Autoimmune Encephalitis

Goodfellow, John; Mackay, Graham

doi:10.4997/jrcpe.2019.407

Cited by 27 publications

(31 citation statements)

References 44 publications

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“…It induces apoptosis to prevent maturation of pre‐B cells into mature antibody‐secreting cells 12 . The successful use of rituximab as a second‐line drug has been widely reported in AE, but there have been no randomized controlled trials in AE 1,7 . Rituximab was initially approved for the treatment of adult B‐cell lymphoma, but it has been increasingly used in autoimmune diseases where B cells are considered to have an important role, such as in systemic lupus erythematosus, rheumatoid arthritis, immune thrombocytopenic purpura, pemphigus, bullous pemphigoid, cryoglobulinemia, Behçet's disease, juvenile idiopathic arthritis, spondyloarthropathy, and systemic sclerosis 25,26 …”

Section: Discussionmentioning

confidence: 99%

“…First‐line immunotherapy generally consists of corticosteroids, intravenous immunoglobulin (IVIg), and/or plasmapheresis. Second‐line treatment is usually administered when the response to first‐line therapy is inadequate or when the disease is known to be severe or relapsing and includes monoclonal antibodies (eg, rituximab), alkylating agents (eg, cyclophosphamide), and antimetabolites (eg, azathioprine or mycophenolate mofetil) 1,7 …”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of rituximab in autoimmune encephalitis: A meta‐analysis

et al. 2020

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Autoimmune encephalitis (AE) is a rare but debilitating neurological disease in which the body develops antibodies against its own neurons and causes inflammation of the brain. It affects all age groups but children and women are more commonly affected. Patients may develop a rapidly progressive encephalopathy syndrome, manifested by changes in mental state and a number of neurological symptoms including impaired memory and cognition, vision and speech problems, impaired coordination, movement disorders and seizures, and psychiatric symptoms including psychosis, euphoria, aggressiveness and compulsiveness, inappropriate sexual behavior, and panic attacks. Symptoms may progress to loss of consciousness or even coma. 1,2

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of rituximab in autoimmune encephalitis: A meta‐analysis

et al. 2020

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“…Among them, anti-LGI1 encephalitis ( 2 ) is a treatable etiology of AE. LGI1-Abs were found in 2010 ( 3 ), which may be the second most common cause of AE following anti- N -methyl- d -aspartate receptor (NMDAR) encephalitis and the most common cause of limbic encephalitis (LE) ( 4 – 6 ). The common manifestations of anti-LGI1 encephalitis are cognitive impairment or rapidly progressive dementia ( 7 ), psychiatric disturbances, convulsions ( 2 , 8 ), faciobrachial dystonic seizures (FBDSs), and refractory hyponatremia ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Clinical Characteristics of Cognitive Impairment and 1-Year Outcome in Patients With Anti-LGI1 Antibody Encephalitis

et al. 2020

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Introduction: Anti-leucine-rich glioma-inactivated 1 antibody (anti-LGI1) encephalitis is one of the most common autoimmune encephalitis. Anti-LGI1 encephalitis presented with subacute or acute onset of cognitive impairment, psychiatric disturbances, faciobrachial dystonic seizures (FBDSs), convulsions, and hyponatremia. The common sequela of anti-LGI1 encephalitis is cognitive disorder, but there are few studies on the recovery of cognitive function after immunotherapy. This study aimed to explore clinical characteristics of cognitive impairment and 1-year outcome in patients with anti-LGI1 encephalitis. Methods: The clinical data and characteristics of cognitive impairment of 21 patients with anti-LGI1 encephalitis from 2016 to 2019 in Nanjing Brain Hospital were analyzed retrospectively. At the time of onset of hospitalization and 1 year after discharge, the cognitive functions in these patients were assessed using two cognitive screening scales—Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment-Basic (MoCA-B). Results: Among the 21 patients, 13 were male and 8 were female, aged 51.10 ± 14.69 (age range 20–72) years. Nineteen patients, comprising 90.48%, had recent memory deterioration. Routine electroencephalography (EEG) results of 13 cases were abnormal. EEG results were epileptic or slow-wave activity involving the temporal lobes. Eleven cases of brain MRI were abnormal, and the focus involved the hippocampus and mediotemporal lobe. The decrease of short-term memory [recall scores: 0.57 ± 0.81 (MMSE), 0.76 ± 1.34 (MoCA-B)] is the most obvious at the time of admission. After intravenous (IV) injection of methylprednisolone and/or immunoglobulin, the clinical symptoms of the patients improved obviously. Total MMSE and MoCA-B scores of patients were significant increased after 1 year (21.19 ± 3.54 vs. 26.10 ± 3.02, P < 0.001; and 19.00 ± 4.38 vs. 25.19 ± 4.25, P < 0.001, respectively). Recall scores and orientation scores of MoCA-B were significantly improved after 1 year (0.76 ± 1.34 vs. 3.24 ± 1.48, P < 0.001; and 3.10 ± 1.26 vs. 5.00 ± 1.22, P < 0.001, respectively). However, 3/21 (14.29%) patients still have obvious short-term memory impairment (recall scores ≤ 1). Conclusion: Cognitive impairment is one of the most common manifestations of anti-LGI1 encephalitis, with the main prominent being acute or subacute short-term memory loss. Although most patients with anti-LGI1 encephalitis respond well to immunotherapy, a small number of patients still have cognitive disorders, mainly recent memory impairment, after 1 year.

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“…Causes of encephalitis include viruses, bacteria, fungi, and parasites (2). Other causes include autoimmune diseases and certain medications (3). In many cases, the etiology remains unknown (4).…”

Section: Introductionmentioning

confidence: 99%

Dysbiosis of Gut Microbiota and Short-Chain Fatty Acids in Encephalitis: A Chinese Pilot Study

Tan

et al. 2020

Front. Immunol.

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Background: Encephalitis, the inflammation of the brain, may be caused by an infection or an autoimmune reaction. However, few researches were focused on the gut microbiome characteristics in encephalitis patients. Methods: A prospective observational study was conducted in an academic hospital in Guangzhou from February 2017 to February 2018. Patients with encephalitis were recruited. Fecal and serum samples were collected at admission. Healthy volunteers were enrolled from a community. Disease severity scores were recorded by specialized physicians, including Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation-II (APACHE-II). 16S rRNA sequence was performed to analyze the gut microbiome, then the α-diversities and β-diversities were estimated. Short-chain fatty acids (SCFAs) were extracted from fecal samples and determined by gas chromatography-mass spectrometry. Serum D-lactate (D-LA), intestinal fatty acid-binding protein (iFABP), lipopolysaccharide (LPS), and lipopolysaccharide-binding protein (LBP) were measured by enzyme-linked immunosorbent assay (ELISA). The associations among microbial indexes and clinical parameters were evaluated by Spearman correlation analysis. Results: In total, twenty-eight patients were recruited for analysis (median age 46 years; 82.1% male; median GCS 6.5; median SOFA 6.5; median APACHE-II 14.5). Twenty-eight age-and sex-matched healthy subjects were selected as controls. The β-diversities between patients and healthy subjects were significantly different. The α-diversities did not show significant differences between these two groups. In the patient group, the abundances of Bacteroidetes, Proteobacteria, and Bacilli were significantly enriched. Accordingly, fecal SCFA levels were decreased in the patient group, whereas serum D-LA, iFABP, LPS, and LBP levels were increased compared with those in healthy subjects. Correlation analyses showed that disease severity had positive correlations with Proteobacteria and Akkermansia but negative correlations with Firmicutes, Clostridia, and Ruminococcaceae abundances. The cerebrospinal fluid

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Autoimmune Encephalitis

Cited by 27 publications

References 44 publications

Efficacy and safety of rituximab in autoimmune encephalitis: A meta‐analysis

Efficacy and safety of rituximab in autoimmune encephalitis: A meta‐analysis

Clinical Characteristics of Cognitive Impairment and 1-Year Outcome in Patients With Anti-LGI1 Antibody Encephalitis

Dysbiosis of Gut Microbiota and Short-Chain Fatty Acids in Encephalitis: A Chinese Pilot Study

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