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

Anti-N-Methyl-D-Aspartate Receptor Encephalitis / therapy Autoantibodies Cross-Sectional Studies Encephalitis Hashimoto Disease Humans Retrospective Studies Syndrome

Journal

Molecular psychiatry
ISSN: 1476-5578
Titre abrégé: Mol Psychiatry
Pays: England
ID NLM: 9607835

Informations de publication

Date de publication:
03 2022
Historique:
received: 12 02 2021
accepted: 23 11 2021
revised: 26 09 2021
pubmed: 21 1 2022
medline: 18 5 2022
entrez: 20 1 2022
Statut: ppublish

Résumé

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.

Identifiants

DOI: 10.1038/s41380-021-01396-4 PMID: 35046526 PMC: PMC9095476
pubmed: 35046526
doi: 10.1038/s41380-021-01396-4
pii: 10.1038/s41380-021-01396-4
pmc: PMC9095476
doi:

Substances chimiques

Autoantibodies 0

Types de publication

Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1479-1489

Commentaires et corrections

Type : CommentIn

Informations de copyright

© 2022. The Author(s).

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Auteurs

Dominique Endres (D)

Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
ORCID: 0000-0001-7322-1195

Eva Lüngen (E)

Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Alkomiet Hasan (A)

Department of Psychiatry, Psychotherapy and Psychosomatics, Medical Faculty, University of Augsburg, BKH Augsburg, Augsburg, Germany.
Department of Psychiatry and Psychotherapy, University Hospital, Munich, Germany.

Michael Kluge (M)

Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.
ORCID: 0000-0002-0098-202X

Sabrina Fröhlich (S)

Department of Psychiatry and Psychotherapy, Ludwig-Noll-Krankenhaus, Kassel, Germany.
Department of Neurology and Clinical Neurophysiology, DRK Hospital Nordhessen, Kassel, Germany.

Jan Lewerenz (J)

Department of Neurology, University of Ulm, Ulm, Germany.

Tom Bschor (T)

Department of Psychiatry and Psychotherapy, University Hospital Dresden, Dresden, Germany.

Ida Sibylle Haußleiter (IS)

Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany.

Georg Juckel (G)

Department of Psychiatry, LWL-University Hospital, Ruhr University Bochum, Bochum, Germany.

Florian Then Bergh (F)

Department of Neurology, University of Leipzig, Leipzig, Germany.

Barbara Ettrich (B)

Department of Neurology, University of Leipzig, Leipzig, Germany.

Lisa Kertzscher (L)

Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany.

Tatiana Oviedo-Salcedo (T)

Department of Psychiatry and Psychotherapy, University Hospital, Munich, Germany.

Robert Handreka (R)

Department of Neurology, Carl-Thiem-Klinikum Cottbus, Cottbus, Germany.

Martin Lauer (M)

Department of Psychiatry, Psychosomatics and Psychotherapy, Center of Mental Health, University Hospital Würzburg, Würzburg, Germany.

Klaas Winter (K)

Department of Psychiatry and Psychotherapy, Carl-Friedrich-Flemming-Klinik, Helios Kliniken Schwerin, Schwerin, Germany.

Norbert Zumdick (N)

Department of Psychiatry and Psychotherapy Medicine, St. Marien-Hospital Hamm, Hamm, Germany.

Anna Drews (A)

Department of Psychiatry and Psychotherapy, Vinzenz von Paul Hospital Rottenmünster, Rottweil, Germany.

Jost Obrocki (J)

Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Regio Klinikum Elmshorn, Elmshorn, Germany.

Yavor Yalachkov (Y)

Department of Neurology, University Hospital/Goethe University, Frankfurt/Main, Germany.

Anna Bubl (A)

Department of Psychiatry and Psychotherapy, University of Saarland, Homburg/Saar, Germany.

Felix von Podewils (F)

Department of Neurology, University Medicine Greifswald, Greifswald, Germany.

Udo Schneider (U)

Department of Psychiatry and Psychotherapy, Ruhr-University Bochum Campus-OWL Lübbecke, Lübbecke, Germany.

Kristina Szabo (K)

Department of Neurology and Mannheim Center for Translational Neuroscience, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Margarete Mattern (M)

Department of General Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.

Alexandra Philipsen (A)

Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.

Katharina Domschke (K)

Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Center for Basics in NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Klaus-Peter Wandinger (KP)

Neuroimmunology Section, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein Kiel/Lübeck, Lübeck, Germany.

Alexandra Neyazi (A)

Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany.

Oliver Stich (O)

Neurology, Medical Care Center, Konstanz, Germany.
Department of Neurology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.

Harald Prüss (H)

Department of Neurology and Experimental Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.
ORCID: 0000-0002-8283-7976

Frank Leypoldt (F)

Neuroimmunology Section, Institute of Clinical Chemistry, University Hospital Schleswig-Holstein Kiel/Lübeck, Lübeck, Germany.
Department of Neurology, Christian-Albrechts-University Kiel, Kiel, Germany.

Ludger Tebartz van Elst (L)

Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. tebartzvanelst@uniklinik-freiburg.de.
Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. tebartzvanelst@uniklinik-freiburg.de.
ORCID: 0000-0002-2274-5447

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Classifications MeSH

questionsmedicales.fr › Maladies du système immunitaire › Maladies auto-immunes › Maladies auto-immunes du système nerveux › Encéphalite à anticorps anti-récepteur N-méthyl-D-aspartate › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › Acides aminés, peptides et protéines › Protéines › Globulines › Sérum-globulines › Immunoglobulines › Anticorps › Autoanticorps › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études transversales › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › Maladies du système nerveux › Encéphalite › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › Maladies endocriniennes › Maladies de la thyroïde › Thyroïdite › Maladie de Hashimoto › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Clinical manifestations and immunomodulatory...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Maladie › Syndrome › Clinical manifestations and immunomodulatory...