Clinical manifestations and immunomodulatory treatment experiences in psychiatric patients with suspected autoimmune encephalitis: a case series of 91 patients from Germany

被引：29

作者：

Endres, Dominique ^{[1
,2
]}

Luengen, Eva ^{[1
,2
]}

Hasan, Alkomiet ^{[3
,4
]}

Kluge, Michael ^{[5
]}

Froehlich, Sabrina ^{[6
,7
]}

Lewerenz, Jan ^{[8
]}

Bschor, Tom ^{[9
]}

Haussleiter, Ida Sibylle ^{[10
]}

Juckel, Georg ^{[10
]}

Bergh, Florian Then ^{[11
]}

Ettrich, Barbara ^{[11
]}

Kertzscher, Lisa ^{[5
]}

Oviedo-Salcedo, Tatiana ^{[4
]}

Handreka, Robert ^{[12
]}

Lauer, Martin ^{[13
]}

Winter, Klaas ^{[14
]}

Zumdick, Norbert ^{[15
]}

Drews, Anna ^{[16
]}

Obrocki, Jost ^{[17
]}

Yalachkov, Yavor ^{[18
]}

Bubl, Anna ^{[19
]}

von Podewils, Felix ^{[20
]}

Schneider, Udo ^{[21
]}

Szabo, Kristina ^{[22
,23
]}

Mattern, Margarete ^{[24
]}

Philipsen, Alexandra ^{[25
]}

Domschke, Katharina ^{[2
,26
]}

Wandinger, Klaus-Peter ^{[27
]}

Neyazi, Alexandra ^{[28
]}

Stich, Oliver ^{[29
,30
]}

Pruess, Harald ^{[31
,32
]}

Leypoldt, Frank ^{[27
,33
]}

van Elst, Ludger Tebartz ^{[1
,2
]}

机构：

[1] Univ Freiburg, Fac Med, Dept Psychiat & Psychotherapy, Sect Expt Neuropsychiat,Med Ctr, Freiburg, Germany

[2] Univ Freiburg, Fac Med, Med Ctr, Dept Psychiat & Psychotherapy, Freiburg, Germany

[3] Univ Augsburg, BKH Augsburg, Med Fac, Dept Psychiat Psychotherapy & Psychosomat, Augsburg, Germany

[4] Univ Hosp, Dept Psychiat & Psychotherapy, Munich, Germany

[5] Univ Leipzig, Dept Psychiat & Psychotherapy, Leipzig, Germany

[6] Ludwig Noll Krankenhaus, Dept Psychiat & Psychotherapy, Kassel, Germany

[7] DRK Hosp Nordhessen, Dept Neurol & Clin Neurophysiol, Kassel, Germany

[8] Univ Ulm, Dept Neurol, Ulm, Germany

[9] Univ Hosp Dresden, Dept Psychiat & Psychotherapy, Dresden, Germany

[10] Ruhr Univ Bochum, LWL Univ Hosp, Dept Psychiat, Bochum, Germany

[11] Univ Leipzig, Dept Neurol, Leipzig, Germany

[12] Carl Thiem Klinikum Cottbus, Dept Neurol, Cottbus, Germany

[13] Univ Hosp Wurzburg, Ctr Mental Hlth, Dept Psychiat Psychosomat & Psychotherapy, Wurzburg, Germany

[14] Carl Friedrich Flemming Klin, Helios Kliniken Schwerin, Dept Psychiat & Psychotherapy, Schwerin, Germany

[15] St Marien Hosp Hamm, Dept Psychiat & Psychotherapy Med, Hamm, Germany

[16] Vinzenz von Paul Hosp Rottenmunster, Dept Psychiat & Psychotherapy, Rottweil, Germany

[17] Regio Klinikum Elmshorn, Dept Psychiat Psychotherapy & Psychosomat Med, Elmshorn, Germany

[18] Goethe Univ, Univ Hosp, Dept Neurol, Frankfurt, Germany

[19] Univ Saarland, Dept Psychiat & Psychotherapy, Homburg, Germany

[20] Univ Med Greifswald, Dept Neurol, Greifswald, Germany

[21] Ruhr Univ Bochum, Dept Psychiat & Psychotherapy, Campus Owl Lubbecke, Lubeck, Germany

[22] Heidelberg Univ, Med Fac Mannheim, Dept Neurol, Mannheim, Germany

[23] Heidelberg Univ, Med Fac Mannheim, Mannheim Ctr Translat Neurosci, Mannheim, Germany

[24] Univ Hosp Heidelberg, Ctr Psychosocial Med, Dept Gen Psychiat, Heidelberg, Germany

[25] Univ Bonn, Dept Psychiat & Psychotherapy, Bonn, Germany

[26] Univ Freiburg, Fac Med, Ctr Basics NeuroModulat, Freiburg, Germany

[27] Univ Hosp Schleswig Holstein Kiel Lubeck, Inst Clin Chem, Neuroimmunol Sect, Lubeck, Germany

[28] Hannover Med Sch, Dept Psychiat Social Psychiat & Psychotherapy, Hannover, Germany

[29] Med Care Ctr, Neurol, Constance, Germany

[30] Univ Freiburg, Fac Med, Med Ctr, Dept Neurol, Freiburg, Germany

[31] Charite Univ Med Berlin, Dept Neurol & Expt Neurol, Berlin, Germany

[32] German Ctr Neurodegenerat Dis DZNE, Berlin, Germany

[33] Christian Albrechts Univ Kiel, Dept Neurol, Kiel, Germany

来源：

MOLECULAR PSYCHIATRY | 2022年 / 27卷 / 03期

关键词：

ANTIBODIES; PSYCHOSIS; DIAGNOSIS; CONSENSUS;

D O I：

10.1038/s41380-021-01396-4

中图分类号：

Q5 [生物化学]; Q7 [分子生物学];

学科分类号：

071010 ; 081704 ;

摘要：

Autoimmune encephalitis (AE) can rarely manifest as a predominantly psychiatric syndrome without overt neurological symptoms. This study's aim was to characterize psychiatric patients with AE; therefore, anonymized data on patients with suspected AE with predominantly or isolated psychiatric syndromes were retrospectively collected. Patients with readily detectable neurological symptoms suggestive of AE (e.g., epileptic seizures) were excluded. Patients were classified as "probable psychiatric AE (pAE)," if well-characterized neuronal IgG autoantibodies were detected or "possible pAE" (e.g., with detection of nonclassical neuronal autoantibodies or compatible cerebrospinal fluid (CSF) changes). Of the 91 patients included, 21 (23%) fulfilled our criteria for probable (autoantibody-defined) pAE and 70 (77%) those for possible pAE. Among patients with probable pAE, 90% had anti-NMDA receptor (NMDA-R) autoantibodies. Overall, most patients suffered from paranoid-hallucinatory syndromes (53%). Patients with probable pAE suffered more often from disorientation (p < 0.001) and impaired memory (p = 0.001) than patients with possible pAE. Immunotherapies were performed in 69% of all cases, mostly with high-dose corticosteroids. Altogether, 93% of the patients with probable pAE and 80% of patients with possible pAE reportedly benefited from immunotherapies (p = 0.251). In summary, this explorative, cross-sectional evaluation confirms that autoantibody-associated AE syndromes can predominantly manifest as psychiatric syndromes, especially in anti-NMDA-R encephalitis. However, in three out of four patients, diagnosis of possible pAE was based on nonspecific findings (e.g., slight CSF pleocytosis), and well-characterized neuronal autoantibodies were absent. As such, the spectrum of psychiatric syndromes potentially responding to immunotherapies seems not to be limited to currently known autoantibody-associated AE. Further trials are needed.

引用

页码：1479 / 1489

页数：11

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