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. 2025 Feb;46(2):871-877.
doi: 10.1007/s10072-024-07857-2. Epub 2024 Oct 29.

Long-term neurological outcome in patients presenting with encephalitis

Arici Davide  1   2 , Pilotto Andrea  3   4   5 , Pedersoli Giulia  3 , Cristillo Viviana  3   4 , Volonghi Irene  3   4 , Guso Enis  3   4 , Castelli Francesco  6 , Padovani Alessandro  3   4   5   7
Affiliations

Long-term neurological outcome in patients presenting with encephalitis

Arici Davide et al. Neurol Sci. 2025 Feb.

Abstract

Background: Advances in encephalitis research have improved the definition and management of encephalitis during the acute phase. Still, little is known about long-term outcomes in different subtypes of encephalitis.

Objectives: To analyze the prevalence and predictors of long-term clinical outcomes in different subtypes of encephalitis.

Methods: All patients discharged from a tertiary hub for acute neurology with a confirmed diagnosis of encephalitis were included. Encephalitis were classified into autoimmune (AE), infectious (IE) and of unknown origin (UE) according to guidelines. Long-term neurological sequelae were evaluated using a 16-item questionnaire assessing severity and frequency of neurological symptoms, disability was scored using the expanded Disability status scale (EDSS). Long-term symptoms distribution and predictors were evaluated using univariate and multivariate regression models.

Results: Seventy out 105 survived patients were included (AE n = 30, IE n = 12, UE n = 28). Disability at discharge was worse in AE compared to UE (p = 0.018). Additionally, AE had a higher risk of relapse (n = 8 AE, n = 1 UE, p = 0.001). 36 patients (51,4%) showed significant disability according to EDSS; whereas 72,9% reported a significant neurological long-term sequela, including cognitive deficits (50,0%), depression (41,4%) and numbness (21,0%). Older age and abnormal MRI at onset were the strongest predictors of long-term severe sequelae. independently from the subtype of encephalitis.

Discussions: Long-term sequelae are common in encephalitis, and are associated with MRI abnormalities, premorbid disability, and older age at onset. Further longitudinal studies are needed to focus on biological and clinical predictors, to identify patients who might benefit from cognitive and behavioral training after discharge.

Keywords: Autoimmune encephalitis; Cognitive disorders in encephalitis; Neurological burden in encephalitis.

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Conflict of interest statement

Declarations. Ethical approval: This study received approval from the ethical standards committee on human experimentation (local ethics committee of the ASST Spedali Civili Hospital, Brescia: NP 4067). All methods were carried out in accordance with relevant guidelines and regulations (Declaration of Helsinki). Consent for publication: Non Applicable. Conflict of interests: Davide Arici none, Andrea Pilotto served on the advisory board of Z-cube (technology division of Zambon pharmaceuticals); he received honoraria from Z-cube s.r.l., Biomarin, Zambon, Abbvie, Nutricia and Chiesi pharmaceuticals. He received research support from Vitaflo Germany and Zambon Italy, Giula Pedersoli none, Irene Volonghi none, Viviana Cristillo none, Enis Guso none, Francesco Castelli none, Alessandro Padovani is consultant and served on the scientific advi-sory board of GE Healthcare, Eli-Lilly and Actelion Ltd. Pharmaceuticals and received speaker honoraria from Nutricia, PIAM, Langstone Technology, GE Healthcare, Lilly, UCB Pharma and Chiesi Pharmaceuticals. He is funded by grant of the Ministry of University (MURST).

References

    1. Abbuehl LS, Hofmann E, Hakim A, Dietmann A (2023) Can we forecast poor outcome in herpes simplex and varicella zoster encephalitis? A narrative review Front Neurol 14:1130090. https://doi.org/10.3389/fneur.2023.1130090 - DOI - PubMed
    1. Ariño H, Armangué T, Petit-Pedrol M, Sabater L, Martinez-Hernandez E, Hara M, Lancaster E, Saiz A, Dalmau J, Graus F (2016) Anti-LGI1-associated cognitive impairment: Presentation and long-term outcome. Neurology 87:759–765. https://doi.org/10.1212/WNL.0000000000003009 - DOI - PubMed - PMC
    1. Armangue T, Spatola M, Vlagea A, Mattozzi S, Cárceles-Cordon M, Martinez-Heras E, Llufriu S, Muchart J, Erro ME, Abraira L, Moris G, Monros-Giménez L, Corral-Corral Í, Montejo C, Toledo M, Bataller L, Secondi G, Ariño H, Martínez-Hernández E, Juan M, Marcos MA, Alsina L, Saiz A, Rosenfeld MR, Graus F, Dalmau J (2018) Frequency, syndromes, risk factors, and outcome of autoimmune encephalitis following herpes simplex encephalitis: a prospective observational study and a retrospective analysis of cases. Lancet Neurol 17:760–772. https://doi.org/10.1016/S1474-4422(18)30244-8 - DOI - PubMed - PMC
    1. Bhat S, Chokroverty S (2022) Sleep disorders and COVID-19. Sleep Med 91:253–261. https://doi.org/10.1016/j.sleep.2021.07.021 - DOI - PubMed
    1. Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA, Gadoth A, Smith CY, Bryant SC, Klein CJ, Aksamit AJ, Toledano M, Boeve BF, Tillema J-M, Flanagan EP (2018) Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol 83:166–177. https://doi.org/10.1002/ana.25131 - DOI - PubMed - PMC

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