| Abstrakt: |
Background: Autoimmune encephalitis (AE) could present with heterogeneous clinical manifestations. Neurobehavioral symptoms were presented diversely in each type of AE and may be misdiagnosed with psychiatric disorders. This study aimed to investigate and categorize the clinical manifestations and evaluate the treatment outcomes in patients with AE. Methods: A retrospective chart review study of AE was done at Siriraj Hospital, Mahidol University. The data between 2009‐2022 were extracted. Thirty‐seven patients were diagnosed with AE. Clinical manifestations were collected and classified into four categories: neurological, cognitive, neuropsychiatric manifestation, and autonomic dysfunction. Results: Among 37 patients who were diagnosed with AE, 32 patients (87.2%) were seropositive with ten different antibodies identified, and five patients (12.8%) were seronegative. The most commonly identified antibodies were anti‐NMDAR (n = 13, 33.2%) and anti‐LGI1 antibodies (n = 8, 20.5%). The neurological manifestation was most presented (92.3%), followed respectively by neuropsychiatric symptoms (76.9%), cognitive impairment (69.2%) and autonomic dysfunction (23.1%). The most frequent clinical features (>30%) were seizure (69.2%), memory impairment (64.1%), sensorium disturbance (51.3%), executive dysfunction (51.3%), abnormal movement (46.2%), and sleep problem (33.3%). All patients with anti‐NMDAR encephalitis had at least one neuropsychiatric symptom, which predominated in behavioral change (92.3%) compared with patients with other antibodies or seronegative (p = 0.02), such as agitation, aberrant motor behaviors, sleep and appetite change. Autonomic dysfunction was found only in anti‐NMDAR encephalitis patients (p<0.01), whereas the proportion of cognitive impairment and neurological deficit were not different among those with or without anti‐NMDAR antibodies. In this study, none of the patients presented solely psychiatric symptoms. The median following‐up duration after diagnosis was 38 weeks (IQR 14‐137). Treatment outcomes at 6‐12 months showed improvement or resolution of symptoms, but five patients (13.5%) developed emerging mood changes, particularly depression and irritability. Cognitive performance measured by Montreal cognitive assessment demonstrated improvement at 6 months of follow‐up (from 15.12±6.89 to 24.00±3.86, p<0.01) but not at 12 months. Conclusions: AE had various manifestations. Most of them had a combination of symptoms in the neurological, psychiatric, cognitive, and autonomic domains. A sole neuropsychiatric manifestation was rarely presented in AE. The symptoms showed improvement at 6‐12 months after treatment. [ABSTRACT FROM AUTHOR] |
