Autoimmune encephalitis: differences of clinical features between antibody-positive and antibody-negative conditions

Abstract

Autoimmune encephalitis is a kind of immune disease with a higher incidence while classification and analysis based upon different states of antibodies are scarcely reported. We intend to compare the clinical features of autoimmune encephalitis between antibody-positive and antibody-negative, with a goal of contributing to early diagnosis and facilitate clinical treatment decisions, especially concerning antibody negative cases. A total of 38 patients with autoimmune encephalitis were enrolled and patients with infections, hereditary, metabolic or toxic neurological diseases were excluded. Based on the serum and cerebrospinal fluid (CSF) antibody results, all patients were divided into antibody-positive group and antibody-negative group. The clinical manifestations of the two groups were compared in detail. The number of antibody-positive group with immuno-related injury (p=0.012), number of combined symptoms (p=0.027) and abnormal secretion of exocrine glands (p=0.023) were higher than antibody-negative group; patients with psychiatry department treatment history exceeded antibody-negative group (p=0.014) and patients with epileptic of antibody-positive group was less than that of antibody-negative group (p=0.028). Majority of patients in antibody-positive group displayed cerebrospinal fluid (CSF) pressure and white blood cell (WBC) count increased while that in a small number of antibody-negative group (p = 0.043, p=0.045). Baseline mRS scores of antibody-positive group were higher than negative group at admission (p=0.049), and mRS in both groups were significantly lower at discharge than admission (p=0.010, p =0.011). Compared with antibody-negative group, the combined therapy in antibody-positive group was more common (p=0.025).Although antibody-positive patients may have more serious conditions,but the data suggest that in spite of some differences between antibody positive and negative patients, they are quite similar and perhaps should be subjected to the same rigorous treatment or management protocols. Immunotherapy might play an important role in relieving symptoms.