Autoimmune Encephalitis: Differences Of Clinical Features Between Antibody-positive And Antibody-negative Conditions

ObjectiveTo identify the differences in the clinical features of autoimmune encephalitis(AE)under different antibody states,the purpose is to promote or assist early diagnosis and clinical treatment decisions,especially antibody-negative cases.MethodsThe 42 cases of patients who have AE with definite diagnosis and antibody-negative AE diagnosed were randomly selected from the Qianfushan Hospital of Shandong Province from August 2016 to October 2018.Clinical data of assessing the prognosis factors were retrospectively collected by the electronic medical records,such as general condition,clinical manifestations,laboratory examinations,imaging examinations,treatment plans and efficacy.According to the Cerebrospinal fluid(CSF)or serum autoimmune antibody test results,the patients were divided into two groups: antibody positive and antibody negative groups.SPSS statistical software(version 20.0)were used to analyse all data.Results1.The general information of patients in two groups,including gender,age,intensive care unit(ICU)occupancy rate,and hospitalization days,showed no significant statistical differences(P>0.05).The incidence of first visited psychiatry department and previous history of immune-related injury in the antibody-positive group was higher than antibodynegative group(P<0.05);2.Prodromal symptoms in both groups was no significant difference(P>0.05),starting symptoms were difference(P<0.05),that is,the antibody-positive group with the most common mental behavior,and the antibody-negative group was the most common with seizures.The clinical manifestations were consistent.The more common symptoms in the antibody-positive group were autonomic dysfunction,mental behavior abnormality,seizure,memory loss,speech disorder,and decreased consciousness.Antibody-negative group were common symptoms of seizures,mental behavior abnormalities and autonomic dysfunction,which the exocrine gland hyperfunction in autonomic dysfunction symptoms was more common in the antibody-positive group(P<0.05);in the course of disease,the antibody-positive group showed more 4 types of symptoms,while the antibody-negative group showed more 3 types of symptoms(P<0.05);3.The CSF pressure,white blood cell count,and serum C-reactive protein increase rate were more common in the antibody-positive group(P<0.05).The magnetic resonance imaging(MRI),electroencephalography(EEG),other serum inflammatory indicators,viral infection indicators,thyroid function,tumor screening and other aspects can be seen in different degrees of abnormalities in both groups with no statistical difference(P> 0.05);4.Baseline m RS scores of antibody-positive group were higher than negative group at admission(P<0.05).And m RS in both groups were significantly lower at discharge than admission(P<0.05).There was no difference in m RS scores(P>0.05).Conclusion1.There were no differences in age,sex,ICU occupancy,length of hospital stay,prodromal symptoms,clinical manifestations,MRI,EEG,and serum indicators between the two groups;2.Antibody-positive AE combined with other immune-related diseases,more symptoms appear in the course of the disease,more abnormal test indicators,more serious neurological deficits on admission,suggesting the overall severity and complexity of antibody-positive AE Higher than antibody negative AE;3.For the most common first-episode symptoms,antibody-positive AEs are abnormal in mental behavior,while negative patients are epilepsy,resulting in a high rate of psychiatric visits in positive patients;4.Responsive to immunotherapy regardless of antibody status.Although antibody-positive patients may have more serious conditions,but the data suggest that in spite of some differences between antibody positive and negative patients,they are quite similar and perhaps should be subjected to the same rigorous treatment or management protocols.