Treatment, and Prognostic Factors in Neuronal Surface Antibody-Mediated Severe Autoimmune Encephalitis

Wang, Baojie; Wang, Chunjuan; Feng, Jie; Hao, Maolin

doi:10.3389/fimmu.2022.890656

Cited by 8 publications

(10 citation statements)

References 31 publications

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“…Functional outcomes reported in this study were worse than those described in the literature. 16 24 27 Even if only patients diagnosed and treated in Latin America were taken into account, most were able to achieve functional independence at follow-up, 17 which differs significantly from our sample. We believe that these worse outcomes are related to the identification of autoantibodies against intracellular antigen in a significant portion of the sample, a condition related to the lower response to immunotherapy.…”

Section: Discussioncontrasting

confidence: 66%

“…In a retrospective cohort focused on patients with AE requiring ICU care, Schubert et al (2019) 26 described that 35% of them evolved with status epilepticus. Similarly, in another observational study of AE patients with severe neurological dysfunction, Wang et al (2022) 27 declared that 40% of them were admitted to ICU because of status epilepticus. In our sample, 41.6% of the patients who presented with status epilepticus died during the hospitalization, which is also greater than what is found in the literature.…”

Section: Discussionmentioning

confidence: 92%

“…This was one of the Abbreviation: SE, status epilepticus. 2022) 27 declared that 40% of them were admitted to ICU because of status epilepticus. In our sample, 41.6% of the patients who presented with status epilepticus died during the hospitalization, which is also greater than what is found in the literature.…”

Section: Discussionmentioning

confidence: 99%

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Autoimmune encephalitis in a resource-limited public health setting: a case series analysis

Morillos,

Borelli,

Noll

et al. 2024

Arq Neuropsiquiatr

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Background Autoimmune encephalitis (AE) consists of a group of acquired diseases that affect the central nervous system. A myriad of phenotypes may be present at the onset. Due to the heterogeneity of clinical presentations, it is difficult to achieve uniformity for the diagnostic and therapeutic processes and follow-up strategies. Objective To describe a series of patients diagnosed with AE in a resource-limited public hospital in southern Brazil and to analyze therapeutics and outcomes. Methods We retrospectively reviewed the electronic medical records of patients diagnosed with AE at the Hospital de Clínicas de Porto Alegre from 2014 to 2022. Data collected included clinical presentation, neuroimaging, cerebrospinal fluid testings, electroencephalogram, autoantibodies, treatments, outcomes, follow-up time, degree of neurological impairment, and mortality. Results Data from 17 patients were retrieved. Eleven cases were classified as definite AE and 6 as possible AE. Autoantibodies were identified in 9 patients. Timing for diagnosis was impacted by the high costs associated with autoantibody testing. Most patients became functionally dependent (82.4%) and most survivors remained with autoimmune-associated epilepsy (75%). Five patients died during hospitalization, and one after a 26-month of follow-up. Conclusion In this resource-limited hospital, patients with AE had a worse clinical outcome than that previously described in the literature. Development of epilepsy during follow-up and mortality were greater, whilst functional outcome was inferior. Autoantibody testing was initially denied in most patients, which impacted the definitive diagnosis and the use of second-line therapies.

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Section: Discussioncontrasting

confidence: 66%

Section: Discussionmentioning

confidence: 92%

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Autoimmune encephalitis in a resource-limited public health setting: a case series analysis

Morillos,

Borelli,

Noll

et al. 2024

Arq Neuropsiquiatr

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“…A previous study showed that a high NLR was associated with poor prognosis during the final follow-up ( 15 ). However, in this study, there was no significant association between NLR and failed first-line treatment.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of the neutrophil-to-lymphocyte ratio for treatment response in patients diagnosed with definite or probable autoimmune encephalitis/encephalopathy

Ogami,

Koh,

Miyamoto

et al. 2023

Front. Neurol.

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IntroductionAutoimmune encephalitis/encephalopathy (AE) is a complex and heterogeneous disease, making it difficult to predict the prognosis. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential prognostic tool, but its usefulness remains a matter of debate. This study aimed to explore prognostic factors in cases of clinically definite or probable AE, including those with autoantibody-negative, or unknown status.MethodsData on patients diagnosed with definite or probable AE, including those with autoantibody-negative, or unknown status, were retrospectively collected from the admission records of our department between January 2013 and December 2022. These patients were then categorized into either a good- or poor-response group, based on their short-term treatment response. Clinical characteristics, auxiliary examinations, and treatments were compared between the two groups. A multivariable logistic regression model was constructed to identify independent predictors of poor short-term treatment response by Akaike information criterion backward stepwise method.ResultsA total of 31 patients were included in the final analysis, with 18 of them included in the poor-response group. In the univariable analysis, the poor-response group had a higher proportion of patients with a modified Rankin Scale (mRS) high score upon admission, female, epileptic seizures, or NLRs of 3.93 or higher than the good-response group (all p < 0.10). Furthermore, the multivariable logistic regression analysis revealed that the mRS score upon admission [OR: 5.51, 95% confidence intervals (CI): 1.29–23.50, p = 0.02], epileptic seizures (OR: 10.01, 95% CI: 1.16–86.66, p = 0.04), and NLRs of 3.93 or higher (OR: 11.37, 95% CI: 1.12–114.68, p = 0.04) were significantly associated with poor short-term treatment response.ConclusionThe NLR may play a supplementary role in predicting the short-term treatment response in patients diagnosed with definite or probable AE, including those with autoantibody-negative, or unknown status.

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“…Earlier epidemiological studies identified infectious pathogens as the main culprits behind encephalitis, whereas more recently, there has been a dramatic increase in the identification of AE associated with neuronal autoantibodies [2]. Both IE and AE can present as neurologic and/or systemic emergencies; indeed, over 30% of patients with encephalitis require ICU admission, which has been associated with poor prognosis [3,4]. Regardless of etiology, delays in diagnosis are common and associated with worse outcomes and increased financial burden, underscoring the need for clinicians to develop and deploy a rational approach to patients with encephalitis [5 ▪▪ ,6].…”

Section: Introductionmentioning

confidence: 99%

Approach to acute encephalitis in the intensive care unit

Venkatesan¹,

Habis²,

Geocadin

2023

Current Opinion in Critical Care

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Purpose of reviewRecent years have seen a dramatic increase in the identification of autoimmune encephalitis (AE) and the emergence of new causes of infectious encephalitis (IE). However, management of these patients remains challenging, with many requiring care in intensive care units. Here, we describe recent advances in the diagnosis and management of acute encephalitis.Recent findingsAdvances in the identification of clinical presentations, neuroimaging biomarkers, and electroencephalogram patterns have enabled more rapid diagnosis of encephalitis. Newer modalities such as meningitis/encephalitis multiplex PCR panels, metagenomic next-generation sequencing, and phage display-based assays are being evaluated in an effort to improve detection of autoantibodies and pathogens. Specific advances in the treatment of AE include establishment of a systematic approach to first-line therapies and the development of newer second-line modalities. The role of immunomodulation and its applications in IE are actively being investigated. In the ICU, particular attention to status epilepticus, cerebral edema, and dysautonomia may improve outcomes.SummarySubstantial diagnostic delays still occur, with many cases left without an identified etiology. Antiviral therapies remain scarce, and optimal treatment regimens for AE still need to be clarified. Nevertheless, our understanding of diagnostic and therapeutic approaches to encephalitis is rapidly evolving.

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Clinical Features, Treatment, and Prognostic Factors in Neuronal Surface Antibody-Mediated Severe Autoimmune Encephalitis

Cited by 8 publications

References 31 publications

Autoimmune encephalitis in a resource-limited public health setting: a case series analysis

Autoimmune encephalitis in a resource-limited public health setting: a case series analysis

Predictive value of the neutrophil-to-lymphocyte ratio for treatment response in patients diagnosed with definite or probable autoimmune encephalitis/encephalopathy

Approach to acute encephalitis in the intensive care unit

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