Autoimmune Encephalitis in the Intensive Care Unit

Diaz-Arias, Luisa A.; Pardo, Carlos A.; Probasco, John C.

doi:10.1007/978-3-030-36548-6_17

Cited by 13 publications

(18 citation statements)

References 89 publications

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“…But EEG results are often non-speci c and MRI has a limited 25-50% sensitivity 10,13 . Because encephalitis patients may suffer severe and sometimes irreversible neurological sequelae, the early initiation of speci c treatments and early follow-up of responses to these treatments 14 are key. This need underscores the importance of nding an early biomarker.…”

Section: Introductionmentioning

confidence: 99%

“…18 F-FDG PET has also been shown to be superior to morphological imaging in the early diagnosis of autoimmune encephalitis 15 . The increasing number of publications studying the results of brain 18 F-FDG PET in autoimmune encephalitis over the past decade is in dire need of consolidation [13][14][15][16][17][18][19][20][21][22][23][24] . The literature is saturated with isolated case-reports and retrospective studies conducted on a small number of patients, leaving the role of PET in the initial assessment of the disease unclear.…”

Section: Introductionmentioning

confidence: 99%

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Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Bordonné

Chawki

Doyen

et al. 2021

Eur J Nucl Med Mol Imaging

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Objective: To consolidate current understanding of detection sensitivity of brain 18 F-FDG PET scans in the diagnosis of autoimmune encephalitis and to de ne speci c metabolic imaging patterns for the most frequently occurring autoantibodies. Methods: A systematic and exhaustive search of data available in the literature was performed by querying the PubMed/MEDLINE and Cochrane databases for the search terms: "FDG PET" and ""encephalitis" or "brain in ammation"". Studies had to satisfy the following criteria: i. include at least one patient suspected or diagnosed with autoimmune encephalitis according to the current recommendations, ii. be an original case-report iii. speci cally present 18 F-FDG PET and/or morphologic imaging ndings. The diagnostic 18 F-FDG PET detection sensitivity in autoimmune encephalitis was determined for all cases reported in the literature and a meta-analysis, according to the PRISMA method, was performed on a subset of these, which included PET scans for at least 10 patients, and whose quality was assessed with the QUADAS-2 tool. Results: The search strategy identi ed 1113 articles. The detection sensitivity of 18 F-FDG PET was 90%, based on 176 publications and 720 patients and 80% [75%-84%] by meta-analysis based on 21 publications and 444 patients. We also report speci c brain 18 F-FDG PET imaging patterns for the main encephalitis autoantibody subtypes. Conclusion and Relevance: Brain 18 F-FDG PET has a high detection sensitivity and should be included in future diagnostic autoimmune encephalitis recommendations. Speci c metabolic 18 F-FDG PET patterns corresponding to the main autoimmune encephalitis autoantibody subtypes further enhance the value of this diagnostic.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Bordonné

Chawki

Doyen

et al. 2021

Eur J Nucl Med Mol Imaging

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“…As autoimmune encephalitis may relapse, follow-up care is important [ 22 ]. Patients with autoimmune encephalitis are usually critically ill and managed in the intensive care unit [ 28 ]. Immunosuppressive therapy is the cornerstone of treatment.…”

Section: Reviewmentioning

confidence: 99%

“…Immunosuppressive therapy is the cornerstone of treatment. The use of immunosuppressive therapy should be prompt and should not wait for the cancer diagnosis or antibody characterization, provided an underlying infectious etiology has been excluded and there are no other contraindications [ 28 ]. The results of antibody testing can then be used to refine or alter the treatment strategy.…”

Section: Reviewmentioning

confidence: 99%

“…Thus, these patients often have limited neurologic recovery even with optimal treatment. The best chance for symptom stabilization or improvement appears to be the early identification and treatment of the tumor and the use of immunotherapy (such as glucocorticoids, intravenous immunoglobulin (IVIG), and plasmapheresis) [ 28 - 29 ]. High-dose corticosteroids are often the first line of treatment and can be given either intravenously or orally [ 22 , 30 ].…”

Section: Reviewmentioning

confidence: 99%

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Autoimmune Encephalitis in Children: From Suspicion to Diagnosis

Hon

Leung²,

Au³

et al. 2021

Cureus

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There are several well-described and studied autoimmune diseases that affect different organ systems, and a limited number of these affect the central nervous system. Autoimmune encephalitis represents a disease with a wide spectrum of clinical manifestations and different levels of severity, from mild cognitive impairment to complex encephalopathy. Immune-mediated encephalitis refers to a diverse and rare group of conditions in children associated with nonspecific symptomatology, altered mental state, and recalcitrant seizures. Infectious etiology must be excluded. Immune-mediated encephalitis syndromes could be associated with paraneoplastic or primarily autoimmune mechanisms. The newest scientific advantages have concluded that autoimmune encephalitis may be further divided into different groups of diseases depending on the immune response; examples are antibodies to cell surface proteins, antibodies to intracellular synaptic proteins, T-cell response with antibodies to intracellular antigens, among others. Treatment consists of supportive therapy, ranging from supplemental oxygen, fluid restriction to mechanical circulatory support. Specific treatment includes immunoglobulin infusion, plasmapheresis, and pulse steroid treatment. Prognosis is poor if specific treatment is not timely instituted. The diagnosis of autoimmune encephalitis could be challenging to clinicians due to its diverse clinical features, which can mimic a variety of other pathologic processes. Screening for cancer and proper management that includes immune therapy are fundamental, although some patients will need immune suppression for weeks or months as autoimmune encephalitis may relapse; therefore, follow-up is always necessary.

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Autoimmune Encephalopathies Presenting in the ICU

Banks,

Rabinstein

2024

Textbook of Neurointensive Care: Volume 1

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Autoimmune Encephalitis in the Intensive Care Unit

Cited by 13 publications

References 89 publications

Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Brain 18F-FDG PET for the diagnosis of autoimmune encephalitis: a systematic review and a meta-analysis

Autoimmune Encephalitis in Children: From Suspicion to Diagnosis

Autoimmune Encephalopathies Presenting in the ICU

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