Clinical Analysis Of Autoimmune Encephalitis

Objective:Through the analysis of Autoimmune Encephalitis(AE)cases,to discuss the clinical characteristics of AE,including Antibody type,clinical manifestations and recovery,so as to deepen the understanding of AE.Methods:The general data,clinical manifestations,auxiliary examinations,complication,treatment plan,and outcome at discharge of patients diagnosed with AE in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2020 were collected and analyzed retrospectively.m RS scoring scale was used to evaluate the condition of patients at discharge,and the patients were divided into good recovery group and bad recovery group for comparative analysis.Results:A total of 40 subjects were included,including22(55%)males and 18(45%)females,with an onset age of 1-77 years old and a median age of 23.5 years old.There were 36 cases(90%)of anti-neuron cell surface antigen antibody associated AE,including 15 cases(37.5%)of anti-NMDAR encephalitis,10cases(25%)of anti-CASPR2 encephalitis,8 cases(20%)of anti-GABA_BR encephalitis,2cases(5%)of anti-LGI-1 encephalitis,and 1 case(2.5%)of anti-AMPAR encephalitis.There were 4 cases(10%)of anti-neuron intracellular antigen antibody associated AE,3 cases(7.5%)of anti-HU antibody encephalitis,and 1 case(2.5%)of anti-MA2 antibody encephalitis.The common clinical manifestations are epileptic seizures,mental and behavioral abnormalities,and cognitive impairment.The serum and/or CSF antibodies can be positive,slow waves were observed on EEG,and unilateral and or bilateral abnormal signals were observed on head MRI.During tumor screening,1patient with anti-NMDAR encephalitis complicated with teratoma,and 1 patient with anti-GABA_BR encephalitis complicated with small cell lung cancer(SCLC).There was no significant difference in general data,clinical manifestations,routine biochemical tests of cerebrospinal fluid,head MRI and EEG between the anti-neuronal cell surface antigen antibody associated AE groups(P>0.05).There was statistical significance of anti-CASPR2 encephalitis between anti-NMDAR encephalitis,anti-GABA_BR encephalitis and other groups in the positive rate of serum and cerebrospinal fluid antibody detection(P<0.05).All patients received first-line immunotherapy,of which 29patients(72.5%)received combination therapy.On discharge,28 cases(70%)recovered well and 12(30%)cases recovered poorly,there was statistically significant difference between the two groups with complications(P<0.05).Conclusion:The onset of AE occurs at all ages,and the common clinical manifestations include epileptic seizures,mental behavior abnormalities,and cognitive impairment.Antibodies associated with autoimmune encephalitis can be detected in cerebrospinal fluid and/or serum.AE can be accompanied by tumor,anti-NMDAR encephalitis complicated with teratoma,anti-GABA_BR encephalitis complicated with SCLC etc.