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Autoimmune encephalitis and seizures, cerebrospinal fluid, imaging, and EEG findings: a case series

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Abstract

Antibody-mediated encephalitides constitute a group of inflammatory brain diseases characterized by prominent neuropsychiatric symptoms and are associated with antibodies against neuronal cell-surface proteins, ion channels, or receptors. The diagnosis and management of autoimmune encephalitis include evaluation of the clinical presentation, brain imaging, cerebrospinal fluid (CSF) findings, antibody detection, and electroencephalography (EEG) findings. This is a retrospective study of adults 18 years or older with autoimmune encephalitis due to antibodies against membrane surface antigens as well as anti-glutamic acid decarboxylase (anti-GAD) antibodies. The electronic medical record was reviewed for demographic data, clinical data, laboratory results, EEG, and imaging findings. Antibody screening was requested for 341 patients between May 2014 and December 2019. Antibody screening was positive in 37 patients presenting with seizures and/or encephalopathy. Of these, 10 patients tested positive for antibodies against neuronal surface antigens or anti-GAD antibodies―2 patients had anti-GAD antibody encephalitis, 5 had anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, and 3 had anti-leucine-rich glioma-inactivated 1 (anti-LGI1) encephalitis. Demographics, clinical presentation, EEG, imaging, and CSF findings are reported. Autoimmune encephalitides are a diverse group of disorders with a few common clinical features and MRI findings. MRI, EEG, and CSF findings can be normal or show nonspecific findings in autoimmune encephalitis. Therefore, early diagnosis of these disorders requires a high level of suspicion to avoid delaying the diagnosis. Carefully looking for diagnostic clinical features (e.g., faciobrachial dystonic seizures in anti-LGI1 encephalitis), significant findings in MRI (e.g., limbic encephalitis), and some EEG patterns (e.g., extreme delta brush and generalized rhythmic delta activity in anti-NMDAR encephalitis) may help in early diagnosis.

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Authors and Affiliations

  1. Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Hisham Elkhider, Rohan Sharma, Nidhi Kapoor & Bashir Shihabuddin

  2. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Surjith Vattoth

  3. Neurology Section, Central Arkansas Veterans Healthcare System, Little Rock, AR, USA

    Bashir Shihabuddin

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  1. Hisham Elkhider
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Correspondence to Hisham Elkhider.

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This research study was conducted retrospectively from data obtained for clinical purposes. The study was approved by the University of Arkansas IRB.

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The need for an informed consent was waved by the University of Arkansas IRB because this is a restrospective chart review study. No data with identifying information is used in the study.

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The manuscript has not been published and is not in consideration for publication in any other journal or for pre-publication. The corresponding author takes full responsibility for the data, the analyses and interpretation, and the conduct of the study. All authors had full access to all of the data. I have the right to publish any and all data separate and apart from any sponsor.

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Elkhider, H., Sharma, R., Kapoor, N. et al. Autoimmune encephalitis and seizures, cerebrospinal fluid, imaging, and EEG findings: a case series. Neurol Sci 43, 2669–2680 (2022). https://doi.org/10.1007/s10072-021-05617-0

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  • DOI: https://doi.org/10.1007/s10072-021-05617-0

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