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Segal Y, Zekeridou A. Interest of rare autoantibodies in autoimmune encephalitis and paraneoplastic neurological syndromes: the utility (or futility) of rare antibody discovery. Curr Opin Neurol 2024; 37:295-304. [PMID: 38533672 DOI: 10.1097/wco.0000000000001261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
PURPOSE OF REVIEW The increasing recognition and diagnosis of autoimmune encephalitis (AE) and paraneoplastic neurological syndromes (PNS) is partly due to neural autoantibody testing and discovery. The past two decades witnessed an exponential growth in the number of identified neural antibodies. This review aims to summarize recent rare antibody discoveries in the context of central nervous system (CNS) autoimmunity and evaluate the ongoing debate about their utility. RECENT FINDINGS In the last 5 years alone 15 novel neural autoantibody specificities were identified. These include rare neural antibody biomarkers of autoimmune encephalitis, cerebellar ataxia or other movement disorders, including multifocal presentations. SUMMARY Although the clinical applications of these rare antibody discoveries may be limited by the low number of positive cases, they still provide important diagnostic, prognostic, and therapeutic insights.
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Affiliation(s)
- Yahel Segal
- Department of Laboratory Medicine and Pathology
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology
- Department of Neurology
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Campetella L, Farina A, Villagrán-García M, Villard M, Benaiteau M, Timestit N, Vogrig A, Picard G, Rogemond V, Psimaras D, Rafiq M, Chanson E, Marchal C, Goncalves D, Joubert B, Honnorat J, Muñiz-Castrillo S. Predictors and Clinical Characteristics of Relapses in LGI1-Antibody Encephalitis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200228. [PMID: 38603771 PMCID: PMC11010249 DOI: 10.1212/nxi.0000000000200228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 01/29/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND AND OBJECTIVES Relapses occur in 15%-25% of patients with leucine-rich glioma-inactivated 1 antibody (LGI1-Ab) autoimmune encephalitis and may cause additional disability. In this study, we clinically characterized the relapses and identified factors predicting their occurrence. METHODS This is a retrospective chart review of patients with LGI1-Ab encephalitis diagnosed at our center between 2005 and 2022. Relapse was defined as worsening of previous or appearance of new symptoms after at least 3 months of clinical stabilization. RESULTS Among 210 patients, 30 (14%) experienced a total of 33 relapses. The median time to first relapse was 23.9 months (range: 4.9-110.1, interquartile range [IQR]: 17.8). The CSF was inflammatory in 11/25 (44%) relapses, while LGI1-Abs were found in the serum in 16/24 (67%) and in the CSF in 12/26 (46%); brain MRI was abnormal in 16/26 (62%) relapses. Compared with the initial episode, relapses manifested less frequently with 3 or more symptoms (4/30 patients, 13% vs 28/30, 93%; p < 0.001) and had lower maximal modified Rankin scale (mRS) score (median 3, range: 2-5, IQR: 1 vs 3, range: 2-5, IQR: 0; p = 0.001). The median mRS at last follow-up after relapse (2, range: 0-4, IQR: 2) was significantly higher than after the initial episode (1, range: 0-4, IQR: 1; p = 0.005). Relapsing patients did not differ in their initial clinical and diagnostic features from 85 patients without relapse. Nevertheless, residual cognitive dysfunction after the initial episode (hazard ratio:13.8, 95% confidence interval [1.5; 129.5]; p = 0.022) and no administration of corticosteroids at the initial episode (hazard ratio: 4.8, 95% confidence interval [1.1; 21.1]; p = 0.036) were significantly associated with an increased risk of relapse. DISCUSSION Relapses may occur years after the initial encephalitis episode and are usually milder but cause additional disability. Corticosteroid treatment reduces the risk of future relapses, while patients with residual cognitive dysfunction after the initial episode have an increased relapse risk.
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Affiliation(s)
- Lucia Campetella
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Antonio Farina
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Macarena Villagrán-García
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Marine Villard
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Marie Benaiteau
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Noémie Timestit
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Alberto Vogrig
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Géraldine Picard
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Véronique Rogemond
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Dimitri Psimaras
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Marie Rafiq
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Eve Chanson
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Cecile Marchal
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - David Goncalves
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Bastien Joubert
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Jérôme Honnorat
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
| | - Sergio Muñiz-Castrillo
- From the French Reference Center for Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis (L.C., A.F., M.V.-G., M.V., M.B., A.V., G.P., V.R., B.J., J.H., S.M.-C.), Hospices Civils de Lyon; MeLiS - UCBL-CNRS UMR 5284 - INSERM U1314 (L.C., A.F., M.V.-G., M.B., A.V., B.J., J.H., S.M.-C.), Université Claude Bernard Lyon 1, France; Department of Neuroscience (A.F.), Psychology, Pharmacology and Child Health, University of Florence, Italy; Department of Biostatistics (N.T.), Hospices Civils de Lyon, France; Clinical Neurology (A.V.), Santa Maria Della Misericordia University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC); Department of Medicine (DAME) (A.V.), University of Udine, Italy; Neurology Department 2-Mazarin (D.P.), Hôpitaux Universitaires La Pitié Salpêtrière-Charles Foix, APHP; Brain and Spinal Cord Institute (D.P.), INSERM U1127/CNRS UMR 7255, Université Pierre-et-Marie-Curie, Universités Sorbonnes, Paris; Neurology Department (M.R.), Hôpital Pierre Paul Riquet, CHU de Toulouse; Neurology Department (E.C.), Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand; Neurology Department (C.M.), Centre Hospitalier Universitaire de Bordeaux; Immunology Department (D.G.), Hôpital Lyon Sud, Hospices Civils de Lyon, France; and Stanford Center for Sleep Sciences and Medicine (S.M.-C.), Stanford University, Palo Alto, CA
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3
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Yu Y, Zhuo B, Xu W, Li L, Jin X, Ji Y, Ge Y. Diagnosis of an immunocompetent adult with acute headache and fever as Epstein-Barr virus encephalitis by mNGS of cerebrospinal fluid. Diagn Microbiol Infect Dis 2024; 109:116213. [PMID: 38359677 DOI: 10.1016/j.diagmicrobio.2024.116213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
Complicated case with fever or headache of unknown origin is currently one of the main challenges in clinical diagnosis. A retrospective analysis was conducted on a 27-year-old female patient hospitalized with headache and fever, and the pathogen species were ultimately determined by metagenomic next-generation sequencing (mNGS) of cerebrospinal fluid (CSF). The culture results of CSF showed no bacterial or fungal growth. CSF cytology showed a significant increase in nucleated cells. Pathogenic index (corresponded to human gamma herpesvirus 4) of the microorganism after correcting for human background was 12846.77 with a host index (human resource) of 27822.48 by mNGS of CSF. The patient improved through antiviral treatment with ganciclovir. Epstein-Barr virus encephalitis is rare in immunocompetent adults, which can easily cause misdiagnosis and should be paid attention to. mNGS of CSF has significant advantages in the diagnosis of Epstein-Barr virus encephalitis.
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Affiliation(s)
- Yan Yu
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Bingqian Zhuo
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Wei Xu
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China; School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Lanhui Li
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Xinyue Jin
- Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China
| | - Youqi Ji
- School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China
| | - Yumei Ge
- Center for Rehabilitation Medicine, Department of Ophthalmology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China; Laboratory Medicine Center, Department of Clinical Laboratory, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310014, China; School of Medical Technology and Information Engineering, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, 310053, China; Key Laboratory of Precision Medicine for Head and Neck Cancers of Zhejiang Province, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, 310014, China.
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Tanemoto M, Suzuki S, Yokokawa K, Saito T, Iwahara N, Tsuda R, Watanabe O, Takahashi Y, Yoneda M, Hisahara S. [Clinical characteristics of seizure-predominant autoimmune encephalitis and utility of anti-neuronal antibody scores for early treatment]. Rinsho Shinkeigaku 2024; 64:272-279. [PMID: 38508734 DOI: 10.5692/clinicalneurol.cn-001911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
We analyzed 20 patients diagnosed with autoimmune neurological diseases with seizure predominance. In these patients, we examined the usefulness of Antibody Prevalence in Epilepsy and Encephalopathy (APE2) score and Antibodies Contributing to Focal Epilepsy Signs and Symptoms (ACES) score in autoimmune encephalitis (AE) for facilitating early treatment. APE2 score was positive in 19 of 20 patients. ACES score was positive in 15 of 20 patients, and 4 of 5 of the patients with negative ACES score did not have AE. Comprehensive assessment including the use of the above scores is desirable in the early stage of AE.
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Affiliation(s)
- Masanobu Tanemoto
- Department of Neurology, Sapporo Medical University, School of Medicine
| | | | - Kazuki Yokokawa
- Department of Neurology, Sapporo Medical University, School of Medicine
| | - Taro Saito
- Department of Neurology, Sapporo Medical University, School of Medicine
| | - Naotoshi Iwahara
- Department of Neurology, Sapporo Medical University, School of Medicine
| | - Reiko Tsuda
- Department of Neurology, Sapporo Medical University, School of Medicine
| | | | - Yukitoshi Takahashi
- Department of Clinical Research, NHO, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
| | - Makoto Yoneda
- Faculty of Nursing and Social Welfare Sciences, Fukui Prefectural University
| | - Shin Hisahara
- Department of Neurology, Sapporo Medical University, School of Medicine
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Fu X, Zhan Q, Zhang L, Tian X. Case report: Shingles-associated probable Bickerstaff brainstem encephalitis with IgM anti-sulfatide positivity. Front Immunol 2024; 15:1358886. [PMID: 38660303 PMCID: PMC11041370 DOI: 10.3389/fimmu.2024.1358886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background Bickerstaff brainstem encephalitis (BBE) is a rare disease considered caused by acute demyelination of the brainstem, most often resulting from secondary autoimmune responses. To our knowledge, this is the first probable case report of shingles-associated BBE with anti-sulfatide IgM positivity. Case presentation We report the case of an 83-year-old woman with symptoms of progressive limb weakness, difficulty swallowing food, and disturbed consciousness that occurred 4 weeks following herpes zoster infection. Autoimmune anti-sulfatide antibodies were positive and fluid-attenuated inversion recovery (FLAIR) sequences revealed clear high signal intensity in pons and bilateral thalamus. Our patient's condition improved markedly with glucocorticoid treatment. After 2 months of treatment, our patient was fully recovered. We considered that for her case, BBE is the most appropriate diagnosis. Conclusions We emphasize the importance of a careful medical history and assessment of clinical symptoms, performing MRI, testing autoimmune antibodies for rapid diagnosis, and ruling out differential diagnoses. Further studies involving more patients with BBE with IgM anti-sulfatide autoantibodies will increase the understanding of the clinical characteristics and advance the diagnosis and treatment of this syndrome. Meanwhile, it is crucial for dermatologists to know about this severe neurological complication following shingles.
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Affiliation(s)
- Xiaoxue Fu
- Baoding First Central Hospital, Baoding, Hebei, China
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Legouy C, Cervantes A, Sonneville R, Thakur KT. Autoimmune and inflammatory neurological disorders in the intensive care unit. Curr Opin Crit Care 2024; 30:142-150. [PMID: 38441114 DOI: 10.1097/mcc.0000000000001139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
PURPOSE OF REVIEW The present review summarizes the diagnostic approach to autoimmune encephalitis (AE) in the intensive care unit (ICU) and provides practical guidance on therapeutic management. RECENT FINDINGS Autoimmune encephalitis represents a group of immune-mediated brain diseases associated with antibodies that are pathogenic against central nervous system proteins. Recent findings suggests that the diagnosis of AE requires a multidisciplinary approach including appropriate recognition of common clinical syndromes, brain imaging and electroencephalography to confirm focal pathology, and cerebrospinal fluid and serum tests to rule out common brain infections, and to detect autoantibodies. ICU admission may be necessary at AE onset because of altered mental status, refractory seizures, and/or dysautonomia. Early management in ICU includes prompt initiation of immunotherapy, detection and treatment of seizures, and supportive care with neuromonitoring. In parallel, screening for neoplasm should be systematically performed. Despite severe presentation, epidemiological studies suggest that functional recovery is likely under appropriate therapy, even after prolonged ICU stays. CONCLUSION AE and related disorders are increasingly recognized in the ICU population. Critical care physicians should be aware of these conditions and consider them early in the differential diagnosis of patients presenting with unexplained encephalopathy. A multidisciplinary approach is mandatory for diagnosis, ICU management, specific therapy, and prognostication.
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Affiliation(s)
- Camille Legouy
- GHU Paris Psychiatrie & Neurosciences, Department of Intensive Care Medicine, Paris, France
| | - Anna Cervantes
- Divisions of Neurocritical Care and Neuroinfectious Disease, Boston Medical Center, Boston, Massachusetts, USA
| | - Romain Sonneville
- Université Paris Cité, IAME, INSERM UMR1137
- AP-HP, Hôpital Bichat - Claude Bernard, Department of Intensive Care Medicine, Paris, France
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center-New York Presbyterian Hospital, New York, New York, USA
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Qin L, Xiang Y, Wu Z, Zhang H, Wu X, Chen Q. Metagenomic next-generation sequencing for diagnosis of fatal Balamuthia amoebic encephalitis. Infect Genet Evol 2024; 119:105570. [PMID: 38382768 DOI: 10.1016/j.meegid.2024.105570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/11/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION Balamuthia amoebic encephalitis (BAE), caused by Balamuthia mandrillaris, is a rare and life-threatening infectious disease with no specific and effective treatments available. The diagnosis of BAE at an early stage is difficult because of the non-specific clinical manifestations and neuroimaging. CASE DESCRIPTION A 52-year-old male patient, who had no previous history of skin lesions, presented to the emergency department with an acute headache, walking difficulties, and disturbance of consciousness. The patient underwent a series of examinations, including regular cerebrospinal fluid (CSF) studies and magnetic resonance imaging, and tuberculous meningoencephalitis was suspected. Despite being treated with anti-TB drugs, no clinical improvement was observed in the patient. Following corticosteroid therapy, the patient developed a rapid deterioration in consciousness with dilated pupils. Metagenomic next-generation sequencing (mNGS) revealed an unexpected central nervous system (CNS) amoebic infection, and the patient died soon after the confirmed diagnosis. CONCLUSION This study highlights the application of mNGS for the diagnosis of patients with suspected encephalitis or meningitis, especially those caused by rare opportunistic infections.
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Affiliation(s)
- Lixia Qin
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Changsha, Hunan, China
| | - Yaqin Xiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Ziwei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xiaomei Wu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qihua Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China.
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8
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Finsterer J. Before SARS-CoV-2-related Encephalitis Can Be Attributed to Anti-GFAP Antibodies, Alternative Etiologies Must Be Ruled out. Intern Med 2024; 63:1039. [PMID: 38311421 PMCID: PMC11045369 DOI: 10.2169/internalmedicine.3237-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
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Kadambari S, Feng S, Liu X, Andersson M, Waterfield R, Fodder H, Jacquemot A, Galal U, Rafferty A, Drew RJ, Rodrigues C, Sadarangani M, Riordan A, Martin NG, Defres S, Solomon T, Pollard AJ, Paulus S. Evaluating the Impact of the BioFire FilmArray in Childhood Meningitis: An Observational Cohort Study. Pediatr Infect Dis J 2024; 43:345-349. [PMID: 38190645 DOI: 10.1097/inf.0000000000004236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Multiplex polymerase chain reaction assays have the potential to reduce antibiotic use and shorten length of inpatient stay in children with suspected central nervous system infection by obtaining an early microbiological diagnosis. The clinical impact of the implementation of the BioFire FilmArray Meningitis/Encephalitis Panel on the management of childhood meningitis was evaluated at the John Radcliffe Hospital in Oxford and Children's Health Ireland at Temple Street in Dublin. METHODS Children who had lumbar punctures performed as part of a septic screen were identified retrospectively through clinical discharge coding and microbiology databases from April 2017 to December 2018. Anonymized clinical and laboratory data were collected. Comparison of antibiotic use, length of stay and outcome at discharge was made with a historical cohort in Oxford (2012-2016), presenting before implementation of the FilmArray. RESULTS The study included 460 children who had a lumbar puncture as part of an evaluation for suspected central nervous system infection. Twelve bacterial cases were identified on the FilmArray that were not detected by conventional bacterial culture. Bacterial culture identified one additional case of bacterial meningitis, caused by Escherichia coli , which had not been identified on the FilmArray. Duration of antibiotics was shorter in children when FilmArray was used than before its implementation; enterovirus meningitis (median: 4 vs. 5 days), human parechovirus meningitis (median: 4 vs. 4.5 days) and culture/FilmArray-negative cerebrospinal fluid (median: 4 vs. 6 days). CONCLUSIONS The use of a FilmArray can identify additional bacterial cases of meningitis in children that had been negative by traditional culture methods. Children with viral meningitis and culture-negative meningitis received shorter courses of antibiotics and had shorter hospital stays when FilmArray was used. Large studies to evaluate the clinical impact and cost effectiveness of incorporating the FilmArray into routine testing are warranted.
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Affiliation(s)
- Seilesh Kadambari
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust
- Infection, Immunity and Inflammation department, University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Shuo Feng
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Xinxue Liu
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Monique Andersson
- Department of Microbiology, Oxford University Hospitals NHS Foundation Trust
- NDCLS, Radcliffe Department of Medicine
| | - Rebecca Waterfield
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Harriet Fodder
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Aimee Jacquemot
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Ushma Galal
- Oxford Primary Care Clinical Trials Unit, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | | | - Richard J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street
- Clinical Innovation Unit, Rotunda Hospital
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Charlene Rodrigues
- Department of Paediatric Infectious Diseases, St Mary's Hospital, Imperial College Healthcare NHS Trust
- Department of Infection Biology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Riordan
- Department of Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Natalie G Martin
- Department of Paediatrics, University of Otago Christchurch, Christchurch, New Zealand
| | - Sylviane Defres
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
- Tropical and Infectious Diseases Unit, Liverpool University Hospitals NHS Foundation Trust
- Department of Clinical Sciences and Education, Liverpool School of Tropical Medicine
| | - Tom Solomon
- The Pandemic Institute
- Department of Clinical Infection, Microbiology, and Immunology (CIMI)
- Institute of Infection, Veterinary & Ecological Sciences
- National Institute for Health and Care Research Health Protection Research Unit in Emerging and Zoonotic Infections, University of Liverpool
- Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew J Pollard
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
| | - Stephane Paulus
- From the Oxford Vaccine Group, Department of Paediatrics, University of Oxford, NIHR Oxford Biomedical Research Centre, Oxford, United Kingdom
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Hanana F, Kalathil B, Uvais NA, Mohammed TP. Stress-Induced Autoimmune Encephalitis. Prim Care Companion CNS Disord 2024; 26:23cr03628. [PMID: 38579262 DOI: 10.4088/pcc.23cr03628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Affiliation(s)
| | - Basheer Kalathil
- Department of Internal Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala
| | - N A Uvais
- Department of Psychiatry, Iqraa International Hospital and Research Centre, Calicut
- Corresponding Author: N. A. Uvais, MD, Iqraa International Hospital and Research Centre, Calicut, Kerala, India
| | - T P Mohammed
- Department of Internal Medicine, Iqraa International Hospital and Research Centre, Calicut, Kerala
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Vaisvilas M, Petrosian D, Bagdonaite L, Taluntiene V, Kralikiene V, Daugelaviciene N, Neniskyte U, Kaubrys G, Giedraitiene N. Seroprevalence of neuronal antibodies in diseases mimicking autoimmune encephalitis. Sci Rep 2024; 14:5352. [PMID: 38438516 PMCID: PMC10912693 DOI: 10.1038/s41598-024-55995-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/29/2024] [Indexed: 03/06/2024] Open
Abstract
Detection of neuronal antibodies for autoimmune encephalitis and paraneoplastic neurological syndromes relies on commercially available cell-based assays and lineblots. However, lineblots may reveal the presence of neuronal antibodies in patients with various non-autoimmune etiologies. Herein we describe patients with non-autoimmune etiologies (cohort B) and detectable neuronal antibodies and compare them to definite cases of autoimmune encephalitis (cohort A) for differences in clinical data. All patients positive for at least one neuronal antibody were retrospectively evaluated for autoimmune encephalitis and/or paraneoplastic neurological syndrome between 2016 and 2022. 39 cases in cohort B and 23 in cohort A were identified. In cohort B, most common diagnoses were neurodegenerative disorders in 9/39 (23.1%), brain tumors in 6/39 (15.4%) while most common detected antibodies were anti-titin (N10), anti-recoverin (N11), anti-Yo (N8) and all were detected in serum only. Differential aspects between cohort A and B were CSF pleocytosis (14/23 (60.8%) vs 11/35 (31.4%), p = 0.042, respectively), MRI features suggestive of encephalitis (6/23 (26.1%) vs 0 (0%), p = 0.002, respectively) and epilepsy restricted to temporal lobes (14/23 (60.9%) vs 2/30 (6.7%), p = 0.0003, respectively). A large proportion of lineblot results were non-specific when only serum was tested and were frequently found in non-autoimmune neurological conditions.
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Affiliation(s)
- Mantas Vaisvilas
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania.
- Department of Neurology, Vilnius University Hospital Santaros Klinikos, Santariskiu str. 2, 08661, Vilnius, Lithuania.
| | | | - Loreta Bagdonaite
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Vera Taluntiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Viktorija Kralikiene
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Neringa Daugelaviciene
- VU LSC-EMBL Partnership for Genome Editing Technologies, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Urte Neniskyte
- Institute of Biosciences, Life Sciences Center, Vilnius University, Vilnius, Lithuania
- VU LSC-EMBL Partnership for Genome Editing Technologies, Life Sciences Center, Vilnius University, Vilnius, Lithuania
| | - Gintaras Kaubrys
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
| | - Natasa Giedraitiene
- Clinic of Neurology and Neurosurgery, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
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Franklin JB, Leewiwatanakul B, Taylor AD, Baller EB, Zwiebel SJ. Consultation-Liaison Case Conference: Overcoming Bias in the Differential Diagnosis of Psychosis. J Acad Consult Liaison Psychiatry 2024; 65:195-203. [PMID: 37717789 PMCID: PMC10947773 DOI: 10.1016/j.jaclp.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/28/2023] [Accepted: 09/09/2023] [Indexed: 09/19/2023]
Abstract
We present the case of a 34-year-old Black patient with no significant psychiatric history who presented with catatonia and psychotic symptoms following a recent severe acute respiratory syndrome coronavirus-2 infection, whose diagnosis of coronavirus disease 2019 encephalitis was delayed by premature attribution of his symptoms to a primary psychiatric etiology. Top experts in the consultation-liaison field provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching topics include the diagnosis and management of coronavirus disease 2019 encephalitis, cognitive bias, and racial bias. Specifically, this case illustrates the role of the consultation-liaison psychiatrist in identifying medical conditions that may overlap with psychiatric presentations and in advocating for marginalized patients.
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Affiliation(s)
- Joshua B Franklin
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
| | - Bruce Leewiwatanakul
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Adrienne D Taylor
- Division of Medical Psychiatry, Department of Psychiatry, Brigham and Women's Hospital, Boston, MA
| | - Erica B Baller
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Samantha J Zwiebel
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Brunet-Possenti F, Birzu C, Deschamps L, Hacein-Bey-Abina S, Psimaras D, Chrétien P. Impact of anti-PD-1 therapy in a melanoma patient with paraneoplastic anti-ITPR1 encephalitis. Rev Neurol (Paris) 2024; 180:216-217. [PMID: 38061970 DOI: 10.1016/j.neurol.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/17/2023] [Accepted: 10/18/2023] [Indexed: 03/17/2024]
Affiliation(s)
- F Brunet-Possenti
- Department of Oncodermatology, Université Paris Cité, Hôpital Bichat Claude-Bernard, Paris, France.
| | - C Birzu
- Inserm, CNRS, UMR S 1127, Institut du cerveau, Sorbonne Université, Paris, France; Department of Neurology Mazarin, Center for Patients with Neurological Complications of Oncologic Treatments, Sorbonne Université, Hôpital La Pitié Salpêtrière, Paris, France
| | - L Deschamps
- Department of Pathology, Hôpital Bichat Claude-Bernard, Paris, France
| | - S Hacein-Bey-Abina
- Department of Immunology, Université Paris Cité, Hôpital Bicêtre, Paris, France
| | - D Psimaras
- Department of Neurology Mazarin, Center for Patients with Neurological Complications of Oncologic Treatments, Sorbonne Université, Hôpital La Pitié Salpêtrière, Paris, France
| | - P Chrétien
- Department of Immunology, Université Paris Cité, Hôpital Bicêtre, Paris, France
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Stewart C, Tung GA. Seronegative Autoimmune Encephalitis with Evanescent Focal T2FLAIR Lesions. R I Med J (2013) 2024; 107:14-15. [PMID: 38412347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Affiliation(s)
- Cameron Stewart
- Resident Physician, Brown Department of Neurology, Providence, Rhode Island
| | - Glenn A Tung
- Professor of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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15
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Rossor T, Lim M. Immune-mediated encephalitis. Dev Med Child Neurol 2024; 66:307-316. [PMID: 37438863 DOI: 10.1111/dmcn.15694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 07/14/2023]
Abstract
A neurological deterioration in a child presents a significant worry to the family and often a diagnostic challenge to the clinician. A dysregulated immune response is implicated in a wide and growing spectrum of neurological conditions. In this review we consider the current paradigms in which immune-mediated encephalopathies are considered; the development of paediatric specific diagnostic criteria that facilitate early consideration and treatment of immune-mediated conditions and the limitations and potential developments in diagnostic testing. We consider the expanding phenotype of myelin oligodendrocyte glycoprotein antibody, the spectrum of virus-associated encephalopathy syndromes, and the strategies that have been employed to build an evidence base for the management of these rare conditions. Looking forward we explore the potential for advanced molecular investigations to improve our understanding of immune-mediated encephalitides and guide future treatment strategies. Recently characterized immune-mediated central nervous system disorders include new antibodies causing previously recognized phenotypes. Aggregation of conditions with similar clinical triggers, and characterization of unique imaging features in virus-associated encephalopathy syndromes. Immune treatment iscurrently guided by meta-analysis of individualized patient data and/or multi-national consensus.
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Affiliation(s)
- Thomas Rossor
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' NHS Foundation Trust, London, UK
- Department Women and Children's Health, School of Life Course Sciences, King's College London, UK
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Gowda VK, Jetha K. Subacute Sclerosing Panencephalitis (SSPE): A Wolf in Sheep's Clothing-Infantile Presentation Masquerading as Autoimmune Encephalitis. Indian J Pediatr 2024; 91:316. [PMID: 38079071 DOI: 10.1007/s12098-023-04975-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/01/2023] [Indexed: 02/15/2024]
Affiliation(s)
- Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Near NIMHANS, Bengaluru, Karnataka, 560029, India.
| | - Kapil Jetha
- Department of Pediatrics, AIIMS Rajkot, Anandpar, Gujarat, India
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Donaldson L, Jeeva-Patel T, Mandell D, Margolin E. Enhancement of Subarachnoid Oculomotor Nerves in Bickerstaff Brainstem Encephalitis. Can J Neurol Sci 2024; 51:323-324. [PMID: 36537000 DOI: 10.1017/cjn.2022.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Laura Donaldson
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Trishal Jeeva-Patel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Mandell
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
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18
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Budhram A, Irani SR, Flanagan EP. Looking Beyond Syndrome-Based Criteria for Autoimmune Encephalitis-The Need for Complementary Neural Antibody-Based Diagnostic Criteria. JAMA Neurol 2024; 81:227-228. [PMID: 38147324 DOI: 10.1001/jamaneurol.2023.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
This Viewpoint discusses how neural antibody–based diagnostic criteria for autoimmune encephalitis would complement the syndrome-based diagnostic algorithm to improve sensitivity while maintaining high specificity.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Sarosh R Irani
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Lin Z, Zhou F, Ni L, Dong S, Fu G, Zhao J. Case report: Successful treatment of an anti-D2R and DPPX antibody-associated autoimmune encephalitis patient with high-dose methylprednisolone and intravenous immunoglobulin. Front Immunol 2024; 15:1338714. [PMID: 38469308 PMCID: PMC10925708 DOI: 10.3389/fimmu.2024.1338714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/02/2024] [Indexed: 03/13/2024] Open
Abstract
Background Autoimmune encephalitis is a neurological condition caused by abnormal immune responses, manifesting as cognitive impairments, behavioral abnormalities, and seizures. Its diagnosis depends on the detecting neuronal surface antibodies in serum or cerebrospinal fluid. Despite recent advances in understanding, clinical recognition remains challenging, especially with rare antibodies such as anti-dopamine D2 receptor (D2R) and anti-dipeptidyl-peptidase-like protein 6 (DPPX) antibodies. Delayed diagnosis can lead to severe complications. This case presentation emphasizes the diagnostic intricacies and effective treatment of the anti-D2R and DPPX antibody-associated autoimmune encephalitis. Case description The patient presented with a 3-day history of fatigue and limb soreness followed by a 3-h episode of confusion and limb convulsions. Upon admission to our facility, the initial diagnosis included status epilepticus, aspiration pneumonia, metabolic acidosis, respiratory alkalosis, and suspected encephalitis. Despite receiving antiepileptic, anti-infection, and antivirus therapy, the patient's condition deteriorated. Both computed tomography (CT) scan and magnetic resonance imaging (MRI) of the brain showed no significant abnormalities. No pathogen was identified in the cerebrospinal fluid (CSF). However, further CSF and serum examination revealed positive results of anti-D2R and anti-DPPX antibodies, confirming a diagnosis of anti-D2R and DPPX antibody-associated autoimmune encephalitis. The patient underwent a comprehensive treatment regimen, including high-dose methylprednisolone pulse therapy combined with intravenous immunoglobulin (IVIG), antiviral and anti-infection treatments, and antiepileptic medications. Significant clinical improvement was observed, and by the 18th day of admission, the patient was stable and coherent. Conclusions The current patient represents the first reported case of double-positive autoimmune encephalitis for anti-D2R and DPPX antibodies, with epilepsy as a prominent feature. High-dose methylprednisolone pulse therapy combined with IVIG has shown significant safety and efficacy in treating anti-D2R and DPPX antibody-positive autoimmune encephalitis-associated epilepsy.
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Affiliation(s)
- Zhangliang Lin
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Feng Zhou
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Lili Ni
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Shiye Dong
- Department of Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai Zhangjiang Institute of Medical Innovation, Shanghai, China
| | - Guoping Fu
- Neurology Department, Shaoxing No.2 Hospital Meical Community General Hospital, Shaoxing, China
| | - Jiangman Zhao
- Department of Medicine, Shanghai Biotecan Pharmaceuticals Co., Ltd., Shanghai Zhangjiang Institute of Medical Innovation, Shanghai, China
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Dutra LA. Diagnosis and treatment of autoimmune encephalitis in Brazil: an urgent call to action. Arq Neuropsiquiatr 2024; 82:1-2. [PMID: 38395423 PMCID: PMC10890919 DOI: 10.1055/s-0044-1781442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Lívia Almeida Dutra
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Instituto do Cérebro do Hospital Israelita Albert Einstein, São Paulo SP, Brazil.
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López N, Cuesta G, Rodríguez-Vega S, Rosas E, Chumbita M, Casals-Pascual C, Morata L, Vergara A, Bodro M, Bosch J, Herrera S, Martínez JA, Mensa J, Garcia-Vidal C, Marcos MÁ, Vila J, Soriano A, Puerta-Alcalde P. Multiplex real-time PCR FilmArray performance in the diagnosis of meningoencephalitis: lights and shadows. Infection 2024; 52:165-172. [PMID: 37515691 PMCID: PMC10810907 DOI: 10.1007/s15010-023-02076-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/13/2023] [Indexed: 07/31/2023]
Abstract
PURPOSE We aimed to evaluate the performance of the FilmArray (FA) meningitis/encephalitis (ME) panel. Secondarily, we analyzed the false positive (FP) and false negative (FN) results, as well as the predictive values of the technique, regarding the cerebrospinal fluid (CSF) characteristics. METHODS FA is a multiplex real-time PCR detecting 14 of the most common ME pathogens in CSF. All FA performed at our hospital (2018-2022) were retrospectively reviewed. FA was compared to conventional techniques and its performance was assessed based on the final diagnosis of the episode. RESULTS FA was performed in 313 patients with suspicion of ME. Most patients had altered mental status (65.2%) and fever (61%). Regarding CSF characteristics, 49.8% and 53.7% presented high CSF proteins and pleocytosis, respectively. There were 84 (26.8%) positive FA results, mainly for HSV-1 (10.9%), VZV (5.1%), Enterovirus (2.6%), and S. pneumoniae (1.9%). In the 136 cases where both FA and routine methods were performed, there was a 25.7% lack of agreement. We identified 6.6% FN results, but 28.6% FP, mainly due to HSV-1. This resulted in a high negative predictive value (NPV) of 93.4%, but a positive predictive value (PPV) of 73%. Remarkably, PPV as low as 36.9%, and 70.2%, were found in cases without pleocytosis, or lack of high CSF protein levels, respectively. CONCLUSION FA was associated with high NPV, but frequent FP results and low PPV, particularly for HSV-1, and especially in patients without high CSF protein levels or pleocytosis.
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Affiliation(s)
- Néstor López
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Genoveva Cuesta
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | | | - Enric Rosas
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Mariana Chumbita
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Climent Casals-Pascual
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Laura Morata
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Andrea Vergara
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
| | - Marta Bodro
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Bosch
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Sabina Herrera
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Jose Antonio Martínez
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Josep Mensa
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
| | - Carolina Garcia-Vidal
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - María Ángeles Marcos
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Jordi Vila
- Microbiology Department, Hospital Clinic, University of Barcelona, ISGLOBAL, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Alex Soriano
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain
- CIBERINF, CIBER Infectious Diseases, Madrid, Spain
- Universitat de Barcelona (UB), Barcelona, Spain
| | - Pedro Puerta-Alcalde
- Infectious Diseases Department, Hospital Clínic-IDIBAPS, Barcelona, Spain.
- Universitat de Barcelona (UB), Barcelona, Spain.
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Manzano GS, McEntire C, Venna N. Case report of palatal tremor as a feature of CASPR2 autoimmune encephalitis. J Neurol 2024; 271:1013-1014. [PMID: 37819461 DOI: 10.1007/s00415-023-11992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 10/13/2023]
Affiliation(s)
- Giovanna S Manzano
- Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Caleb McEntire
- Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Nagagopal Venna
- Division of Neuroimmunology and Neuroinfectious Diseases, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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Kim A, Kim M, Baek JY, Lee JY, Kim SH, Kang JM, Ahn JG, Kang HC. Aetiology and Prognosis of Encephalitis in Korean Children: A Retrospective Single-Centre Study, 2005-2020. Yonsei Med J 2024; 65:78-88. [PMID: 38288648 PMCID: PMC10827636 DOI: 10.3349/ymj.2023.0250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/25/2023] [Accepted: 10/16/2023] [Indexed: 02/01/2024] Open
Abstract
PURPOSE Encephalitis is a heterogeneous syndrome that occurs in childhood and is not rare. However, epidemiological studies of encephalitis based on the International Encephalitis Consortium (ICS) and expert recommendations are lacking. We investigated the aetiology and prognosis of encephalitis in Korean children. MATERIALS AND METHODS This retrospective study included children aged <19 years hospitalised for encephalitis at Severance Children's Hospital between 2005 and 2020. The 2013 ICS criteria were used to diagnose encephalitis, and causality was classified according to the site from which the specimen was obtained. Neurological sequelae were categorised using the modified Rankin Scale (mRS) score. RESULTS In total, 551 children were included, with 7% classified as possible, 77% as probable, and 15% as proven cases. A cause was identified in 42% of the cases (n=222), with viruses being the most common (42%), followed by bacteria (38%) and autoimmune encephalitis (12%). In cases of proven/probable encephalitis (n=65), bacteria accounted for 52%, followed by viruses (25%) and autoimmune encephalitis (22%). In cases with a single pathogen, the anti-N-methyl-D-aspartate receptor autoantibody (n=14) was the most common, followed by Group B streptococcus (n=13), herpes simplex virus (n=11), enterovirus (n=4), and others. Approximately 37% of patients had severe sequelae (mRS score ≥3) at discharge, which decreased to 31% 6 months after discharge. CONCLUSION This large-scale study showed that autoimmune and infectious causes accounted for a significant proportion of encephalitis in Korean children. Further studies are needed to determine whether early targeted treatment following early diagnosis leads to a favourable prognosis in these populations.
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Affiliation(s)
- Ahra Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Minyoung Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Jee Yeon Baek
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Hee Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Seoul, Korea.
| | - Ji-Man Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea.
| | - Jong Gyun Ahn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Institute for Immunology and Immunological Disease, Yonsei University College of Medicine, Seoul, Korea
| | - Hoon-Chul Kang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
- Pediatric Neurology, Epilepsy Research Institute, Severance Children's Hospital, Seoul, Korea
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Landré S, Ader F, Epaulard O, Tattevin P, Stahl JP, Mailles A. Encephalitis in HIV-negative immunodeficient patients: a prospective multicentre study, France, 2016 to 2019. Euro Surveill 2024; 29:2300046. [PMID: 38333938 PMCID: PMC10853978 DOI: 10.2807/1560-7917.es.2024.29.6.2300046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/01/2023] [Indexed: 02/10/2024] Open
Abstract
BackgroundData on infectious encephalitis in immunodeficient (ID) individuals are scarce. This population may present with atypical clinical symptoms, be infected by uncommon pathogens and develop poor outcomes.AimWe aimed to describe the epidemiology of infectious encephalitis among HIV-negative ID patients.MethodsPatients from the ENCEIF (Etude Nationale de Cohorte des Encéphalites Infectieuses en France) prospective cohort meeting criteria for infectious encephalitis between January 2016 and December 2019 were included. We compared clinical presentation, magnetic resonance imaging (MRI) results, biological results, infection causes and outcome of ID patients with immunocompetent (IC) patients using Pearson's chi-squared test and Student's t-test. We carried out logistic regression to assess the role of immunodeficiency as risk factor for poor outcome.ResultsID patients (n = 58) were older (mean 72 vs 59 years), had higher prevalence of diabetes (26% vs 12%), pre-existing neurological disorders (12% vs 5%) and higher case-fatality rate (23.6% vs 5.6%) compared to IC patients (n = 436). Varicella zoster virus was the primary cause of encephalitis in ID patients (this aetiology was more frequent in ID (25.9%) than in IC patients (11.5%)), with herpes simplex virus second (22.4% in ID patients vs 27.3% in IC patients). Immunodeficiency was an independent risk factor for death or major sequelae (odds ratio: 3.41, 95%CI: 1.70-6.85).ConclusionsVaricella zoster virus is the most frequent cause of infectious encephalitis in ID patients. Immunodeficiency is a major risk factor for poor outcome. ID encephalitis patients should benefit from stringent investigation of cause and early empiric treatment.
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Affiliation(s)
- Sophie Landré
- University Claude Bernard Lyon 1, Hospices Civils de Lyon, Infectious disease department, Lyon, France
| | - Florence Ader
- University Claude Bernard Lyon 1, Hospices Civils de Lyon, Infectious disease department, Lyon, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm 1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, École Normale Supérieure de Lyon, Univ Lyon, France
| | - Olivier Epaulard
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Pierre Tattevin
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- Infectious diseases department, CHU Pontchaillou, Rennes, France
| | - Jean Paul Stahl
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- University Grenoble Alpes, Infectious diseases department, Grenoble, France
| | - Alexandra Mailles
- ESCMID Study Group on the infections of the Brain (ESGIB), Basel, Switzerland
- Santé Publique France, Saint-Maurice, France
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Zhang M, Chen L, Zhao H, Qiao T, Jiang L, Wang C, Zhong X, Li X, Xu Y. Metagenomic next-generation sequencing for diagnosis of infectious encephalitis and meningitis: a retrospective study of 90 patients. Neurol Res 2024; 46:187-194. [PMID: 37931016 DOI: 10.1080/01616412.2023.2265243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 09/24/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Infections of the central nervous system (CNS) are potentially life-threatening and can cause serious morbidity. We evaluated the clinical value of metagenomic next-generation sequencing (mNGS) in the diagnosis of infectious encephalitis and meningitis and explored the factors affecting the results of mNGS. METHODS Patients with suspected cases of encephalitis or meningitis who presented in Northern Jiangsu People's Hospital from 1 March 2018 to 30 September 2022 were collected. Demographic, historical, and clinical information were obtained, and cerebrospinal fluid (CSF) samples were treated with mNGS. The pathogen was identified using National Center for Biotechnology Information (NCBI) GenBank sequence data. RESULTS Ninety-six patients were screened and finally 90 subjects enrolled. Of the 90 enrolled cases, 67 (74.4%) were diagnosed with central nervous system infections, which included 48 cases (71.6%) of viral infection, 11 (12.2%) of bacterial infection, 5 (7.5%) of mycobacterium tuberculosis, 2 (3.0%) of fungal infection, and 1 (1.5%) of rickettsia infection. From these cases, mNGS identified 40 (44.4%) true-positive cases, 3 (3.3%) false-positive case, 22 (24.4%) true-negative cases, and 25 (27.8%) false-negative cases. The sensitivity and specificity of mNGS were 61.5% and 88%, respectively. mNGS of CSF could show a higher positive rate in patients with marked CSF abnormalities, including elevated protein concentrations and monocyte counts. CONCLUSION mNGS of CSF is an effective method for detecting infectious encephalitis and meningitis, and the results should be analyzed combined with conventional microbiological testing results.
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Affiliation(s)
- Mengling Zhang
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Lanlan Chen
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Haina Zhao
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Tingting Qiao
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Li Jiang
- Department of Gerontology Northern Jiangsu People's Hospital, Clinical Medical School of Yangzhou University, Yangzhou, China
| | - Chenxin Wang
- Department of Neurology, Northern Jiangsu People's Hospital, The Yangzhou School of Clinical Medicine of Dalian Medical University, Yangzhou, China
| | - Xingxing Zhong
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Xiaobo Li
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Yao Xu
- Department of Neurology, Northern Jiangsu People's Hospital, Clinical Medical College of Yangzhou University, Yangzhou, China
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Jin Y, Lan W, Chen X, Liu W, Luo W, Chen S. A rare case of anti-DPPX encephalitis combined with neuroleptospirosis. BMC Neurol 2024; 24:34. [PMID: 38243162 PMCID: PMC10797929 DOI: 10.1186/s12883-024-03538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/14/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Neuroleptospirosis and anti-dipeptidyl-peptidase-like protein 6 (DPPX) encephalitis are both very rare and have only been reported in the form of respective case reports. There are no reports of anti-DPPX encephalitis combined with neuroleptospirosis in the literature. We reported the first case of neuroleptospirosis combined with elevated DPPX antibodies in serum and cerebrospinal fluid (CSF). CASE PRESENTATION A previously healthy 53-year-old Chinese male farmer with a history of drinking raw stream water and flood sewage exposure was brought to the hospital due to an acute onset of neuropsychiatric symptoms. No fever or meningeal irritation signs were detected on physical examination. Routine laboratory investigations, including infection indicators, leukocyte and protein in CSF, electroencephalogram and gadolinium-enhanced magnetic resonance imaging of the brain, all revealed normal. While metagenomic next-generation sequencing (mNGS) identified the DNA genome of Leptospira interrogans in the CSF. Anti-DPPX antibody was detected both in blood and in CSF. A diagnosis of neuroleptospirosis combined with autoimmune encephalitis associated with DPPX-Ab was eventually made. He resolved completely after adequate amount of penicillin combined with immunotherapy. CONCLUSION We highlight that in patients with acute or subacute behavioral changes, even in the absence of fever, if the most recent freshwater exposure is clear, physicians should pay attention to leptospirosis. Due to the low sensitivity of routine microscopy, culture, polymerase chain reaction and antibody testing, mNGS may have more advantages in diagnosing neuroleptospirosis. As autoimmune encephalitis can be triggered by various infections, neuroleptospirosis may be one of the causes of autoimmune encephalitis. Since neuronal antibody measurements themselves are not that common in neuroleptospirosis, future studies are needed to determine whether the detection of anti-DPPX antibodies is a rare event in leptospirosis. Early identification of autoimmune encephalitis and timely administration of immunotherapy may lead to a better outcome.
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Affiliation(s)
- Yong Jin
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Wei Lan
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Xiaodong Chen
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Wu Liu
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China
| | - Weiliang Luo
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China.
| | - Suqin Chen
- Department of Neurology, Huizhou Central People's Hospital, No. 41, Eling North Road, Huizhou, Guangdong Province, 516001, China.
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Harris E. Brain Inflammation May Underlie Neuropsychiatric Symptoms of Dementia. JAMA 2024; 331:190. [PMID: 38150219 DOI: 10.1001/jama.2023.25768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
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Zhou Y, Chen H, Zhu M, Li M, Wang L, Xie Z, Zhou M, Wu X, Hong D. Clinical characteristics of autoimmune encephalitis with co-existence of multiple anti-neuronal antibodies. BMC Neurol 2024; 24:1. [PMID: 38163879 PMCID: PMC10759401 DOI: 10.1186/s12883-023-03514-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND An increasing number of cases of autoimmune encephalitis (AE) with co-existing multiple anti-neuronal antibodies have been reported in recent years. However, the clinical significance of the concurrent presence of multiple anti-neuronal antibodies in patients with AE remains unclear. METHODS We retrospectively enrolled AE patients with multiple anti-neuronal antibodies treated at our center between August 2019 and February 2022. We also reviewed cases reported in multiple literature databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed on selection process. And then the clinical and laboratory data of these cases were collected for review and summary. RESULTS A total of 83 AE cases with multiple antibodies (9 cases from our center and 74 cases from the literatures reviewed) were identified. In our center, nine patients presented with encephalitis symptoms, clinically characterized as disturbed consciousness, seizures, cognitive impairment, and psychiatric disorders. Of the 83 cases, 73 cases had co-existence of 2 types of antibodies, 8 cases had 3 types, and 2 cases had 4 types. Thirty-nine cases (39/83, 46.9%) were confirmed or suspected of also having a tumor, of which the most common was lung cancer (28/83, 33.7%). Partial or complete recovery was achieved in 57 cases (57/83, 68.6%), while 26 cases (26/83, 31.3%) died during treatment or follow-up. CONCLUSIONS AE with co-existing multiple anti-neuronal antibodies is a specific subgroup, that is increasingly recognized in clinical practice. The co-existence of multiple anti-neuronal antibodies has a major impact on clinical features, disease progression, and prognosis.
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Affiliation(s)
- Yiyi Zhou
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Hao Chen
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Min Zhu
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Menghua Li
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Lianqun Wang
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Zunchun Xie
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Meihong Zhou
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Xiaomu Wu
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
| | - Daojun Hong
- Department of Neurology, The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China.
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Aboseif A, Li Y, Amin M, Lapin B, Milinovich A, Abbatemarco JR, Cohen JA, Punia V, Rae-Grant AD, Galioto R, Kunchok A. Clinical Determinants of Longitudinal Disability in LGI-1-IgG Autoimmune Encephalitis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200178. [PMID: 37949667 PMCID: PMC10691218 DOI: 10.1212/nxi.0000000000200178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 09/05/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Longitudinal outcome studies in leucine-rich glioma inactivated-1 (LGI-1) immunoglobulin G (IgG) autoimmune encephalitis (AE) are needed to inform clinical management and prognostication. This study aims to evaluate longitudinal predictors of disability and disease severity in LGI-1-IgG AE. METHODS This retrospective observational study of patients with LGI-1-IgG AE was conducted between 2013-2022. Disability and disease severity were defined by scores on the modified Rankin Scale (mRS) and the clinical assessment scale in AE (CASE), respectively. Demographic variables, clinical/paraclinical data, brain MRI, and Montreal Cognitive Assessment (MOCA) scores were examined as predictors of mRS and CASE scores in logistic and linear regression models, respectively. RESULTS Thirty patients (60% male, median age = 68.5; interquartile range (IQR) = 63.0-75.0) were included, with a median follow-up time of 19.1 months (IQR = 5.3-47.1) The majority developed seizures (29, [97%]) and/or cognitive impairment (30, [100%]) and received acute (27, [90%]) and maintenance (23 [77%]) immunotherapy. The median initial MOCA was 23/30 (IQR = 21.0-25.0). Baseline mRS (median = 2.0, IQR = 2.0-3.0) and CASE (mean = 4.3, SD = 3.7) correlated with one another (r = 0.58, p < 0.001) and with initial MOCA score (mRS r = -0.60, p = 0.012; CASE r = -0.56, p = 0.021) After 12 months from symptom onset, mRS (OR = 0.88, [95% CI = 0.82-0.94], p < 0.001) and CASE (β = -0.03, [SE = 0.01], p < 0.001) improved significantly. Lower initial MOCA score (OR = 0.68, 95% CI = 0.47-0.98, p = 0.041) and temporal lobe(s) T2 hyperintensity (OR = 16.50, 95% CI = 2.29-119.16, p = 0.006) were associated with higher mRS longitudinally. At last follow-up, most patients had persistent memory dysfunction (25, [83%]) while few had ongoing seizure activity (3, [10%]). DISCUSSION Overall, there was a high degree of correlation between mRS and CASE scores in patients with LGI-1-IgG AE, with both scores improving significantly after 12 months. Memory dysfunction and psychiatric disturbance were the most prevalent longitudinal symptoms. Cognitive impairment and temporal lobe T2 hyperintensity at baseline were both associated with greater disability at long-term follow-up, underscoring these as important determinants of disability outcomes in LGI-1-IgG AE.
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Affiliation(s)
- Albert Aboseif
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Yadi Li
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Moein Amin
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Brittany Lapin
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Alex Milinovich
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Justin R Abbatemarco
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Jeffrey A Cohen
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Vineet Punia
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Alex D Rae-Grant
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Rachel Galioto
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH
| | - Amy Kunchok
- From the Department of Neurology (A.A.), Neurological Institute; Department of Quantitative Health Sciences (Y.L., B.L., A.M.), Lerner Research Institute; Center for Outcomes Research and Evaluation (Y.L., B.L.); Mellen Center for Multiple Sclerosis Treatment and Research (M.A., J.R.A., J.A.C., A.K.); Epilepsy Center (V.P.), Neurologic Institute, Cleveland Clinic; and Cleveland Clinic Lerner College of Medicine (A.D.R.-G.), OH.
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Wagner B, Irani S. Autoimmune and paraneoplastic seizures. Handb Clin Neurol 2024; 200:151-172. [PMID: 38494275 DOI: 10.1016/b978-0-12-823912-4.00009-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Seizures are a common feature of autoimmune encephalitis and are especially prevalent in patients with the commonest autoantibodies, against LGI1, CASPR2 and the NMDA, GABAB, and GABAA receptors. In this chapter, we discuss the classification, clinical, investigation, and treatment aspects of patients with these, and other autoantibody-mediated and -associated, illnesses. We highlight distinctive and common seizure semiologies which, often alongside other features we outline, can help the clinical diagnosis of an autoantibody-associated syndrome. Next, we classify these syndromes by either focusing on whether they represent underlying causative autoantibodies or T-cell-mediated syndromes and on the distinction between acute symptomatic seizures and a more enduring tendency to autoimmune-associated epilepsy, a practical and valuable distinction for both patients and clinicians which relates to the pathogenesis. We emphasize the more effective immunotherapy response in patients with causative autoantibodies, and discuss the emerging evidence for various first-, second-, and third-line immunotherapies. Finally, we highlight available clinical rating scales which can guide autoantibody testing and immunotherapy in patients with seizures of unknown etiology. Throughout, we relate the clinical and therapeutic observations to the immunobiology and neuroscience which drive these seizures.
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Affiliation(s)
- Barbara Wagner
- Neuroscience Department, NDCN, University of Oxford and Oxford University Hospitals, Oxford, United Kingdom; Kantonsspital Aarau Switzerland, Tellstrasse, Aarau, Switzerland
| | - Sarosh Irani
- Neuroscience Department, NDCN, University of Oxford and Oxford University Hospitals, Oxford, United Kingdom.
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Nakazawa M, Abe S, Ikeno M, Shima T, Shimizu T, Okumura A. A nationwide survey of adenovirus-associated encephalitis/encephalopathy in Japan. Brain Dev 2024; 46:10-17. [PMID: 37884431 DOI: 10.1016/j.braindev.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Adenovirus is a major pathogen causing febrile illness among children. It may also cause acute encephalitis/encephalopathy. This study aimed to elucidate the clinical features of adenovirus-associated encephalitis/encephalopathy (AdVE) among children in Japan. METHODS A nationwide survey of children with AdVE was conducted. An initial survey was distributed among pediatricians to obtain information about children with AdVE treated between January 2014 and March 2019. A second survey was used to obtain the clinical information of children with AdVE from hospitals that responded to the initial survey and those identified from a literature search of the reported cases. We collected demographic data and information about symptoms of infection, neurological symptoms, laboratory parameters, treatment, and outcomes. Outcomes were determined using the Pediatric Cerebral Performance Category Score. RESULTS Clinical information was available for 23 children with a median age of 39 months. Two had preexisting neurological disorders and six had a history of febrile seizures. The outcome was good in 15 patients and poor in eight patients. Serum lactate dehydrogenase, glucose, and ammonia levels were higher among children with a poor outcome compared to those with a good outcome. Clinically mild encephalitis/encephalopathy with a reversible splenial lesion was the most common type (n = 8), followed by acute encephalopathy with biphasic seizures and late reduced diffusion (n = 7). CONCLUSION A prior history of febrile seizures was frequent in children with AdVE. Several different subtypes of acute encephalopathy were seen in children with AdVE, and the outcome was poor in those with acute encephalopathy with biphasic seizures and late reduced diffusion and hemorrhagic shock and encephalopathy syndrome. Elevated lactate dehydrogenase, glucose, and ammonia levels on admission were found to correlate with a poor outcome.
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Affiliation(s)
- Mika Nakazawa
- Department of Pediatrics, Sanikukai Hospital, Japan; Department of Pediatrics, Juntendo University, Faculty of Medicine, Japan
| | - Shinpei Abe
- Department of Pediatrics, Juntendo University, Faculty of Medicine, Japan
| | - Mitsuru Ikeno
- Department of Pediatrics, Juntendo University, Faculty of Medicine, Japan
| | - Taiki Shima
- Department of Pediatrics, Juntendo University Urayasu Hospital, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University, Faculty of Medicine, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University School of Medicine, Japan.
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Rajpal N, Bera R, Dabas A. Infection-Induced Auto-Immune Encephalitis or Relapse of Japanese Encephalitis? A Case Report and Review of Literature. Neurol India 2024; 72:191-192. [PMID: 38443035 DOI: 10.4103/neurol-india.neurol-india-d-23-00465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/25/2024] [Indexed: 03/07/2024]
Affiliation(s)
- Neha Rajpal
- Department of Pediatrics, Maulana Azad Medical College (MAMC) and Lok Nayak Hospital, Delhi, India
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Budhram A, Flanagan EP. Optimizing the diagnostic performance of neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice. Handb Clin Neurol 2024; 200:365-382. [PMID: 38494290 DOI: 10.1016/b978-0-12-823912-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The detection of neural antibodies in patients with paraneoplastic and autoimmune encephalitis has majorly advanced the diagnosis and management of neural antibody-associated diseases. Although testing for these antibodies has historically been restricted to specialized centers, assay commercialization has made this testing available to clinical chemistry laboratories worldwide. This improved test accessibility has led to reduced turnaround time and expedited diagnosis, which are beneficial to patient care. However, as the utilization of these assays has increased, so too has the need to evaluate how they perform in the clinical setting. In this chapter, we discuss assays for neural antibody detection that are in routine use, draw attention to their limitations and provide strategies to help clinicians and laboratorians overcome them, all with the aim of optimizing neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Chen LW, Guasp M, Olivé-Cirera G, Martínez-Hernandez E, Ruiz García R, Naranjo L, Saiz A, Armangue T, Dalmau J. Antibody Investigations in 2,750 Children With Suspected Autoimmune Encephalitis. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200182. [PMID: 37968128 PMCID: PMC10683852 DOI: 10.1212/nxi.0000000000200182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/06/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES To assess the frequency and types of neuronal and glial (neural) antibodies in children with suspected autoimmune encephalitis (AE). METHODS Patients younger than 18 years with suspected AE other than acute disseminated encephalomyelitis, whose serum or CSF samples were examined in our center between January 1, 2011, and April 30, 2022, were included in this study. Samples were systematically examined using brain immunohistochemistry; positive immunostaining was further investigated with cell-based assays (CBA), immunoblot, or live neuronal immunofluorescence. RESULTS Of 2,750 children, serum or CSF samples of 542 (20%) showed brain immunoreactivity, mostly (>90%) against neural cell surface antigens, and 19 had antibodies only identified by CBA. The most frequent targets were N-methyl-d-aspartate receptor (NMDAR, 76%) and myelin oligodendrocyte glycoprotein (MOG, 5%), followed by glutamic acid decarboxylase 65 (2%) and γ-aminobutyric acid A receptor (2%). Antibodies against other known cell surface or intracellular neural antigens (altogether 6% of positive cases) and unknown antigens (9%) were very infrequent. DISCUSSION The repertoire of antibodies in children with AE is different from that of the adults. Except for NMDAR and MOG antibodies, many of the antibodies included in diagnostic panels are rarely positive and their up-front testing in children seems unneeded.
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Affiliation(s)
- Li-Wen Chen
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Mar Guasp
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Gemma Olivé-Cirera
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eugenia Martínez-Hernandez
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Raquel Ruiz García
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Laura Naranjo
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Albert Saiz
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Thaís Armangue
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Josep Dalmau
- From the Neuroimmunology Program (L.-W.C., M.G., G.O.-C., E.M.-H., R.R.G., A.S., T.A., J.D.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Spain; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (M.G., E.M.-H., A.S., J.D.), University of Barcelona; Centro de Investigación Biomédica en Red (M.G., J.D.), Enfermedades Raras (CIBERER) Madrid, Spain; Pediatric Neurology Unit (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Department (R.R.G., L.N.), Centre de Diagnòstic Biomèdic, Hospital Clínic, Barcelona; Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain.
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Brenner J, Olijslagers SHC, Crijnen YS, de Vries JM, Mandarakas MR, Titulaer MJ. Clinical Outcome Assessments in Encephalitis: A Systematic Review. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200168. [PMID: 38086078 PMCID: PMC10758981 DOI: 10.1212/nxi.0000000000200168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/11/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Most patients with encephalitis experience persisting neurocognitive and neuropsychiatric sequelae in the years following this acute illness. Reported outcomes are often based on generic clinical outcome assessments that rarely capture the patient perspective. This may result in an underestimation of disease-specific sequelae. Disease-specific clinical outcome assessments can improve clinical relevance of reported outcomes and increase the power of research and trials. There are no patient-reported outcome measures (PROMs) developed or validated specifically for patients with encephalitis. The primary objective of this systematic literature review was to identify PROMs that have been developed for or validated in patients with encephalitis. METHODS We performed a systematic review of the literature published from inception until May 2023 in 3 large international databases (MEDLINE, EMBASE and Cochrane libraries). Eligible studies should have developed or validated a PROM in patients with encephalitis or encephalopathy. Methodologic quality was evaluated using the Consensus-based Standards for the selection of health status Measurement Instruments study design checklist for PROMs. RESULTS We identified no disease-specific PROMs developed or validated for patients with encephalitis. We identified one study on the development and validation of a disease-specific PROM for hepatic encephalopathy, although this disease course is substantially different to that of patients with encephalitis. The methodologic quality of the included study was generally rated as "doubtful." We identified 30 PROMs that have been applied in 46 studies on encephalitis or encephalopathy, although not validated in these populations. The most commonly applied PROMs for measuring Health-Related Quality of Life were the Medical Outcomes Study Short Form-36 and the Sickness Impact Profile. Emotional well-being was often assessed with the Beck Depression Inventory (BDI-II). Sporadically, PROMs were applied to address other aspects of outcome including daily functioning and sleep quality. DISCUSSION This systematic review confirms a critical gap in clinical outcome assessments in patients with encephalitis, failing to identify a validated measuring tool for detecting neurocognitive, functional, and health status. It is therefore essential to develop and/or validate disease-specific PROMs for the population with encephalitis to capture relevant information for patient management and clinical trials about the effects of disease that are at risk of being overlooked.
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Affiliation(s)
- Juliette Brenner
- From the Department of Neurology (J.B., Y.S.C., J.M.V., M.R.M., M.J.T.), Erasmus University Medical Center, Rotterdam; and Department of Neurology (S.H.C.O.), Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Sammy H C Olijslagers
- From the Department of Neurology (J.B., Y.S.C., J.M.V., M.R.M., M.J.T.), Erasmus University Medical Center, Rotterdam; and Department of Neurology (S.H.C.O.), Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Yvette S Crijnen
- From the Department of Neurology (J.B., Y.S.C., J.M.V., M.R.M., M.J.T.), Erasmus University Medical Center, Rotterdam; and Department of Neurology (S.H.C.O.), Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Juna M de Vries
- From the Department of Neurology (J.B., Y.S.C., J.M.V., M.R.M., M.J.T.), Erasmus University Medical Center, Rotterdam; and Department of Neurology (S.H.C.O.), Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Melissa R Mandarakas
- From the Department of Neurology (J.B., Y.S.C., J.M.V., M.R.M., M.J.T.), Erasmus University Medical Center, Rotterdam; and Department of Neurology (S.H.C.O.), Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Maarten J Titulaer
- From the Department of Neurology (J.B., Y.S.C., J.M.V., M.R.M., M.J.T.), Erasmus University Medical Center, Rotterdam; and Department of Neurology (S.H.C.O.), Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
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Chen J. Ramsay-Hunt Syndrome with Brainstem Encephalitis. Neurol India 2024; 72:196-197. [PMID: 38443038 DOI: 10.4103/neurol-india.neurol-india-d-23-00613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/19/2023] [Indexed: 03/07/2024]
Affiliation(s)
- Jinqiong Chen
- Department of Neurology, Jiading District Central Hospital Affiliated Shanghai University of Medicine and Health Sciences, Shanghai, China
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37
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Khannanova AN, Brylev LV, Prusova AA, Aksenova EV, Kondrasheva EA, Kovaleva IS. [Autoimmune encephalitis: psychiatric aspects]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:20-27. [PMID: 38465807 DOI: 10.17116/jnevro202412402120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Autoimmune encephalitis is a group of diseases researched by both neurologists and psychiatrists. Despite a large number of studies and practical recommendations, the differential diagnosis and early diagnostics still remains an important issue. The most difficult to diagnose are cases that debut as mental disorders and/or occur without neurological symptoms. The literature review presents the current state of the problem with an emphasis on the practice of a psychiatrist.
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Affiliation(s)
- A N Khannanova
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
- Russian Biotechnological University, Moscow, Russia
| | - L V Brylev
- V.M. Bujanov Moscow Clinical Hospital, Moscow, Russia
- Institute of Higher Nervous Activity and Neurophysiology, Moscow, Russia
| | - A A Prusova
- Gannushkin Psychiatric Clinical Hospital No. 4, Moscow, Russia
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Murata Y, Saito Y, Obonai T. Usefulness of BioFire Filmarray Meningitis/Encephalitis Panel for Diagnosis of Human Parechovirus Infection in Infants and Identification of Local Outbreaks. Pediatr Infect Dis J 2024; 43:e22-e23. [PMID: 37971249 DOI: 10.1097/inf.0000000000004113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Affiliation(s)
- Yo Murata
- Department of Pediatrics, Tokyo Metropolitan Tama-Hokubu Medical Center, Higashimurayama, Tokyo, Japan
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Diehl-Schmid J, Ellerbrock P, Winkler T, Zwanzger P, Ledderose S, Herms J, Roeber S. [Neoplastic meningitis as differential diagnosis of a rapidly progressive dementia]. Nervenarzt 2024; 95:53-56. [PMID: 38055019 DOI: 10.1007/s00115-023-01578-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Affiliation(s)
- Janine Diehl-Schmid
- kbo-Inn-Salzach-Klinikum, Fachkrankenhaus für Psychiatrie, Psychotherapie, Psychosomatische Medizin, Geriatrie und Neurologie, Wasserburg/Inn, Deutschland.
| | - Peter Ellerbrock
- kbo-Inn-Salzach-Klinikum, Fachkrankenhaus für Psychiatrie, Psychotherapie, Psychosomatische Medizin, Geriatrie und Neurologie, Wasserburg/Inn, Deutschland
| | - Tobias Winkler
- kbo-Inn-Salzach-Klinikum, Fachkrankenhaus für Psychiatrie, Psychotherapie, Psychosomatische Medizin, Geriatrie und Neurologie, Wasserburg/Inn, Deutschland
| | - Peter Zwanzger
- kbo-Inn-Salzach-Klinikum, Fachkrankenhaus für Psychiatrie, Psychotherapie, Psychosomatische Medizin, Geriatrie und Neurologie, Wasserburg/Inn, Deutschland
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Stephan Ledderose
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Str. 36, 80337, München, Deutschland
| | - Jochen Herms
- Zentrum für Neuropathologie und Prionforschung, Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Sigrun Roeber
- Zentrum für Neuropathologie und Prionforschung, Medizinische Fakultät, Ludwig-Maximilians-Universität München, München, Deutschland
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40
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Masciocchi S, Businaro P, Scaranzin S, Morandi C, Franciotta D, Gastaldi M. General features, pathogenesis, and laboratory diagnostics of autoimmune encephalitis. Crit Rev Clin Lab Sci 2024; 61:45-69. [PMID: 37777038 DOI: 10.1080/10408363.2023.2247482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 08/09/2023] [Indexed: 10/02/2023]
Abstract
Autoimmune encephalitis (AE) is a group of inflammatory conditions that can associate with the presence of antibodies directed to neuronal intracellular, or cell surface antigens. These disorders are increasingly recognized as an important differential diagnosis of infectious encephalitis and of other common neuropsychiatric conditions. Autoantibody diagnostics plays a pivotal role for accurate diagnosis of AE, which is of utmost importance for the prompt recognition and early treatment. Several AE subgroups can be identified, either according to the prominent clinical phenotype, presence of a concomitant tumor, or type of neuronal autoantibody, and recent diagnostic criteria have provided important insights into AE classification. Antibodies to neuronal intracellular antigens typically associate with paraneoplastic neurological syndromes and poor prognosis, whereas antibodies to synaptic/neuronal cell surface antigens characterize many AE subtypes that associate with tumors less frequently, and that are often immunotherapy-responsive. In addition to the general features of AE, we review current knowledge on the pathogenic mechanisms underlying these disorders, focusing mainly on the potential role of neuronal antibodies in the most frequent conditions, and highlight current theories and controversies. Then, we dissect the crucial aspects of the laboratory diagnostics of neuronal antibodies, which represents an actual challenge for both pathologists and neurologists. Indeed, this diagnostics entails technical difficulties, along with particularly interesting novel features and pitfalls. The novelties especially apply to the wide range of assays used, including specific tissue-based and cell-based assays. These assays can be developed in-house, usually in specialized laboratories, or are commercially available. They are widely used in clinical immunology and in clinical chemistry laboratories, with relevant differences in analytic performance. Indeed, several data indicate that in-house assays could perform better than commercial kits, notwithstanding that the former are based on non-standardized protocols. Moreover, they need expertise and laboratory facilities usually unavailable in clinical chemistry laboratories. Together with the data of the literature, we critically evaluate the analytical performance of the in-house vs commercial kit-based approach. Finally, we propose an algorithm aimed at integrating the present strategies of the laboratory diagnostics in AE for the best clinical management of patients with these disorders.
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Affiliation(s)
- Stefano Masciocchi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Pietro Businaro
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Chiara Morandi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Neuroimmunology Research Section, IRCCS Mondino Foundation, Pavia, Italy
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Côrtes LGF, Maldonado MM, Koga PCM, Santiago KADS, Fernandes GBP, Maluf MM, Martino MDV. Evaluation of pathogen from the FilmArray meningitis/encephalitis panel and recommendations on atypical findings. Arq Neuropsiquiatr 2024; 82:1-8. [PMID: 38316425 PMCID: PMC10843913 DOI: 10.1055/s-0044-1779035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 10/04/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND Infectious meningoencephalitis is a potentially fatal clinical condition that causes inflammation of the central nervous system secondary to the installation of different microorganisms. The FilmArray meningitis/encephalitis panel allows the simultaneous detection of 14 pathogens with results in about one hour. OBJECTIVE This study is based on retrospectively evaluating the implementation of the FilmArray meningitis/encephalitis panel in a hospital environment, highlighting the general results and, especially, analyzing the consistency of the test results against the clinical and laboratory conditions of the patients. METHODS Data were collected through the results reported by the BioFire FilmArray system software from the meningitis/encephalitis panel. The correlated laboratory tests used in our analysis, when available, included biochemical, cytological, direct and indirect microbiological tests. RESULTS In the analyzed period, there were 496 samples with released results. Of the total of 496 samples analyzed, 88 (17.75%) were considered positive, and 90 pathogens were detected, and in 2 of these (2.27%) there was co-detection of pathogens. Viruses were the agents most frequently found within the total number of pathogens detected. Of the 496 proven samples, 20 (4.03%) were repeated, 5 of which were repeated due to invalid results, 6 due to the detection of multiple pathogens and 9 due to disagreement between the panel results and the other laboratory tests and/or divergence of the clinical-epidemiological picture. Of these 20 repeated samples, only 4 of them (20%) maintained the original result after repeating the test, with 16 (80%) being non-reproducible. The main factor related to the disagreement of these 16 samples during retesting was the detection of bacterial agents without any relationship with other laboratory tests or with the patients' clinical condition. CONCLUSION In our study, simply reproducing tests with atypical results from the FilmArray meningitis/encephalitis panel proved, in most cases, effective and sufficient for interpreting these results.
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Fellner A, White S, Rockwell E, Giandomenico D, Diaz MM, Weber DJ, Miller MB, Boyce RM. The clinical epidemiology, management, and outcomes of patients diagnosed with encephalitis in North Carolina, 2015-2020. J Clin Microbiol 2023; 61:e0073123. [PMID: 38014985 PMCID: PMC10729753 DOI: 10.1128/jcm.00731-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 10/12/2023] [Indexed: 11/29/2023] Open
Abstract
IMPORTANCE Despite the relatively high mortality and the difficulty in diagnosis, nearly one-third of patients hospitalized with a documented diagnosis of encephalitis did not undergo a lumbar puncture (LP). When an LP was performed, pathogen-specific testing was greatly underutilized. Infectious etiologies were most common, but over 40% of cases were idiopathic at discharge. These findings suggest that there is a substantial opportunity to improve the quality of care through more accurate and timely diagnosis.
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Affiliation(s)
- Anuva Fellner
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Samuel White
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Emmanuel Rockwell
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dana Giandomenico
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David J. Weber
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Melissa B. Miller
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ross M. Boyce
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Chen QT, Chen MH, Lin YK, Yeh RH, Lu CC, Hsiao PJ, Sung YF. Case report: Hemophagocytic lymphohistiocytosis complicated by multiple organ dysfunction syndrome following aseptic encephalitis. Front Immunol 2023; 14:1296575. [PMID: 38193074 PMCID: PMC10773876 DOI: 10.3389/fimmu.2023.1296575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition caused by excessive immune activation. Secondary HLH is usually triggered by infection, most often from viral infection or malignancy. Here, we present a case of secondary HLH, complicated by multiple organ dysfunction syndrome triggered by critical aseptic encephalitis. A 27-year-old man without any underlying disease presented to our hospital with fever, disturbance of consciousness, and generalized seizures. The patient was diagnosed with aseptic encephalitis with super-refractory status epilepticus. Although antiseizure medications and immunoglobulins were administered, the patient developed multiple organ dysfunction syndrome. HLH was later diagnosed based on hypertriglyceridemia, hyperferritinemia, splenomegaly, cytopenia, and phagocytosis of nucleated cells, as shown by a blood smear of bone marrow aspiration. Treatment with pulse steroid therapy and plasmapheresis was initiated rather than chemotherapy because of the patient's critical condition. However, the patient died of profound shock and multiple organ failure. Diagnosis of HLH is challenging in patients with severe infections because of similar clinical manifestations and laboratory findings. The early recognition of HLH provides patients with the opportunity to receive appropriate treatment, which can lead to increased survival and remission rates.
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Affiliation(s)
- Quan-Ting Chen
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ming-Hua Chen
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yu-Kai Lin
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ren-Hua Yeh
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Chi Lu
- Division of Rheumatology/Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Po-Jen Hsiao
- Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yueh-Feng Sung
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Olofsson KM, van de Velde N, Peletto S, Iulini B, Pratley L, Modabberzadeh B, Małek E, Grandi G. First Swedish case of fatal equine parasitic encephalitis by Halicephalobus gingivalis. Acta Vet Scand 2023; 65:56. [PMID: 38102633 PMCID: PMC10722705 DOI: 10.1186/s13028-023-00719-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Halicephalobus gingivalis is a nematode with zoonotic potential which can cause fatal opportunistic infections in various mammals. The parasite has never been diagnosed in Sweden, in any species, prior to the presented case. CASE PRESENTATION An imported 21-year-old Icelandic mare developed severe neurological signs. The horse was eventually euthanized and submitted for post-mortem examination where severe lesions in the kidneys were noted. Histopathology revealed the presence of H. gingivalis in both kidneys and the brain. Phylogenetic analysis of the parasite determined it to belong to Lineage 1. CONCLUSIONS With the occurrence of H. gingivalis in Sweden, the disease should be added to the list of differential diagnoses in cases with acute onset of neurological disease in both horses and other mammals including humans.
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Affiliation(s)
- Karin Maria Olofsson
- Department of Pathology and Wildlife Diseases, National Veterinary Institute (SVA), Uppsala, Sweden
| | - Norbert van de Velde
- Department of Pathology and Wildlife Diseases, National Veterinary Institute (SVA), Uppsala, Sweden
| | - Simone Peletto
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Barbara Iulini
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, Turin, Italy
| | - Laura Pratley
- Evidensia Specialisthästsjukhuset Helsingborg, Helsingborg, Sweden
| | | | - Emilian Małek
- Department of Pathology and Wildlife Diseases, National Veterinary Institute (SVA), Uppsala, Sweden
| | - Giulio Grandi
- Department of Microbiology, National Veterinary Institute (SVA), Uppsala, Sweden.
- Department of Biomedical Sciences and Veterinary Public Health, Swedish University of Agricultural Sciences (SLU), Uppsala, Sweden.
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45
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Rode MM, Itoh C, Martinez-Sosa S, Ebner BA, Chang BK, Flanagan EP, Pinto MV. Systematic approach to diagnosing suspected Creutzfeldt-Jakob disease. BMJ Case Rep 2023; 16:e255174. [PMID: 38061853 PMCID: PMC10711900 DOI: 10.1136/bcr-2023-255174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Evaluation of rapidly progressive dementia (RPD) is usually challenging. In most cases, patients progress to dementia in weeks to months, and the differential diagnosis is broad. In this case, a woman in her 60s presented with a 1-month history of episodic vertigo, cognitive decline, ataxia and myoclonus. Cerebrospinal fluid total tau was markedly elevated, which was helpful in establishing the diagnosis and discussing prognosis/end-of-life measures with the patient's family. This case summarises a stepwise diagnostic approach for patients with RPD and highlights recent literature on biomarkers of Creutzfeldt-Jakob disease and autoimmune encephalitis.
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Affiliation(s)
- Matthew M Rode
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | | | | | - Blake A Ebner
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | - Bryce K Chang
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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46
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Acampora R, de Falco A, Lanfranchi F, Montella S, Scala R, Lieto M, Durante L, Bruno R. Delayed onset Bickerstaff brainstem encephalitis overlapping Miller-Fisher Syndrome during SARS-CoV-2 infection. Neurol Sci 2023; 44:4179-4182. [PMID: 37889381 DOI: 10.1007/s10072-023-07142-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
Bickerstaff brainstem encephalitis (BBE) is a neuroimmunologic disease characterized by the acute onset of external ophthalmoplegia, ataxia, and consciousness disturbance, mostly subsequent to an infection. BBE is considered to be a variant of Miller-Fisher syndrome (MFS), which also exhibits external ophthalmoplegia and ataxia but not presenting consciousness alterations. Therefore, these two medical conditions are included in the clinical spectrum of the "Fisher-Bickerstaff syndrome" ( Shahrizaila and Yuki in J Neurol Neurosurg Psychiatry 84(5):576-583) [1]. With regard to the etiopathogenesis, increasing evidence worldwide suggests that SARS-CoV-2 infection-enhanced immune response is involved in a wide range of neurological complications such as Guillain-Barré syndrome (GBS), MFS, acute necrotizing encephalitis (ANE), myelitis, acute disseminated encephalomyelitis (ADEM), and, although very rarely, BBE either (Hosseini et al. in Rev Neurosci 32:671-691) [2]. We report a case of a patient affected by delayed onset BBE overlapping MFS during a mild SARS-CoV-2 infection. To the best of our knowledge, similar cases have never been reported.
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Affiliation(s)
- R Acampora
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy.
| | - A de Falco
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - F Lanfranchi
- Department of Health Sciences (DISSAL), University of Genoa, 16132, Genoa, Italy
| | - S Montella
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - R Scala
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - M Lieto
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - L Durante
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
| | - R Bruno
- Department of Neurology and Stroke Unit, Ospedale del Mare Hospital, Naples, Italy
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47
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Nair AS, Jadav D, Shekhawat RS, Rathore M, Khera S, Sharma R. Autopsy Diagnosis of Invasive Pulmonary Aspergillosis and Fungal Encephalitis Due to Disseminated Pulmonary Mucormycosis in a Pediatric Patient. Am J Forensic Med Pathol 2023; 44:e117-e119. [PMID: 37278368 DOI: 10.1097/paf.0000000000000847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
| | - Devendra Jadav
- From the Departments of Forensic Medicine and Toxicology
| | | | | | - Sudeep Khera
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Rashim Sharma
- Pathology and Lab Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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48
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Himeno Y, Tateishi T, Irie KI, Ueno S, Morimitsu M, Mizoguchi S, Koga T, Taniwaki T. Association of Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease with Coronavirus Disease 2019 Vaccination and Infection: A Case Report of Cortical Encephalitis and Transverse Myelitis Relapse. Intern Med 2023; 62:3549-3554. [PMID: 37743511 PMCID: PMC10749814 DOI: 10.2169/internalmedicine.2471-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
We herein report a case of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) that occurred following coronavirus disease 2019 (COVID-19) vaccination and its subsequent relapse after COVID-19 infection. A 34-year-old woman developed cortical encephalitis in the right temporoparietal lobe one week after receiving the mRNA-1273 vaccine. The cerebrospinal fluid was positive for anti-MOG antibody. Her symptoms gradually improved after three courses of intravenous methylprednisolone therapy. Six months later, she experienced a relapse of transverse myelitis following COVID-19 infection. Despite treatment with plasma exchange, the patient remained paralyzed in both lower limbs. We herein review the relationship between MOGAD and COVID-19 vaccination/infection.
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Affiliation(s)
- Yohei Himeno
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Takahisa Tateishi
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Ken-Ichi Irie
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Shuntaro Ueno
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Makoto Morimitsu
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Shino Mizoguchi
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Tamon Koga
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Takayuki Taniwaki
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
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49
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Dono F, Consoli S, Tappatà M, Evangelista G, Russo M, Lanzone J, Pozzilli V, Nucera B, Rinaldi F, Di Pietro M, Tinti L, Troisi S, Calisi D, D'Apolito M, Narducci F, Assenza G, Anzellotti F, Brigo F, Vollono C, Onofrj M, Sensi SL, Michelucci R. Autoimmune encephalitis during pregnancy: A diagnostic and therapeutic challenge-A systematic review with individual patients' analysis and clinical recommendations. Epilepsia Open 2023; 8:1221-1240. [PMID: 37562964 PMCID: PMC10690706 DOI: 10.1002/epi4.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/06/2023] [Indexed: 08/12/2023] Open
Abstract
Several reports have described the autoimmune encephalitis' (AE) possible onset during pregnancy. In this systematic review, we summarize the available data on the diagnostic and therapeutic approach to AE during pregnancy, highlighting the associated maternal and fetal clinical outcomes. A systematic search of the literature was performed. The following databases were used: PubMed, Google Scholar, EMBASE, and CrossRef. The revision was registered on the PROSPERO platform (CRD42022336357). Forty-nine patients were included. AE onset was mainly observed during the first and the second trimester of pregnancy with psychiatric manifestations and seizures as main onset symptoms. CSF analysis showed AE-specific autoantibody positivity in 33 patients (anti-NMDA receptor as the most frequent). EEG generally showed normal findings. MRI revealed pathological findings in less than half of patients. Tumor screening was positive in 14 cases. First-line immunotherapy (single or combined) was generally employed while second line was administered in a minority of patients. Levetiracetam was the most used antiseizure medication. Cesarean section was performed in 18 women. Most of the women had an excellent early outcome after delivery but 22 showed persistent neurological deficits in long-term follow-up. Fetal outcome was positive in 33 cases, whereas 12 cases of fetal death were reported. A logistic regression showed that no variable significantly influenced the odds of good/bad maternal and fetal clinical outcome. Diagnosis and treatment of AE during pregnancy is challenging. The rate of miscarriage in women with AE seems to be higher than the general population. In addition, mothers may show long-term neurological deficits.
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Affiliation(s)
- Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Stefano Consoli
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Maria Tappatà
- IRCCS Istituto delle Scienze Neurologiche di BolognaBolognaItaly
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
| | - Jacopo Lanzone
- Neurorehabilitation Department, IRCCS Salvatore Maugeri FoundationInstitute of MilanMilanItaly
- Department of Systems Medicine, NeuroscienceUniversity of Rome Tor VergataRomeItaly
| | - Valeria Pozzilli
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Bruna Nucera
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Fabrizio Rinaldi
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Lorenzo Tinti
- Department of NeurologySan Gerardo Hospital ASST MonzaMonzaItaly
| | - Serena Troisi
- Pediatric Neurology, Department of NeuroscienceSantobono‐Pausilipon Children's HospitalNaplesItaly
| | - Dario Calisi
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Maria D'Apolito
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Flavia Narducci
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐Medico of RomeRomeItaly
| | - Francesca Anzellotti
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Francesco Brigo
- Department of NeurologyHospital of Merano (SABES‐ASDAA)MeranoItaly
| | - Catello Vollono
- Unit of Neurophysiopathology and Sleep Medicine, Department of Geriatrics, Neurosciences and OrthopedicsIRCCS Policlinico Universitario Agostino Gemelli, Catholic UniversityRomeItaly
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
| | - Stefano L. Sensi
- Department of Neuroscience, Imaging and Clinical Science“G. d'Annunzio” University of Chieti‐PescaraChietiItaly
- Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies, and Technology – CAST‐University G. d'Annunzio of Chieti‐PescaraChietiItaly
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50
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Rudrabhatla PK, Mehnaz F, Metta S. Atypical Rasmussen's encephalitis presenting as focal status epilepticus and periodic generalised myoclonus. Acta Neurol Belg 2023; 123:2431-2433. [PMID: 37038033 DOI: 10.1007/s13760-023-02267-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/05/2023] [Indexed: 04/12/2023]
Affiliation(s)
| | - Fazala Mehnaz
- Department of Pediatrics, Apollo Hospitals, Visakhapatnam, India
| | - Srinivas Metta
- Department of Radiology, Apollo Hospitals, Visakhapatnam, India
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