Study Of Clinical Characteristics And Electroencephalography Features Of Neuronal Surface Antibody-associated Encephalitis

Objective:Systemic review and analysis of neuronal surface antibody(NSAb)-associated encephalitis is quite rare in literature. Early recognition of these syndromes, reliable methods of diagnosis, and immediate targeted immunotherapy could lead to a significant satisfying outcome and dramatically decrease the associated morbidity and mortality if left untreated. By investigating and analyzing the clinical manifestations and electroencephalography (EEG) results of a series of cases, we try to conclude typical common features of several types of NSAb-associated encephalitis and factors that may contribute to their prognosis. Thus, it might be helpful for future clinical reference.Method:Patients who were clinically diagnosed with NSAb-associated encephalitis from January of2014to February of2015in the Second Affiliated Hospital of Zhejiang University were included in this investigation. Retrospective review of patients’medical records, analysis of work-ups, especially EEG, and2-to14-month long follow-ups were performed. Meanwhile, the clinical presentations, imaging findings, EEG features and outcome of autoimmune encephalitis were analyzed according to the data from our patients and the review of the literature. Results:According to clinical manifestations, which were consistent with encephalitis presentations and positive results of neuronal surface antibodies in cerebrospinal fluids,13patients were included in this cohort. Among these patients,2of them were proved to have leucine-rich glioma inactivated-1(LGI1) antibody encephalitis, while8of them got diagnosis of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis. And the other3had γ-aminobutyric acid B receptor (GABABR) antibody encephalitis. All the patients mentioned above presented with episodes of seizures, cognitive and memory dysfunction and behavioral abnormalities, and only one of them had a systemic tumor complication. Almost all of them responded well to immunotherapies.Conclusions:Due to its untypical seizure episodes and neuropsychiatric symptoms, it is indeed difficult and confusing to recognize and diagnose NSAb-associated encephalitis. And traditional management toward encephalitis doesn’t work well with it. Physicians should pay extra attentions to this kind of patients so as to make diagnosis and initiate immunotherapy as early as possible by taking laboratory results, image findings, and EEG features into considerations.