Neurobehavioral outcomes in autoimmune encephalitis

Yeshokumar, Anusha K.; Gordon-Lipkin, Eliza; Arenivas, Ana; Cohen, Jesse; Venkatesan, Arun; Saylor, Deanna; Probasco, John C.

doi:10.1016/j.jneuroim.2017.08.010

Cited by 57 publications

(61 citation statements)

References 36 publications

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“…Disruptions in sleep architecture were apparent in AE patients who underwent PSG in our cohort, with prominent decreases in sleep efficiency, loss of stage III and REM sleep, and sleep fragmentation compared to age-similar healthy adults. This finding raises the possibility that sleep disturbances may contribute to the impairments in memory and attention that are increasingly reported in recovering AE patients [18,26,31,41,44].…”

Section: Discussionmentioning

confidence: 80%

Sleep disturbances are common in patients with autoimmune encephalitis

et al. 2019

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Objectives: Autoimmune encephalitis (AE) is increasingly recognized as an important cause of subacute cognitive decline, seizures, and encephalopathy, with an ever-broadening clinical phenotype. Sleep disturbances are reported in AE patients, including rapid eye movement sleep behavior disorder, hypersomnia, fragmented sleep, and sleep-disordered breathing; however, the prevalence of sleep disturbances and contributions to outcomes in AE patients remain unknown. There is a need to determine the prevalence of sleep disturbances in AE patients, and to clarify the relationship between specific autoantibodies and disruptions in sleep. Methods: Clinical history, results of serum and cerebrospinal fluid testing, electroencephalography, and neuroimaging were reviewed from 26 AE patients diagnosed and managed at our tertiary care hospital. Polysomnography was performed in patients with clinical indications, yielding data from 12 patients. Results: The median age of AE patients was 53 years (range, 18-83). Autoantibodies against intracellular antigens (including Ma and Hu autoantibodies) were identified in 6/26 (23%) patients, while autoantibodies against cell-surface neuronal antigens (including NMDAR and LGI1) were identified in 20/26 (77%) patients. New sleep complaints were reported by 19/26 (73%) AE patients, including gasping or snoring (9/19, 47%), dream enactment behavior (6/19, 32%), insomnia (5/19, 29%), hypersomnia (4/19, 21%), other parasomnias (4/19, 21%), and dream-wake confusional states (2/19, 11%). Dream enactment behaviors were particularly common in AE associated with LGI1 autoantibodies, reported in 4/7 (57%) patients.

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Section: Discussionmentioning

confidence: 80%

Sleep disturbances are common in patients with autoimmune encephalitis

et al. 2019

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“…While the mortality following anti-NMDAR encephalitis patients is low if the disease is identified early and immunotherapy is instituted, many survivors suffer from memory deficits and executive dysfunction. [81][82][83] FDG-PET may shed light on prognosis, as the time to normalization of occipital hypometabolism may correlate with outcomes in some patients with anti-NMDAR encephalitis. 55,82 In addition, structural and functional neuroimaging correlates to neurocognitive dysfunction following anti-NMDAR encephalitis are being vigorously explored.…”

Section: Neuroimaging Biomarkers and Outcomesmentioning

confidence: 99%

Imaging in Encephalitis

Venkatesan

Jagdish

2019

Semin Neurol

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Despite recent advances in diagnostic and therapeutic modalities for infectious and autoimmune encephalitis, the management of patients with suspected or confirmed encephalitis poses a great challenge to physicians. Neuroimaging, including magnetic resonance imaging (MRI) and positron emission tomography (PET) scanning, can play a crucial role in substantiating the diagnosis of encephalitis and eliminating clinical mimics of encephalitis from consideration. Moreover, characteristic neuroimaging patterns can aid in defining specific infectious and autoimmune etiologies. Volumetric and functional MRI, in particular, are being increasingly used to characterize outcomes following encephalitis and can shed light on brain reorganization and function after the acute phase of disease has resolved. Here, we discuss the uses of structural, functional, and PET neuroimaging in the clinical assessment of the acute and recovery phases of encephalitis.

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“…Another retrospective multicenter study surveyed a total of 13 patients with antibodymediated SE and found that 62% (8/13) of these patients recovered almost completely despite a mean duration of 50 days for SE [6]. One recent study evaluated the long-term neurobehavioral functions in patients with autoimmune encephalitis and found that half of the patients had a 'good' neurological disability score, although a majority complained about ongoing difficulties such as fatigue, emotional lability, short-term memory or concentration issues [23]. In this study, 68% could perform the daily activities independently (mRS ≤ 2).…”

Section: Discussionmentioning

confidence: 99%