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Antibody Negative Autoimmune Encephalitis- Does it Differ from Definite One?

Sunil Pradhan1, Animesh Das1, Ananya Das1

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Annals of Indian Academy of Neurology
|November 19, 2019
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Summary
This summary is machine-generated.

Autoimmune encephalitis (AE) patients without antibodies show similar clinical features and treatment responses to those with antibodies. Early immunotherapy is recommended for suspected AE cases while excluding other conditions.

Keywords:
Autoimmunedefiniteencephalitisimmunotherapy

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Area of Science:

  • Neurology
  • Immunology
  • Clinical Medicine

Background:

  • Autoimmune encephalitis (AE) is an emerging cause of non-infective encephalitis with diverse presentations.
  • Diagnosis traditionally relies on detecting specific antibodies alongside suggestive clinical symptoms.

Purpose of the Study:

  • To evaluate clinical characteristics and immunotherapy response in antibody-negative AE patients.
  • To compare these findings with antibody-positive (definite) AE cases.

Main Methods:

  • Prospective follow-up study of presumptive AE patients (January 2017-January 2019) in a tertiary care institute.
  • Clinical parameters and investigations were recorded; patients received steroids and/or IVIg.
  • Follow-up assessed treatment response and relapse at 2-month intervals; statistical comparison between antibody-positive and negative groups was performed.

Main Results:

  • Out of 31 presumptive AE patients, 16 were antibody-positive (definite AE).
  • Seizures, behavioral changes, dementia, and altered sensorium were similar between groups (p > 0.05).
  • All patients showed complete or partial response to immunotherapy (p=0.716); higher CSF protein in definite AE was significant (p=0.002).
  • Malignancy was found in 2 definite AE and 1 antibody-negative AE patient.

Conclusions:

  • Antibody-negative AE cases present similarly to definite AE.
  • Similar treatment responses suggest immunotherapy is beneficial for suspected AE while excluding mimics.
  • This approach is crucial for managing this evolving neurological condition.