Autoimmune Encephalitis and Its Relation to Infection

  • Arun Venkatesan
  • David R. Benavides
Infection (ML Solbrig, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Infection


Encephalitis, an inflammatory condition of the brain that results in substantial morbidity and mortality, has numerous causes. Over the past decade, it has become increasingly recognized that autoimmune conditions contribute significantly to the spectrum of encephalitis causes. Clinical suspicion and early diagnosis of autoimmune etiologies are of particular importance due to the need for early institution of immune suppressive therapies to improve outcome. Emerging clinical observations suggest that the most commonly recognized cause of antibody-mediated autoimmune encephalitis, anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, may in some cases be triggered by herpes virus infection. Other conditions such as Rasmussen’s encephalitis (RE) and febrile infection-related epilepsy syndrome (FIRES) have also been posited to be autoimmune conditions triggered by infectious agents. This review focuses on emerging concepts in central nervous system autoimmunity and addresses clinical and mechanistic findings linking autoimmune encephalitis and infections. Particular consideration will be given to anti-NMDA receptor encephalitis and its relation to herpes simplex encephalitis.


Autoimmune encephalopathy CNS autoimmunity Anti-NMDA receptor antibodies FIRES Rasmussen’s syndrome Molecular mimicry 



David R. Benavides is supported by NINDS T32 training grant in neuroimmunology and neurological infectious disease (T32NS069351).

Arun Venkatesan receives support from the National Institutes of Health, Maryland Stem Cell Research Fund, and Accelerated Cure Project for Multiple Sclerosis.

Compliance with Ethics Guidelines

Conflict of Interest

Arun Venkatesan and David R. Benavides declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Tunkel AR, Glaser CA, Bloch KC, Sejvar JJ, Marra CM, Roos KL, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47:303–27.CrossRefPubMedGoogle Scholar
  2. 2.
    Venkatesan A, Tunkel AR, Bloch KC, Lauring AS, Sejvar J, Bitnun A, et al. Case definitions, diagnostic algorithms, and priorities in encephalitis: consensus statement of the international encephalitis consortium. Clin Infect Dis. 2013;57:1114–28.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Sejvar JJ, Kohl KS, Bilynsky R, Blumberg D, Cvetkovich T, Galama J, et al. Encephalitis, myelitis, and acute disseminated encephalomyelitis (ADEM): case definitions and guidelines for collection, analysis, and presentation of immunization safety data. Vaccine. 2007;25:5771–92.CrossRefPubMedGoogle Scholar
  4. 4.
    Granerod J, Ambrose HE, Davies NW, Clewley JP, Walsh AL, Morgan D, et al. Causes of encephalitis and differences in their clinical presentations in England: a multicentre, population-based prospective study. Lancet Infect Dis. 2010;10:835–44.CrossRefPubMedGoogle Scholar
  5. 5.
    Kolski H, Ford-Jones EL, Richardson S, Petric M, Nelson S, Jamieson F, et al. Etiology of acute childhood encephalitis at The Hospital for Sick Children, Toronto, 1994-1995. Clin Infect Dis. 1998;26:398–409.CrossRefPubMedGoogle Scholar
  6. 6.
    Ball R, Halsey N, Braun MM, Moulton LH, Gale AD, Rammohan K, et al. Development of case definitions for acute encephalopathy, encephalitis, and multiple sclerosis reports to the vaccine: Adverse Event Reporting System. J Clin Epidemiol. 2002;55:819–24.CrossRefPubMedGoogle Scholar
  7. 7.
    Mailles A, Stahl JP. Infectious encephalitis in France in 2007: a national prospective study. Clin Infect Dis. 2009;49:1838–47.CrossRefPubMedGoogle Scholar
  8. 8.
    Granerod J, Cousens S, Davies NW, Crowcroft NS, Thomas SL. New estimates of incidence of encephalitis in England. In: Emerg Infect Dis [Internet]. Edited by; 2013;19(9).
  9. 9.
    George BP, Schneider EB, Venkatesan A. Encephalitis hospitalization rates and inpatient mortality in the United States, 2000-2010. PLoS One. 2014;9:e104169.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Glaser CA, Honarmand S, Anderson LJ, Schnurr DP, Forghani B, Cossen CK, et al. Beyond viruses: clinical profiles and etiologies associated with encephalitis. Clin Infect Dis. 2006;43:1565–77.CrossRefPubMedGoogle Scholar
  11. 11.
    Mailles A, Stahl JP, Group SCaI. Infectious encephalitis in France in 2007: a national prospective study. Clin Infect Dis. 2009;49:1838–47.CrossRefPubMedGoogle Scholar
  12. 12.
    Graus F, Dalmau J. Paraneoplastic neurological syndromes. Curr Opin Neurol. 2012;25:795–801.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Irani SR, Gelfand JM, Al-Diwani A, Vincent A. Cell-surface central nervous system autoantibodies: clinical relevance and emerging paradigms. Ann Neurol. 2014;76:168–84.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Thakur KT, Motta M, Asemota AO, Kirsch HL, Benavides DR, Schneider EB, et al. Predictors of outcome in acute encephalitis. Neurology. 2013;81:793–800.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.•
    Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol. 2013;12:157–65. A large observational study of 577 patients, including 211 pediatric patients, with anti-NMDAR antibodies provides data on response to therapy, longitudinal outcomes, and prognostic factors.Google Scholar
  16. 16.
    Venkatesan A, Geocadin RG. Diagnosis and management of acute encephalitis: a practical approach. Neurol Clin Pract. 2014;4:206–15.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Miller FW, Pollard KM, Parks CG, Germolec DR, Leung PS, Selmi C, et al. Criteria for environmentally associated autoimmune diseases. J Autoimmun. 2012;39:253–8.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Atassi MZ, Casali P. Molecular mechanisms of autoimmunity. Autoimmunity. 2008;41:123–32.CrossRefPubMedGoogle Scholar
  19. 19.
    Ransohoff RM, Engelhardt B. The anatomical and cellular basis of immune surveillance in the central nervous system. Nat Rev Immunol. 2012;12:623–35.CrossRefPubMedGoogle Scholar
  20. 20.
    Kapadia M, Sakic B. Autoimmune and inflammatory mechanisms of CNS damage. Prog Neurobiol. 2011;95:301–33.CrossRefPubMedGoogle Scholar
  21. 21.
    Venkatesan A, Johnson RT. Infections and multiple sclerosis. Handb Clin Neurol. 2014;122:151–71.CrossRefPubMedGoogle Scholar
  22. 22.
    Fujinami RS, von Herrath MG, Christen U, Whitton JL. Molecular mimicry, bystander activation, or viral persistence: infections and autoimmune disease. Clin Microbiol Rev. 2006;19:80–94.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Coutinho A, Kazatchkine MD, Avrameas S. Natural autoantibodies. Curr Opin Immunol. 1995;7:812–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Alves-Leon SV, Veluttini-Pimentel ML, Gouveia ME, Malfetano FR, Gaspareto EL, Alvarenga MP, et al. Acute disseminated encephalomyelitis: clinical features, HLA DRB1*1501, HLA DRB1*1503, HLA DQA1*0102, HLA DQB1*0602, and HLA DPA1*0301 allelic association study. Arq Neuropsiquiatr. 2009;67:643–51.CrossRefPubMedGoogle Scholar
  25. 25.
    Shwetank, Date OS, Kim KS, Manjunath R. Infection of human endothelial cells by Japanese encephalitis virus: increased expression and release of soluble HLA-E. PLoS One. 2013;8(11):e79197.Google Scholar
  26. 26.
    Clarke P, Leser JS, Bowen RA, Tyler KL. Virus-induced transcriptional changes in the brain include the differential expression of genes associated with interferon, apoptosis, interleukin 17 receptor A, and glutamate signaling as well as flavivirus-specific upregulation of tRNA synthetases. MBio. 2014;5:e00902–14.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Gregersen PK, Behrens TW. Genetics of autoimmune diseases—disorders of immune homeostasis. Nat Rev Genet. 2006;7:917–28.CrossRefPubMedGoogle Scholar
  28. 28.
    de Aquino MT, Kapil P, Hinton DR, Phares TW, Puntambekar SS, Savarin C, et al. IL-27 limits central nervous system viral clearance by promoting IL-10 and enhances demyelination. J Immunol. 2014;193:285–94.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Cervantes-Barragán L, Firner S, Bechmann I, Waisman A, Lahl K, Sparwasser T, et al. Regulatory T cells selectively preserve immune privilege of self-antigens during viral central nervous system infection. J Immunol. 2012;188:3678–85.CrossRefPubMedGoogle Scholar
  30. 30.
    Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011;10:63–74.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis in children and adolescents. Ann Neurol. 2009;66:11–8.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Iizuka T, Sakai F, Ide T, Monzen T, Yoshii S, Iigaya M, et al. Anti-NMDA receptor encephalitis in Japan: long-term outcome without tumor removal. Neurology. 2008;70:504–11.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Irani SR, Bera K, Waters P, Zuliani L, Maxwell S, Zandi MS, et al. N-methyl-d-aspartate antibody encephalitis: temporal progression of clinical and paraclinical observations in a predominantly non-paraneoplastic disorder of both sexes. Brain. 2010;133:1655–67.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Gable MS, Gavali S, Radner A, Tilley DH, Lee B, Dyner L, et al. Anti-NMDA receptor encephalitis: report of ten cases and comparison with viral encephalitis. Eur J Clin Microbiol Infect Dis. 2009;28:1421–9.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.••
    Prüss H, Finke C, Höltje M, Hofmann J, Klingbeil C, Probst C, et al. N-methyl-d-aspartate receptor antibodies in herpes simplex encephalitis. Ann Neurol. 2012;72:902–11. This is the first report of anti-NMDAR antibodies in patients with herpes simplex encephalitis with retrospective analysis of 44 patients with proven HSE, 13 of which were found to have anti-NMDAR in the course of HSE.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Leypoldt F, Titulaer MJ, Aguilar E, Walther J, Bönstrup M, Havemeister S, et al. Herpes simplex virus-1 encephalitis can trigger anti-NMDA receptor encephalitis: case report. Neurology. 2013;81:1637–9.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Desena A, Graves D, Warnack W, Greenberg BM. Herpes simplex encephalitis as a potential cause of anti-N-methyl-d-aspartate receptor antibody encephalitis: report of 2 cases. JAMA Neurol. 2014;71:344–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Wickström R, Fowler A, Cooray G, Karlsson-Parra A, Grillner P. Viral triggering of anti-NMDA receptor encephalitis in a child—an important cause for disease relapse. Eur J Paediatr Neurol. 2014;18:543–6.CrossRefPubMedGoogle Scholar
  39. 39.
    Mohammad SS, Sinclair K, Pillai S, Merheb V, Aumann TD, Gill D, et al. Herpes simplex encephalitis relapse with chorea is associated with autoantibodies to N-methyl-d-aspartate receptor or dopamine-2 receptor. Mov Disord. 2014;29:117–22.CrossRefPubMedGoogle Scholar
  40. 40.
    Bektaş O, Tanyel T, Kocabaş BA, Fitöz S, Ince E, Deda G. Anti-N-methyl-d-aspartate receptor encephalitis that developed after herpes encephalitis: a case report and literature review. Neuropediatrics. 2014;45(6):396–401.Google Scholar
  41. 41.
    Hacohen Y, Deiva K, Pettingill P, Waters P, Siddiqui A, Chretien P, et al. N-methyl-d-aspartate receptor antibodies in post-herpes simplex virus encephalitis neurological relapse. Mov Disord. 2014;29:90–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Armangue T, Titulaer MJ, Málaga I, Bataller L, Gabilondo I, Graus F, Dalmau J, Group SA-N-m-D-ARNEW: pediatric anti-N-methyl-d-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients. J Pediatr. 2013;162:850–856:e852.Google Scholar
  43. 43.••
    Armangue T, Leypoldt F, Málaga I, Raspall-Chaure M, Marti I, Nichter C, et al. Herpes simplex virus encephalitis is a trigger of brain autoimmunity. Ann Neurol. 2014;75:317–23. This series of patients with “relapsing post-HSE” and well-characterized serum and CSF contributes to our understanding of the timing and nature of the interaction between HSE, NMDAR antibodies, and a post-HSE immune syndrome.CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol. 2008;7:1091–8.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.•
    Gleichman AJ, Spruce LA, Dalmau J, Seeholzer SH, Lynch DR. Anti-NMDA receptor encephalitis antibody binding is dependent on amino acid identity of a small region within the GluN1 amino terminal domain. J Neurosci. 2012;32:11082–94. The N368/G369 region of GluN1 is identified as crucial for anti-NMDAR antibody immunoreactivity, and it is shown that antibody binding alters receptor function by increasing open channel time.CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Planagumà J, Leypoldt F, Mannara F, Gutiérrez-Cuesta J, Martín-García E, Aguilar E, Titulaer MJ, Petit-Pedrol M, Jain A, Balice-Gordon R,Lakadamyali M, Graus F, Maldonado R, Dalmau J. Human N-methyl-d-aspartate receptor antibodies alter memory and behaviour in mice. Brain. 2015;138(Pt 1):94–109.Google Scholar
  47. 47.
    Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. J Neurosci. 2010;30:5866–75.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.•
    Moscato EH, Peng X, Jain A, Parsons TD, Dalmau J, Balice-Gordon RJ. Acute mechanisms underlying antibody effects in anti-N-methyl-d-aspartate receptor encephalitis. Ann Neurol. 2014;76:108–19. Using dissociated neuronal culture, the authors provide biochemical and electrophysiological evidence of antibody-mediated downregulation of surface NMDARs independent of NMDAR activity, and show evidence of homeostatic synaptic plasticity mechanisms with a decrease in inhibitory synapse density onto excitatory hippocampal neurons.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.•
    Mikasova L, De Rossi P, Bouchet D, Georges F, Rogemond V, Didelot A, et al. Disrupted surface cross-talk between NMDA and Ephrin-B2 receptors in anti-NMDA encephalitis. Brain. 2012;135:1606–21. High-resolution nanoparticle imaging and live imaging is used to shed light on cellular and molecular mechanisms of anti-NMDAR autoantibody pathogenic mechanisms, implicating dysfunction of NMDAR-EphB2R interactions in the trafficking abnormalities of synaptic and extrasynaptic NMDAR.Google Scholar
  50. 50.
    Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Ann N Y Acad Sci. 2014;1–21.Google Scholar
  51. 51.
    Armangue T, Titulaer MJ, Sabater L, Pardo-Moreno J, Gresa-Arribas N, Barbero-Bordallo N, et al. A novel treatment-responsive encephalitis with frequent opsoclonus and teratoma. Ann Neurol. 2014;75:435–41.CrossRefPubMedGoogle Scholar
  52. 52.
    Panzer JA, Gleichman AJ, Lynch DR. Glutamatergic autoencephalitides: an emerging field. J Neural Transm. 2014;121:957–68.CrossRefPubMedGoogle Scholar
  53. 53.
    Bien CG, Granata T, Antozzi C, Cross JH, Dulac O, Kurthen M, et al. Pathogenesis, diagnosis and treatment of Rasmussen encephalitis: a European consensus statement. Brain. 2005;128:454–71.CrossRefPubMedGoogle Scholar
  54. 54.
    Varadkar S, Bien CG, Kruse CA, Jensen FE, Bauer J, Pardo CA, et al. Rasmussen’s encephalitis: clinical features, pathobiology, and treatment advances. Lancet Neurol. 2014;13:195–205.CrossRefPubMedCentralPubMedGoogle Scholar
  55. 55.
    RASMUSSEN T, OLSZEWSKI J, LLOYDSMITH D. Focal seizures due to chronic localized encephalitis. Neurology. 1958;8:435–45.CrossRefPubMedGoogle Scholar
  56. 56.
    Rogers SW, Andrews PI, Gahring LC, Whisenand T, Cauley K, Crain B, et al. Autoantibodies to glutamate receptor GluR3 in Rasmussen’s encephalitis. Science. 1994;265:648–51.CrossRefPubMedGoogle Scholar
  57. 57.
    Wiendl H, Bien CG, Bernasconi P, Fleckenstein B, Elger CE, Dichgans J, et al. GluR3 antibodies: prevalence in focal epilepsy but no specificity for Rasmussen’s encephalitis. Neurology. 2001;57:1511–4.CrossRefPubMedGoogle Scholar
  58. 58.
    Mantegazza R, Bernasconi P, Baggi F, Spreafico R, Ragona F, Antozzi C, et al. Antibodies against GluR3 peptides are not specific for Rasmussen’s encephalitis but are also present in epilepsy patients with severe, early onset disease and intractable seizures. J Neuroimmunol. 2002;131:179–85.CrossRefPubMedGoogle Scholar
  59. 59.
    Watson R, Jiang Y, Bermudez I, Houlihan L, Clover L, McKnight K, et al. Absence of antibodies to glutamate receptor type 3 (GluR3) in Rasmussen encephalitis. Neurology. 2004;63:43–50.CrossRefPubMedGoogle Scholar
  60. 60.
    Watson R, Jepson JE, Bermudez I, Alexander S, Hart Y, McKnight K, et al. Alpha7-acetylcholine receptor antibodies in two patients with Rasmussen encephalitis. Neurology. 2005;65:1802–4.CrossRefPubMedGoogle Scholar
  61. 61.
    Yang R, Puranam RS, Butler LS, Qian WH, He XP, Moyer MB, et al. Autoimmunity to munc-18 in Rasmussen’s encephalitis. Neuron. 2000;28:375–83.CrossRefPubMedGoogle Scholar
  62. 62.
    Bien CG, Bauer J, Deckwerth TL, Wiendl H, Deckert M, Wiestler OD, et al. Destruction of neurons by cytotoxic T cells: a new pathogenic mechanism in Rasmussen’s encephalitis. Ann Neurol. 2002;51:311–8.CrossRefPubMedGoogle Scholar
  63. 63.
    Schwab N, Bien CG, Waschbisch A, Becker A, Vince GH, Dornmair K, et al. CD8+ T-cell clones dominate brain infiltrates in Rasmussen encephalitis and persist in the periphery. Brain. 2009;132:1236–46.CrossRefPubMedGoogle Scholar
  64. 64.••
    Owens GC, Huynh MN, Chang JW, McArthur DL, Hickey MJ, Vinters HV, et al. Differential expression of interferon-γ and chemokine genes distinguishes Rasmussen encephalitis from cortical dysplasia and provides evidence for an early Th1 immune response. J Neuroinflammation. 2013;10:56. Brain tissue from patients with RE subjected to quantitative PCR was found to express high levels of Th1-associated genes in the early symptomatic phase of disease, suggesting a role for the Th1 immune response in the pathogenesis of RE.CrossRefPubMedCentralPubMedGoogle Scholar
  65. 65.
    Friedman H, Ch'ien L, Parham D. Virus in brain of child with hemiplegia, hemiconvulsions, and epilepsy. Lancet. 1977;2:666.CrossRefPubMedGoogle Scholar
  66. 66.
    Jay V, Becker LE, Otsubo H, Cortez M, Hwang P, Hoffman HJ, et al. Chronic encephalitis and epilepsy (Rasmussen’s encephalitis): detection of cytomegalovirus and herpes simplex virus 1 by the polymerase chain reaction and in situ hybridization. Neurology. 1995;45:108–17.CrossRefPubMedGoogle Scholar
  67. 67.
    Power C, Poland SD, Blume WT, Girvin JP, Rice GP. Cytomegalovirus and Rasmussen’s encephalitis. Lancet. 1990;336:1282–4.CrossRefPubMedGoogle Scholar
  68. 68.
    Walter GF, Renella RR. Epstein-Barr virus in brain and Rasmussen’s encephalitis. Lancet. 1989;1:279–80.CrossRefPubMedGoogle Scholar
  69. 69.
    Vinters HV, Wang R, Wiley CA. Herpesviruses in chronic encephalitis associated with intractable childhood epilepsy. Hum Pathol. 1993;24:871–9.CrossRefPubMedGoogle Scholar
  70. 70.
    Berg AT, Berkovic SF, Brodie MJ, Buchhalter J, Cross JH, van Emde Boas W, et al. Revised terminology and concepts for organization of seizures and epilepsies: report of the ILAE Commission on Classification and Terminology, 2005-2009. Epilepsia. 2010;51(4):676–85.Google Scholar
  71. 71.
    van Baalen A, Häusler M, Boor R, Rohr A, Sperner J, Kurlemann G, et al. Febrile infection-related epilepsy syndrome (FIRES): a nonencephalitic encephalopathy in childhood. Epilepsia. 2010;51:1323–8.CrossRefPubMedGoogle Scholar
  72. 72.••
    Kramer U, Chi CS, Lin KL, Specchio N, Sahin M, Olson H, et al. Febrile infection-related epilepsy syndrome (FIRES): pathogenesis, treatment, and outcome: a multicenter study on 77 children. Epilepsia. 2011;52:1956–65. This retrospective multicenter study identified the largest group of children to date who fit criteria for FIRES. The clinical presentations, results of serologic and CSF testing, and neuroimaging results are comprehensively presented.CrossRefPubMedGoogle Scholar
  73. 73.
    Illingworth MA, Hanrahan D, Anderson CE, O'Kane K, Anderson J, Casey M, et al. Elevated VGKC-complex antibodies in a boy with fever-induced refractory epileptic encephalopathy in school-age children (FIRES). Dev Med Child Neurol. 2011;53:1053–7.CrossRefPubMedGoogle Scholar
  74. 74.
    van Baalen A, Häusler M, Plecko-Startinig B, Strautmanis J, Vlaho S, Gebhardt B, et al. Febrile infection-related epilepsy syndrome without detectable autoantibodies and response to immunotherapy: a case series and discussion of epileptogenesis in FIRES. Neuropediatrics. 2012;43:209–16.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Johns Hopkins Encephalitis Center, Department of NeurologyJohns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations