Autoimmune Encephalitis – Case Reports

Česká verzia

Authors: V. Jakubčiaková; J. Slonková
Authors place of work: Neurologická klinika LF OU a FN Ostrava
Published in the journal: Cesk Slov Neurol N 2016; 79/112(6): 707-714
Category: Kazuistika
doi: https://doi.org/10.14735/amcsnn2016707

Summary

Introduction:
Autoimmune encephalitis is a heterogeneous group of neurological diseases manifested by acute onset of epileptic seizures, cognitive impairment, memory dysfunction or psychiatric symptoms due to inflammation of limbic (or extralimbic) structures mediated by autoimmune antibodies. The anti-NMDAr encephalitis, characterized by symptoms of diffuse cortical structures impairment, differs clinically from this etiopathogenicly heterogenous entity. According to its association with neoplasm, we can distinguish paraneoplastic and non-paraneoplastic LE.

Methodology:
We retrospectively analysed patient records and identified five cases suspected of autoimmune encephalitis.

Conclusion and discussion:
Patients with an acute onset of epileptic seizures accompanied by cognitive impairment and psychiatric symptoms should undergo neurological assessment, EEG, lumbar puncture including detection of antibodies against intracellular antigens (onconeural paraneoplastic antibodies), detection of antibodies against membrane and synaptic antigens and magnetic resonance of the brain. Immunotherapy should be started immediately when non-paraneoplastic limbic encephalitis is considered. Negative findings in cerebrospinal fluid do not exclude autoimmune brain inflammation. In paraneoplastic limbic encephalitis, surgical and anticancer therapy is the first-line treatment. Onset of secondary epilepsy cannot be excluded after a series of acute symptomatic seizures. Cooperation of neurologists, infectionists and psychiatrists is essential.

Key words:
autoimmune diseases – autoantibodies – encephalitis – paraneoplastic syndromes – epilepsy – limbic encephalitis – NMDAr encephalitis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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