Characteristics and Prognosis of Autoimmune Encephalitis in the East of China: A Multi-Center Study

Abstract

Objective: This study aimed to investigate epidemiological characteristics, clinical manifestations, and long-term outcomes of patients with autoimmune encephalitis (AE) in the east of China.Methods: From January 2015 to December 2019, 226 potential AE patients were recruited from five clinical centers, and a total of 185 patients who met the diagnostic criteria were included in the study. We retrospectively reviewed clinical features, auxiliary examinations, details of treatments, and outcomes of AE, and identified risk factors of poor prognosis. Modified Rankin Scale scores were used to evaluate neurological function, and scores of 3–6 indicated a poor-prognosis.Results: Patients with five main subtypes of AE were enrolled in the study, as follows: anti-NMDAR (79), anti-LGI1 (55), anti-CASPR2 (30), anti-GABABR (16), and anti-AMPAR (5). Among 185 patients, 58.38% (108/185) were male and 41.62% (77/185) were female. The median age at disease onset was 41 years (interquartile range, 17–62). The most common clinical manifestations of AE were seizures (146, 78.92%) and memory deficit (123, 66.49%). A total of 95 (51.35%) patients had abnormal brain magnetic resonance imaging results. Electroencephalographic findings were abnormal in 131 (70.81%) patients, and 168 (90.81%) and 26 (14.05%) patients were treated with first- and second-line immunotherapies, respectively. All surviving patients were followed-up for at least 1 year (range 12–36 months). Good clinical outcomes were achieved in 117 (63.24%), while 68 (36.76%) patients had a poor prognosis. Further, 33 (17.84%) patients relapsed and 10 (5.41%) died within 1 year post-discharge. Older patients tended to have a poorer prognosis, and the occurrence of mental behavioral disorders, movement disorders, disturbance of consciousness, central hypoventilation, and tumors were overrepresented in the poor-prognosis group.Conclusions: AE is a treatable disease, and most patients have a good prognosis. There are differences in the clinical manifestations of patients with different AE subtypes. Some with AE will relapse, and long-term follow-up is of great significance for further research.

Thyroid Function and Low Free Triiodothyronine in Chinese Patients With Autoimmune Encephalitis

“…In our previous study ( 17 ) of 117 patients with anti-LGI1 encephalitis, we found that abnormal thyroid function was frequent in this group: 31.6% (37/117) showed abnormal thyroid function, and 22% of these had elevated levels of serum thyroid peroxidase antibodies. In another multicenter study ( 18 ) that included 185 patients with multiple subtypes of AE, 63 (34.05%) had abnormal thyroid function. However, to the best of our knowledge, studies on multiple subtypes of AE and thyroid function are rare.…”

A Case Report of Autoimmune Encephalitis: Could Post-COVID-19 Autoimmunity Become a Lethal Health Issue?

“…A multicenter study in eastern and central China was performed and concluded that, regardless of study limitations, several risk factors have been associated with a poor prognosis of AE [16,17]. These factors include older age, mental and behavioral disorders, movement disorders, impaired consciousness at admission, central respiratory depression, EEG with ≥50% slow waves, and tumors [16,17]. All of which explains why our patient's outcome was less favorable.…”

“…What factors correlate with the outcome of AE, and whether COVID-19 infection negatively affects the outcome, even with early, aggressive, and appropriate management. A multicenter study in eastern and central China was performed and concluded that, regardless of study limitations, several risk factors have been associated with a poor prognosis of AE [16,17]. These factors include older age, mental and behavioral disorders, movement disorders, impaired consciousness at admission, central respiratory depression, EEG with ≥50% slow waves, and tumors [16,17].…”

Coexistence of multiple anti-neuronal antibodies in autoimmune encephalitis in China: A multi-center study

“…With the development of detection technology, an increasing number of AE antibodies have been reported (5)(6)(7). AE-associated antibodies can be divided into two categories: antibodies against cell-surface-targeting antigens and antibodies against intracellular-targeting antigens.…”