Movement disorders in cell surface antibody mediated autoimmune encephalitis: a meta-analysis

Area of Science:

• Neurology
• Neuroimmunology
• Clinical Neuroscience

Background:

• Autoimmune encephalitis (AE) is a critical neuroinflammatory condition where prompt diagnosis and treatment are vital for optimal patient outcomes.
• Movement disorders are recognized clinical manifestations of AE, yet their specific characteristics and impact remain incompletely defined.
• Understanding the spectrum of movement disorders in AE is essential for improving diagnostic accuracy and therapeutic strategies.

Approach:

• A systematic review and random-effects meta-analysis was performed to investigate movement disorders in cell surface antibody-mediated AE.
• Data from 37 studies, encompassing 1,192 reviewed titles and abstracts, were analyzed, focusing on adult patients (≥18 years) with at least 10 described cases.
• Searches were conducted across Medline, EMBASE, APA Psychinfo, and the Cochrane library to ensure comprehensive data retrieval.

Key Points:

• Movement disorders were identified in 40% of the overall AE cohort, with higher frequencies observed in anti-NMDA receptor antibody (53%) and anti-LGI1 antibody (30%) associated AE.
• Dyskinesia was the predominant movement disorder in anti-NMDA receptor antibody encephalitis, while faciobrachial dystonic seizures were most common in anti-LGI1 antibody encephalitis.
• Patients presenting with movement disorders showed a trend towards increased mortality, although the risk of bias in the included studies was generally moderate to high.

Conclusions:

• Movement disorders are a frequent clinical feature in autoimmune encephalitis, contributing to the diagnostic landscape.
• The presence of movement disorders may serve as an important indicator for earlier AE diagnosis when considered alongside other clinical and paraclinical findings.
• Further dedicated research is necessary to fully elucidate the prognostic significance of movement disorders in the context of autoimmune encephalitis.