RESIDENT: Antibody-Mediated Encephalitis in Adults: A Review of Clinical Presentation and Course, Treatments, and Future Directions

Evaluate the session

Presenting Author(s): Dr. Joseph Emerson Marinas

Co-Author(s): Dmitriy Matveychuk

Date and time: 23 Mar 2019 from 13:50 to 14:10

Location: Hawthorn C  

Objective(s)

1. Review the clinical course of selected antibodymediated encephalitides;
2. Delineate features that may distinguish antibodymediated encephalitides from primary psychotic disorders; and
3. Provide an overview of the current state of research and areas requiring further study.

Literature References

1. Dalmau, J; Geis, C; Graus, F. Autoantibodies to Synaptic Receptors and Neuronal Cell Surface Proteins in Autoimmune Diseases of the
   Central Nervous System. Physiol Rev. 2017, 97, 839-887.
2. Dalmau, J; Lancaster, E; Martinez-Hernandez, E; Rosenfeld, M; Balice-Gordon, R. Clinical experience and laboratory investigations in
   patients with anti-NMDAR encephalitis. Lancet Neurol. 2011, 10, 63-74.
3. Dalmau, J; Graus, F. Antibody-Mediated Encephalitis. N Engl J Med. 2018, 378, 840-851.
4. Dalmau, J et al. Paraneoplastic anti N-methyl-D-aspartate receptor encephalitis associated with the ovarian teratoma. Ann Neurol.
   2007, 61, 25–36.
5. Dalmau J et al. Anti NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008, 7, 1091–
   1098.
6. Graus, F et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016, 15, 391-404.
7. Herken, J; Pruss, H. Red Flags: Clinical Signs for Identifying Autoimmune Encephalitis in Psychiatric Patients. Front Psychiatry. 2017,
   16, 25.
8. Titulaer, M et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an
   observational cohort study. Lancet Neruol. 2013, 12, 157-165.

Abstract

Antibody-mediated encephalitides are a group of conditions with neuropsychiatric features that have gained increasing recognition over
the past decades with NMDA receptor encephalitis being one of the most studied. The association of these conditions with tumours and
their possible reversible course have led to interest in early identification and treatment. Further, prominent behavioural and psychotic
features can result in the initial presentation to clinical attention and at times leads to psychiatric admissions. We searched PubMed,
PsycINFO, and Web of Science databases for references published between the years 2000 to 2018 in our literature review. Although
there do not appear to be clinical features that consistently differentiate between antibody-mediated encephalitides and primary
psychiatric disorders at first presentation, the suspicion of autoimmune causes may be guided by monitoring the evolution of patient
symptoms, imaging and cerebrospinal fluid investigations, and other features associated with specific antibody targets. Further study of
the antibody-mediated encephalitides can help direct treatment approaches and further the understanding of this group of conditions.