Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations-Reference-Cited by-同舟云学术

Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations

Published:2024-07 Issue:07 Volume:82 Page:001-015
ISSN:0004-282X
Container-title:Arquivos de Neuro-Psiquiatria
language:en
Short-container-title:Arq Neuropsiquiatr

Author:

Dutra Lívia Almeida¹^ORCID,Silva Pedro Victor de Castro¹^ORCID,Ferreira João Henrique Fregadolli¹^ORCID,Marques Alexandre Coelho¹^ORCID,Toso Fabio Fieni¹^ORCID,Vasconcelos Claudia Cristina Ferreira²^ORCID,Brum Doralina Guimarães³^ORCID,Pereira Samira Luisa dos Apóstolos⁴^ORCID,Adoni Tarso⁴^ORCID,Rocha Leticia Januzi de Almeida⁵^ORCID,Sampaio Leticia Pereira de Brito⁶^ORCID,Sousa Nise Alessandra de Carvalho⁷^ORCID,Paolilo Renata Barbosa⁶^ORCID,Pizzol Angélica Dal⁸^ORCID,Costa Bruna Klein da^ORCID,Disserol Caio César Diniz^ORCID,Pupe Camila⁹^ORCID,Valle Daniel Almeida do¹⁰^ORCID,Diniz Denise Sisterolli¹¹^ORCID,Abrantes Fabiano Ferreira de¹²^ORCID,Schmidt Felipe da Rocha¹³^ORCID,Cendes Fernando¹⁴^ORCID,Oliveira Francisco Tomaz Meneses de¹⁵^ORCID,Martins Gabriela Joca¹⁶^ORCID,Silva Guilherme Diogo⁴^ORCID,Lin Katia¹⁷^ORCID,Pinto Lécio Figueira⁴^ORCID,Santos Mara Lúcia Schimtz Ferreira¹⁰^ORCID,Gonçalves Marcus Vinícius Magno¹⁸^ORCID,Krueger Mariana Braatz¹⁹^ORCID,Haziot Michel Elyas Jung¹⁵^ORCID,Barsottini Orlando Graziani Povoas¹²^ORCID,Nascimento Osvaldo José Moreira do^ORCID,Nóbrega Paulo Ribeiro²⁰^ORCID,Proveti Priscilla Mara²¹^ORCID,Castilhos Raphael Machado do²²^ORCID,Daccach Vanessa²³^ORCID,Glehn Felipe von²⁰^ORCID

Affiliation:

1. Hospital Israelita Albert Einstein, Instituto do Cérebro, São Paulo, São Paulo SP, Brazil.

2. Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro RJ, Brazil.

3. Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Neurologia, Psicologia e Psiquiatria, Botucatu SP, Brazil.

4. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.

5. Universidade Federal de Alagoas, Hospital Universitário, Maceió AL, Brazil.

6. Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo SP, Brazil.

7. Universidade Federal do Amazonas, Manaus AM, Brazil.

8. Hospital Moinhos de Vento, Departamento de Neurologia, Porto Alegre RS, Brazil.

9. Universidade Federal Fluminense, Niterói RJ, Brazil.

10. Hospital Pequeno Príncipe, Curitiba PR, Brazil.

11. Universidade Federal de Goiás, Goiânia GO, Brazil.

12. Universidade Federal de São Paulo, São Paulo SP, Brazil.

13. Universidade do Estado do Rio de Janeiro, Rio de Janeiro RJ, Brazil.

14. Universidade Estadual de Campinas, Campinas SP, Brazil.

15. Santa Casa de Misericórdia de São Paulo, São Paulo SP, Brazil.

16. Hospital Geral de Fortaleza, Fortaleza CE, Brazil.

17. Universidade Federal de Santa Catarina, Florianópolis SC, Brazil.

18. Universidade da Região de Joinville, Joinville SC, Brazil.

19. Hospital Infantil Albert Sabin, Fortaleza CE, Brazil.

20. Universidade Federal do Ceará, Fortaleza CE, Brazil.

21. Universidade de Brasília, Faculdade de Medicina, Brasília DF, Brazil.

22. Hospital de Clínicas de Porto Alegre, Porto Alegre RS, Brazil.

23. Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto SP, Brazil.

Abstract

Abstract Background Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. Objective With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. Methods A total of 25 panelists, including adult and child neurologists, participated in the study. Results The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusion The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.

Publisher

Georg Thieme Verlag KG

Link

http://www.thieme-connect.de/products/ejournals/pdf/10.1055/s-0044-1788586.pdf

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