The multiple faces of encephalitis: Antibody profile in a case series of autoimmune encephalitis in Bogotá, Colombia

2021 ◽  
Vol 350 ◽  
pp. 577451
Author(s):  
Habib Moutran-Barroso ◽  
Hellen Kreinter-Rosembaun ◽  
Maria Alejandra Beltrán S. ◽  
Hernán Bayona ◽  
Luis Carlos Mayor
Keyword(s):  
Case Series ◽  
Autoimmune Encephalitis ◽  
Antibody Profile

scholarly journals Autoimmune Encephalitis in Latin America: A Critical Review

2021 ◽  
Vol 11 ◽  
Author(s):  
Gabriel de Albuquerque Vasconcelos ◽  
Rodrigo Montenegro Barreira ◽  
Karmelita Emanuelle Nogueira Torres Antoniollo ◽  
Alina Maria Nuñez Pinheiro ◽  
Cíntia Fernandes Rodrigues Maia ◽  
...  
Keyword(s):  
Latin America ◽  
Latin American ◽  
World Literature ◽  
Case Reports ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Developed Countries ◽  
Future Research ◽  
Epidemiologic Factors ◽  
Nmda Receptor Encephalitis

Autoimmune encephalitis is an increasingly recognized cause of encephalitis. The majority of case series report patients residing in developed countries in the northern hemisphere. The epidemiologic features of autoimmune encephalitis in Latin America are still unclear. The aim of the study was to perform a review of the clinical presentation of autoimmune encephalitis in Latin America and compare to world literature. References were identified by an in-depth literature search and selected on the basis of relevance to the topic and authors' judgment. We selected clinical studies and case reports published from 2007 to July, 2020 including patients from Latin American countries. Of the 379 patients included, the majority were cases of anti-NMDA receptor encephalitis (93.14%), followed by anti-VGKC-complex encephalitis (N = 17; 4.48%), anti-GAD encephalitis (N = 9; 2.37%), anti-AMPA receptor encephalitis (N = 1; 0.26%), anti-GABA receptor encephalitis (N = 1; 0. 26%), anti-mGluR5 encephalitis (N = 1; 0. 26%), and anti-mGluR1 encephalitis (N = 1; 0. 26%). Reported cases of Anti-NMDA encephalitis in Latin-America had a very slight female predominance, lower prevalence of associated tumors and a lower incidence of extreme delta brush on electroencephalogram. Autoimmune encephalitis is possibly underdiagnosed in underdeveloped countries. Its outcome after treatment, however, appears to be similarly favorable in Latin American patients as has been reported in developed countries based on available case reports and case series. Regional specificities in the manifestation of autoimmune encephalitis could be related to epidemiologic factors, such as the presence of different triggers and different genetic and immunologic background, that need to be studied by future research.

Autoimmune encephalitis and seizures, cerebrospinal fluid, imaging, and EEG findings: a case series

2021 ◽  
Author(s):  
Hisham Elkhider ◽  
Rohan Sharma ◽  
Nidhi Kapoor ◽  
Surjith Vattoth ◽  
Bashir Shihabuddin
Keyword(s):  
Cerebrospinal Fluid ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Fluid Imaging

scholarly journals Use of intravenous immunoglobulin for the treatment of autoimmune encephalitis: audit of the NHS experience

JRSM Open ◽  
2018 ◽  
Vol 9 (9) ◽  
pp. 205427041879302 ◽  
Author(s):  
JA Kinsella ◽  
SR Irani ◽  
R Hollingsworth ◽  
D O’Shaughnessy ◽  
P Kane ◽  
...  
Keyword(s):  
Intravenous Immunoglobulin ◽  
Limbic Encephalitis ◽  
Tertiary Care ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Symptomatic Treatment ◽  
Outcome Data ◽  
National Database ◽  
Retrospective Audit ◽  
Autoimmune Limbic Encephalitis

Objectives The treatments of limbic and other autoimmune encephalitis include immunosuppression, symptomatic treatment, and in the case of paraneoplastic syndromes, appropriate therapy for underlying neoplasms. When immunotherapy is considered, intravenous immunoglobulin is one option for treatment, either alone or in combination with corticosteroids. To date, however, evidence for the use of intravenous immunoglobulin in this context comes from case series/expert reviews as no controlled trials have been performed. We aimed to analyse the NHS England Database of intravenous immunoglobulin usage, which was designed to log use and guide procurement, to explore usage and therapeutic effect of intravenous immunoglobulin in autoimmune encephalitis in England. Design We conducted a retrospective audit and review of the NHS England Database on intravenous immunoglobulin use. Setting NHS England Database of intravenous immunoglobulin use which covers secondary and tertiary care prescribing and use of intravenous immunoglobulin for all patients in hospitals in England. Participants Hospital in-patients with confirmed or suspected autoimmune/limbic encephalitis between September 2010 and January 2017. Results A total of 625 patients who were 18 years of age or older were treated with intravenous immunoglobulin for autoimmune encephalitis, of whom 398 were determined as having 'highly likely' or 'definite' autoimmune/limbic encephalitis. Ninety-six percent were treated with a single course of intravenous immunoglobulin. The availability and accuracy of reporting of outcomes was very poor, with complete data only available in 27% of all cases. Conclusions This is the first review of data from this unique national database. Whilst there was evidence for clinical improvement in many cases of patients treated with intravenous immunoglobulin, the quality of outcome data was generally inadequate. Methods to improve quality, accuracy and completeness of reporting are crucial to maximise the potential value of this resource as an auditing tool.

scholarly journals [18F]-Fluoro-Deoxy-Glucose Positron Emission Tomography Scan Should Be Obtained Early in Cases of Autoimmune Encephalitis

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
C. R. Newey ◽  
A. Sarwal ◽  
S. Hantus
Keyword(s):  
Positron Emission Tomography ◽  
Temporal Lobe ◽  
Fdg Pet ◽  
Brain Mri ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Altered Mental Status ◽  
Emission Tomography ◽  
Positron Emission ◽  
Mesial Temporal Lobe

Introduction. Autoimmune encephalitis (AE) is a clinically challenging diagnosis with nonspecific neurological symptoms. Prompt diagnosis is important and often relies on neuroimaging. We present a case series of AE highlighting the importance of an early [18F]-fluoro-deoxy-glucose positron emission tomography (FDG-PET) scan.Methods. Retrospective review of seven consecutive cases of autoimmune encephalitis.Results. All patients had both magnetic resonance imaging (MRI) and FDG-PET scans. Initial clinical presentations included altered mental status and/or new onset seizures. Six cases had serum voltage-gated potassium channel (VGKC) antibody and one had serum N-methyl-D-aspartate (NMDA) antibody. MRI of brain showed mesial temporal lobe hyperintensity in five cases of VGKC. The other two patients with VGKC or NMDA AE had restiform body hyperintensity on MRI brain or a normal MRI, respectively. Mesial temporal lobe hypermetabolism was noted in three cases on FDG-PET, despite initial unremarkable MRI. Malignancy workup was negative in all patients.Conclusion. A high index of suspicion for AE should be maintained in patients presenting with cognitive symptoms, seizures, and limbic changes on neuroimaging. In cases with normal initial brain MRI, FDG-PET can be positive. Additionally, extralimbic hyperintensity on MRI may also be observed.

scholarly journals Headache, Delirium or Encephalitis? A Case of Residual Mutism Secondary to Anti-NMDA Receptor Encephalitis

2019 ◽  
Vol 11 (3) ◽  
pp. 330-343
Author(s):  
Omar Jiménez-Zarazúa ◽  
María Andrea Martínez-Rivera ◽  
Pedro Luis González-Carrillo ◽  
Lourdes N. Vélez-Ramírez ◽  
María Alcocer-León ◽  
...  
Keyword(s):  
Neuropsychiatric Symptoms ◽  
Hospital Setting ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Systemic Steroid ◽  
Paraneoplastic Encephalitis ◽  
Nmda Receptor Encephalitis ◽  
Management Procedure ◽  
Specialized Hospital ◽  
Systemic Steroid Therapy

Encephalitis is a heterogeneous syndrome that is diagnosed through clinical assessment and the assistance of laboratory, neuroimaging and electroencephalographic workup. Over the past 10 years, autoimmune encephalitis has been more frequently recognized; however, most reports come from highly specialized hospital settings. Anti-N-methyl-D-aspartate receptor (NDMAR) encephalitis has been associated with paraneoplastic encephalitis syndromes and was first recognized in 2005. We present the case of a 34-year-old male patient who debuted clinically with a headache associated with neuropsychiatric symptoms (i.e., visual and auditory hallucinations, anxiety, aggressiveness) and memory deficits, progressing to autonomic dysfunction (i.e., tachycardia and hypertension), seizures, and stupor with catatonic features. Initially, infectious, metabolic, and toxicological etiologies were excluded; followed by the assessment of immunological and paraneoplastic etiologies, yielding positive IgG levels for anti-NMDAR antibodies. The patient was treated successfully with systemic steroid therapy and therapeutic plasmapheresis, while mutism was the only sequela. Although large case series reporting on paraneoplastic and autoimmune anti-NMDAR encephalitis have been reported in the literature in recent years, this case is of particular importance due to the stepwise differential diagnosis and treatment management procedure that was used in a regional but not highly specialized hospital setting.

Autoimmune Encephalitis in Children: A Case Series at a Tertiary Care Center

2020 ◽  
Vol 35 (9) ◽  
pp. 591-599 ◽  
Author(s):  
Alice Rutatangwa ◽  
Nikita Mittal ◽  
Carla Francisco ◽  
Kendall Nash ◽  
Emmanuelle Waubant
Keyword(s):  
San Francisco ◽  
Care Center ◽  
Tertiary Care ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Complete Recovery ◽  
Response To Treatment ◽  
High Dose ◽  
Presenting Symptoms ◽  
Nmdar Encephalitis

Autoimmune encephalitis is the third most common cause of encephalitis in children. We provide a detailed account of presenting symptoms, diagnosis, and response to treatment in pediatric autoimmune encephalitis patients evaluated at University of California San Francisco within a 2.5-year period. Eleven were identified: anti– N-methyl-d-aspartate receptor (NMDAR) encephalitis (n = 4), antibody-negative autoimmune encephalitis (n = 4), steroid-responsive encephalopathy associated with thyroiditis (SREAT) (n = 2), and glial fibrillary acidic protein (GFAP)–associated encephalitis (n = 1). Most common presenting symptoms included seizures and behavior changes (54%). More than 90% of patients showed improvement following first-line immunotherapy (high-dose corticosteroids, intravenous immunoglobulin, and/or plasma exchange). A total of 64% received second-line treatment with rituximab, cyclophosphamide, or mycophenolate mofetil. One patient with NMDAR encephalitis died despite escalating immunotherapy. None of the patients showed complete recovery after median follow-up of 9 months (range 0.5-66). Children with autoimmune encephalitis have a diverse clinical presentation and may lack an identifiable autoantibody. Majority of patients show a good response to immunotherapy; however, recovery can be delayed.

Clinical Presentation and Outcome in Autoimmune Encephalitis Associated With N-Type Voltage-Gated Calcium Channels in Children

2019 ◽  
Vol 34 (9) ◽  
pp. 499-505 ◽  
Author(s):  
Jeffrey Kornitzer ◽  
Firas Taha ◽  
Eric Segal
Keyword(s):  
Calcium Channel ◽  
Intravenous Immunoglobulin ◽  
Pediatric Patients ◽  
Expressive Language ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Clinical Spectrum ◽  
Voltage Gated ◽  
Presenting Symptoms ◽  
Voltage Gated Calcium Channel

Objective: We present the diagnostic and clinical course of the first multicenter case series of pediatric patients with autoimmune encephalitis associated with N-type voltage-gated calcium channel antibodies. Methods: Data from 2 university hospitals were retrospectively reviewed and records of 3 patients with autoimmune encephalitis associated with N-type voltage-gated calcium channel antibodies were evaluated. Results: The 3 pediatric patients (all female) had symptoms that spanned the clinical spectrum. All 3, however, had regression of expressive language and agitation. Neuroimaging in all 3 patients was normal; electroencephalographic (EEG) findings varied among the 3 patients. Positive titers against the N-type voltage-gated calcium channel antibody were found in their cerebrospinal fluid. Following administration of intravenous immunoglobulin, all 3 had improvement in their core presenting symptoms. Conclusion: Autoimmune encephalitis associated with N-type voltage-gated calcium channel antibodies in the pediatric population presents with a wide clinical spectrum, although expressive language delay and agitation seem to be common symptoms. Treatment with intravenous immunoglobulin improves core symptoms.

scholarly journals Intravenous immunoglobulin response in new-onset refractory status epilepticus (NORSE) COVID-19 adult patients

2021 ◽  
Author(s):  
Paolo Manganotti ◽  
Giovanni Furlanis ◽  
Miloš Ajčević ◽  
Cristina Moras ◽  
Lucia Bonzi ◽  
...  
Keyword(s):  
Status Epilepticus ◽  
Intravenous Immunoglobulin ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Refractory Status Epilepticus ◽  
Adult Patients ◽  
University Hospital ◽  
Paroxysmal Activity ◽  
Refractory Status ◽  
New Onset

AbstractNeurological manifestations may be common in COVID-19 patients. They may include several syndromes, such as a suggested autoimmune abnormal response, which may result in encephalitis and new-onset refractory status epilepticus (NORSE). Quickly recognizing such cases and starting the most appropriate therapy is mandatory due to the related rapid worsening and bad outcomes. This case series describes two adult patients admitted to the university hospital and positive to novel coronavirus 2019 (SARS-CoV-2) infection who developed drug-resistant status epilepticus. Both patients underwent early electroencephalography (EEG) assessment, which showed a pathological EEG pattern characterized by general slowing, rhythmic activity and continuous epileptic paroxysmal activity. A suspected autoimmune etiology, potentially triggered by SARS-CoV-2 infection, encouraged a rapid work-up for a possible autoimmune encephalitis diagnosis. Therapeutic approach included the administration of 0.4 g/kg intravenous immunoglobulin, which resulted in a complete resolution of seizures after 5 and after 10 days, respectively, without adverse effects and followed by a normalization of the EEG patterns.

Leptospira Triggered Anti-N-Methyl-d-Aspartate Receptor Encephalitis

2020 ◽  
Author(s):  
Prateek Kumar Panda ◽  
Indar Kumar Sharawat ◽  
Rishi Bolia
Keyword(s):  
Sleep Disturbances ◽  
Early Recognition ◽  
Case Reports ◽  
Case Series ◽  
Autoimmune Encephalitis ◽  
Acute Disseminated Encephalomyelitis ◽  
Neurological Symptoms ◽  
Aspartate Receptor ◽  
Systemic Symptoms ◽  
Extrapyramidal Features

Abstract Primary neuroleptospirosis although rare but has been reported in the literature in the form of case reports and case series. However, there are no reports of autoimmune encephalitis triggered by leptospirosis in the literature, although four cases of acute disseminated encephalomyelitis, which is also considered to have autoimmune etiology have been reported. We are reporting an adolescent girl, who developed anti-N-methyl-d-aspartate receptor encephalitis after the resolution of systemic symptoms of leptospirosis. Her symptoms including neuropsychiatric and extrapyramidal features and sleep disturbances resolved completely after immunotherapy. As recently autoimmune encephalitis triggered by various infections are getting reported more frequently around the world, the clinicians need to consider this clinical possibility, even in patients with leptospirosis, who develop neurological symptoms while systemic clinical features are subsiding. Early recognition and timely administration of immunotherapy have the potential to completely reverse the neurological symptoms.

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