A scoping review on paraneoplastic autoimmune limbic encephalitis (PALE) psychiatric manifestations

Abstract

The term limbic encephalitis has been used with an oncological precedent for over 50 years and, since then, has been applied in relation to multiple antibodies found in its etiological process. Over the last decade, the psychiatric community has brought paraneoplastic autoimmune limbic encephalitis (PALE) to a new light, scattering the once known relationships between said screened antibodies responsible for causing limbic encephalitis. Due to the fact that some individuals with this condition have a psychiatric syndrome as an initial manifestation, the aim of this updated scoping review is to reestablish a causal relationship between the onconeuronal autoantibodies, both intracellular and extracellular, possible underlying malignancies and subsequent neuropsychiatric syndrome. In pair with it, there is the idea of sketching a cleaner thorough picture of what poses as psychiatric symptoms as well as possible therapeutics. Even though the always evolving epistemology of the neurosciences achieved a significant unveiling of what includes PALE in its relevant pathological subgroups, the amount of gray literature still is much superior, appealing to a further research with more randomized controlled trials, with larger populations, so that the results corroborate the small amount of data that already exist and posteriorly be applied in the general population.

Autoimmune antibodies in first-episode psychosis with red flags: A hospital-based case-control study protocol

“…However, before taking advantage of these modern developments, we should always bear in mind the primary rules in this area. First, psychiatric symptoms are common among individuals with neurological disease, e.g., catatonia in patients with anti-NMDAR encephalitis ( 29 ), and psychiatric symptoms in paraneoplastic autoimmune limbic encephalitis ( 30 ). Second, whenever antibodies are measured as biomarkers for AIPs, the results should be interpreted with caution, as there will always be false positives and false negatives.…”

Antibodies against N-Methyl D-Aspartate Receptor in Psychotic Disorders: A Systematic Review

“…in these disorders are presented not so often as in anti-NMDAR encephalitis and mainly go along with prominent neurological symptoms. Psychotic features are reported in up to 21–33% of patients with LGI1, CASPR2, GABAa, and GABAb ABs [16, 18-20] and less than in 7% of patients with GAD65 and onconeuronal ABs [14, 21]. Although rare, but such patients may also present with isolated psychiatric features and be admitted to a psychiatric ward [18, 20].…”