Clinical manifestations and immunomodulatory treatment experiences in psychiatric patients with suspected autoimmune encephalitis: a case series of 91 patients from Germany
-
Published:2022-01-19
Issue:3
Volume:27
Page:1479-1489
-
ISSN:1359-4184
-
Container-title:Molecular Psychiatry
-
language:en
-
Short-container-title:Mol Psychiatry
Author:
Endres DominiqueORCID, Lüngen Eva, Hasan Alkomiet, Kluge MichaelORCID, Fröhlich Sabrina, Lewerenz Jan, Bschor Tom, Haußleiter Ida Sibylle, Juckel Georg, Then Bergh Florian, Ettrich Barbara, Kertzscher Lisa, Oviedo-Salcedo Tatiana, Handreka Robert, Lauer Martin, Winter Klaas, Zumdick Norbert, Drews Anna, Obrocki Jost, Yalachkov Yavor, Bubl Anna, von Podewils Felix, Schneider Udo, Szabo Kristina, Mattern Margarete, Philipsen Alexandra, Domschke Katharina, Wandinger Klaus-Peter, Neyazi Alexandra, Stich Oliver, Prüss HaraldORCID, Leypoldt Frank, Tebartz van Elst LudgerORCID
Abstract
AbstractAutoimmune encephalitis (AE) can rarely manifest as a predominantly psychiatric syndrome without overt neurological symptoms. This study’s aim was to characterize psychiatric patients with AE; therefore, anonymized data on patients with suspected AE with predominantly or isolated psychiatric syndromes were retrospectively collected. Patients with readily detectable neurological symptoms suggestive of AE (e.g., epileptic seizures) were excluded. Patients were classified as “probable psychiatric AE (pAE),” if well-characterized neuronal IgG autoantibodies were detected or “possible pAE” (e.g., with detection of nonclassical neuronal autoantibodies or compatible cerebrospinal fluid (CSF) changes). Of the 91 patients included, 21 (23%) fulfilled our criteria for probable (autoantibody-defined) pAE and 70 (77%) those for possible pAE. Among patients with probable pAE, 90% had anti-NMDA receptor (NMDA-R) autoantibodies. Overall, most patients suffered from paranoid-hallucinatory syndromes (53%). Patients with probable pAE suffered more often from disorientation (p < 0.001) and impaired memory (p = 0.001) than patients with possible pAE. Immunotherapies were performed in 69% of all cases, mostly with high-dose corticosteroids. Altogether, 93% of the patients with probable pAE and 80% of patients with possible pAE reportedly benefited from immunotherapies (p = 0.251). In summary, this explorative, cross-sectional evaluation confirms that autoantibody-associated AE syndromes can predominantly manifest as psychiatric syndromes, especially in anti-NMDA-R encephalitis. However, in three out of four patients, diagnosis of possible pAE was based on nonspecific findings (e.g., slight CSF pleocytosis), and well-characterized neuronal autoantibodies were absent. As such, the spectrum of psychiatric syndromes potentially responding to immunotherapies seems not to be limited to currently known autoantibody-associated AE. Further trials are needed.
Publisher
Springer Science and Business Media LLC
Subject
Cellular and Molecular Neuroscience,Psychiatry and Mental health,Molecular Biology
Reference35 articles.
1. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15:391–404. https://doi.org/10.1016/S1474-4422(15)00401-9. 2. Kayser MS, Titulaer MJ, Gresa-Arribas N, Dalmau J. Frequency and characteristics of isolated psychiatric episodes in anti–N-methyl-d-aspartate receptor encephalitis. JAMA Neurol. 2013;70:1133–9. https://doi.org/10.1001/jamaneurol.2013.3216. 3. Endres D, Maier V, Leypoldt F, Wandinger KP, Lennox B, Pollak TA, et al. Autoantibody-associated psychiatric syndromes: a systematic literature review resulting in 145 cases. Psychol Med. 2020:1–12. https://doi.org/10.1017/S0033291720002895. 4. Endres D, Meixensberger S, Dersch R, Feige B, Stich O, Venhoff N, et al. Cerebrospinal fluid, antineuronal autoantibody, EEG, and MRI findings from 992 patients with schizophreniform and affective psychosis. Transl Psychiatry. 2020;10:279. https://doi.org/10.1038/s41398-020-00967-3. 5. Endres D, Prüss H, Rauer S, Süß P, Venhoff N, Feige B, et al. Probable autoimmune catatonia with antibodies against cilia on hippocampal granule cells and highly suspicious cerebral FDG-PET findings. Biol Psychiatry. 2020;S0006-3223:31982–1. https://doi.org/10.1016/j.biopsych.2019.12.020.
Cited by
28 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|