Functional Recovery in Autoimmune Encephalitis: A Prospective Observational Study.

Abstract

Background:

Prospective observations of functional recovery are lacking in patients with autoimmune encephalitis defined by antibodies against synaptic proteins and neuronal cell surface receptors.

Methods:

Adult patients with a diagnosis of autoimmune encephalitis were included into a prospective registry. At 3, 6 and 12 months of follow-up, the patients' modified Rankin Scale (mRS) was obtained.

Results:

Patients were stratified into three groups according to their antibody (Ab) status: anti-NMDAR-Ab (n=12; group I), anti-LGI1/CASPR2-Ab (n=35; group II), and other antibodies (n=24; group III). A comparably higher proportion of patients in group I received plasma exchange/immunoadsorption and second line immunosuppressive treatments at baseline. A higher proportion of patients in group II presented with seizures. Group III mainly included patients with anti-GABABR-, anti-GAD65- and anti-GlyR-Ab. At baseline, one third of them had cancer. Patients in groups I and III had much higher median mRS scores at 3 months compared to patients in group II. A median mRS of 1 was found at all follow-up time points in group II.

Conclusions:

The different dynamics in the recovery of patients with certain autoimmune encephalitides have important implications for clinical trials. The high proportion of patients with significant disability at 3 months after diagnosis in groups I and III points to the need for improving treatment options. More distinct scores rather than the mRS are necessary to differentiate potential neurological improvements in patients with anti-LGI1-/CASPR2-encephalitis.

• Authors: Thomas Seifert-Held, Katharina Eberhard, Christian Lechner, Stefan Macher, Harald Hegen, Tobias Moser, Gregor Brecl Jacob, Gertraud Puttinger, Raffi Topakian, Michael Guger, Emrah Kacar, Lea Zoche, Desiree De Simoni, Andreas Seiser, Stefan Oberndorfer, Christoph Baumgartner, Walter Struhal, Friedrich Zimprich, Johann Sellner, Florian Deisenhammer, Christian Enzinger, Markus Reindl, Helmut Rauschka, Thomas Berger, Romana Höftberger
• Journal: Frontiers in immunology (Front Immunol) Vol. 12 Pg. 641106 ( 2021) ISSN: 1664-3224 [Electronic] Switzerland
• PMID: 34093529 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 Seifert-Held, Eberhard, Lechner, Macher, Hegen, Moser, Jacob, Puttinger, Topakian, Guger, Kacar, Zoche, De Simoni, Seiser, Oberndorfer, Baumgartner, Struhal, Zimprich, Sellner, Deisenhammer, Enzinger, Reindl, Rauschka, Berger and Höftberger.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Autoimmune Diseases of the Nervous System (immunology)
• Encephalitis (immunology)
• Female
• Humans
• Male
• Middle Aged
• Prospective Studies
• Recovery of Function
• Young Adult