Criminality in patients with autoimmune encephalitis: A case series

Author:

Michael Sophia12,Varley James12,Williams Robyn13ORCID,Bajorek Tomasz2,Easton Ava45,Irani Sarosh R.123ORCID

Affiliation:

1. Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences University of Oxford Oxford UK

2. Department of Neurology, John Radcliffe Hospital Oxford University Hospitals Oxford UK

3. Departments of Neurology and Neurosciences Mayo Clinic Jacksonville Florida USA

4. Encephalitis Society Malton UK

5. Department of Clinical Infection, Microbiology, and Immunology University of Liverpool Liverpool UK

Abstract

AbstractBackground and purposeDespite it being an immunotherapy‐responsive neurological syndrome, patients with autoimmune encephalitis (AE) frequently exhibit residual neurobehavioural features. Here, we report criminal behaviours as a serious and novel postencephalitic association.MethodsThis retrospective cohort study included 301 AE patients. Five of who committed crimes underwent direct assessments and records review alongside autoantibody studies.ResultsFive of 301 patients (1.7%) with AE exhibited criminal behaviours, which included viewing child pornography (n = 3), repeated shoplifting, and conspiracy to commit murder. All five were adult males, with LGI1 autoantibodies (n = 3), CASPR2 autoantibodies, or seronegative AE. None had evidence of premorbid antisocial personality traits or psychiatric disorders. Criminal behaviours began a median of 18 months (range = 15 months–12 years) after encephalitis onset. At the time of crimes, two patients were immunotherapy‐naïve, three had been administered late immunotherapies (at 5 weeks–4 months), many neurobehavioural features persisted, and new obsessive behaviours had appeared. However, cognition, seizure, and disability measures had improved, alongside reduced autoantibody levels.ConclusionsCriminal behaviours are a rare, novel, and stigmatizing residual neurobehavioural phenotype in AE, with significant social and legal implications. With caution towards overattribution, we suggest they occur as part of a postencephalitis limbic neurobehavioural syndrome.

Funder

Medical Research Council

Wellcome Trust

British Medical Association

Epilepsy Research UK

National Institute for Health and Care Research

Publisher

Wiley

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