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Observational Study
. 2021 May 21:12:641106.
doi: 10.3389/fimmu.2021.641106. eCollection 2021.

Functional Recovery in Autoimmune Encephalitis: A Prospective Observational Study

Thomas Seifert-Held  1 , Katharina Eberhard  2 , Christian Lechner  3   4 , Stefan Macher  5 , Harald Hegen  6 , Tobias Moser  7 , Gregor Brecl Jacob  8 , Gertraud Puttinger  9 , Raffi Topakian  10 , Michael Guger  11 , Emrah Kacar  12 , Lea Zoche  13 , Desiree De Simoni  14 , Andreas Seiser  12 , Stefan Oberndorfer  14 , Christoph Baumgartner  13   15   16 , Walter Struhal  12 , Friedrich Zimprich  5 , Johann Sellner  17 , Florian Deisenhammer  6 , Christian Enzinger  1 , Markus Reindl  6 , Helmut Rauschka  18   19 , Thomas Berger  5 , Romana Höftberger  4
Affiliations
Observational Study

Functional Recovery in Autoimmune Encephalitis: A Prospective Observational Study

Thomas Seifert-Held et al. Front Immunol. .

Abstract

Background: Prospective observations of functional recovery are lacking in patients with autoimmune encephalitis defined by antibodies against synaptic proteins and neuronal cell surface receptors.

Methods: Adult patients with a diagnosis of autoimmune encephalitis were included into a prospective registry. At 3, 6 and 12 months of follow-up, the patients' modified Rankin Scale (mRS) was obtained.

Results: Patients were stratified into three groups according to their antibody (Ab) status: anti-NMDAR-Ab (n=12; group I), anti-LGI1/CASPR2-Ab (n=35; group II), and other antibodies (n=24; group III). A comparably higher proportion of patients in group I received plasma exchange/immunoadsorption and second line immunosuppressive treatments at baseline. A higher proportion of patients in group II presented with seizures. Group III mainly included patients with anti-GABABR-, anti-GAD65- and anti-GlyR-Ab. At baseline, one third of them had cancer. Patients in groups I and III had much higher median mRS scores at 3 months compared to patients in group II. A median mRS of 1 was found at all follow-up time points in group II.

Conclusions: The different dynamics in the recovery of patients with certain autoimmune encephalitides have important implications for clinical trials. The high proportion of patients with significant disability at 3 months after diagnosis in groups I and III points to the need for improving treatment options. More distinct scores rather than the mRS are necessary to differentiate potential neurological improvements in patients with anti-LGI1-/CASPR2-encephalitis.

Keywords: anti-CASPR2-encephalitis; anti-LGI1-encephalitis; anti-NMDAR-encephalitis; autoimmune encephalitis; modified Rankin Scale.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flow chart (Ab, antibodies; mRS, modified Rankin scale).
Figure 2
Figure 2
Longitudinal analysis of modified Rankin Scale (mRS) scores of patients who have completed all follow-ups at 3, 6 and 12 months: (A) anti-NMDAR-antibodies (n=10), (B) anti-LGI1/CASPR2-antibodies (n=22), (C) other antibodies (n=8). Diamonds indicate individual patients’ scores. Horizontal lines show median mRS scores. P-values are derived from Friedman’s test. *p < 0.0167 for post-hoc two-group comparisons (3 vs. 6 months and 3 vs. 12 months). **p < 0.0167 for post-hoc two-group comparisons (3 vs. 6 months).
See this image and copyright information in PMC

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