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Clinical characteristics and outcome of patients with autoimmune encephalitis: clues for paraneoplastic aetiology.

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Title: Clinical characteristics and outcome of patients with autoimmune encephalitis: clues for paraneoplastic aetiology.
Authors: Iorio, R. (AUTHOR), Damato, V. (AUTHOR), Spagni, G. (AUTHOR), Della Marca, G. (AUTHOR), Vollono, C. (AUTHOR), Masi, G. (AUTHOR), Papi, C. (AUTHOR), Campetella, L. (AUTHOR), Monte, G. (AUTHOR), Evoli, A. (AUTHOR)
Source: European Journal of Neurology. Oct2020, Vol. 27 Issue 10, p2062-2071. 10p.
Subjects: Anti-NMDA receptor encephalitis, Immunoglobulin G, Cerebrospinal fluid, Encephalitis, Cell surface antigens, Temporal lobe
Abstract: Background and purpose: Autoimmune encephalitis (AE) represents a complex syndrome with diverse clinical manifestations and therapeutic outcomes. The aim of this study was to report the clinical characteristics and the long‐term outcome of patients with paraneoplastic and idiopathic AE. Methods: All patients with subacute encephalopathy admitted to the Neurology Department of our Institution from January 2012 to May 2019 were consecutively enrolled. Patients' serum and cerebrospinal fluid were tested for neural‐specific autoantibodies by indirect immunofluorescence assays on mouse brain, rat neurons, cell‐based assays and immunoblots. Outcome was assessed by the modified Rankin Scale score. Results: From 107 adult patients with subacute encephalopathy, 50 patients were finally diagnosed with AE. Neural antibodies (Abs) were detected in 45/50 patients (90%). Leucine‐rich glioma‐inactivated protein 1 immunoglobulin G was the most frequent (6/50, 12%) Ab specific to neural surface antigens detected in adults with AE. Paraneoplastic encephalitis was diagnosed in 16/50 patients (32%). The presence of bilateral temporal lobe lesions on magnetic resonance imaging and cerebrospinal fluid restricted oligoclonal bands was associated with a higher probability to detect cancer at the time of AE diagnosis. All patients with Abs to neural surface antigens had a good outcome at last follow‐up. Severe disability at AE onset and the lack of long‐term immunosuppression predicted a poor outcome. Conclusions: Leucine‐rich glioma‐inactivated protein 1 immunoglobulin G was the most frequent Ab detected. Patients with bilateral temporal lobe lesions and oligoclonal bands have a higher probability to harbour an occult tumour. In these patients, a strict surveillance and monitoring for cancer detection is recommended. [ABSTRACT FROM AUTHOR]
Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: Clinical characteristics and outcome of patients with autoimmune encephalitis: clues for paraneoplastic aetiology.
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  Data: <searchLink fieldCode="JN" term="%22European+Journal+of+Neurology%22">European Journal of Neurology</searchLink>. Oct2020, Vol. 27 Issue 10, p2062-2071. 10p.
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  Data: <searchLink fieldCode="DE" term="%22Anti-NMDA+receptor+encephalitis%22">Anti-NMDA receptor encephalitis</searchLink><br /><searchLink fieldCode="DE" term="%22Immunoglobulin+G%22">Immunoglobulin G</searchLink><br /><searchLink fieldCode="DE" term="%22Cerebrospinal+fluid%22">Cerebrospinal fluid</searchLink><br /><searchLink fieldCode="DE" term="%22Encephalitis%22">Encephalitis</searchLink><br /><searchLink fieldCode="DE" term="%22Cell+surface+antigens%22">Cell surface antigens</searchLink><br /><searchLink fieldCode="DE" term="%22Temporal+lobe%22">Temporal lobe</searchLink>
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  Data: Background and purpose: Autoimmune encephalitis (AE) represents a complex syndrome with diverse clinical manifestations and therapeutic outcomes. The aim of this study was to report the clinical characteristics and the long‐term outcome of patients with paraneoplastic and idiopathic AE. Methods: All patients with subacute encephalopathy admitted to the Neurology Department of our Institution from January 2012 to May 2019 were consecutively enrolled. Patients' serum and cerebrospinal fluid were tested for neural‐specific autoantibodies by indirect immunofluorescence assays on mouse brain, rat neurons, cell‐based assays and immunoblots. Outcome was assessed by the modified Rankin Scale score. Results: From 107 adult patients with subacute encephalopathy, 50 patients were finally diagnosed with AE. Neural antibodies (Abs) were detected in 45/50 patients (90%). Leucine‐rich glioma‐inactivated protein 1 immunoglobulin G was the most frequent (6/50, 12%) Ab specific to neural surface antigens detected in adults with AE. Paraneoplastic encephalitis was diagnosed in 16/50 patients (32%). The presence of bilateral temporal lobe lesions on magnetic resonance imaging and cerebrospinal fluid restricted oligoclonal bands was associated with a higher probability to detect cancer at the time of AE diagnosis. All patients with Abs to neural surface antigens had a good outcome at last follow‐up. Severe disability at AE onset and the lack of long‐term immunosuppression predicted a poor outcome. Conclusions: Leucine‐rich glioma‐inactivated protein 1 immunoglobulin G was the most frequent Ab detected. Patients with bilateral temporal lobe lesions and oligoclonal bands have a higher probability to harbour an occult tumour. In these patients, a strict surveillance and monitoring for cancer detection is recommended. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of European Journal of Neurology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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