Autoimmune encephalitis in a resource-limited public health setting: a case series analysis

• Published in: Arquivos de neuro-psiquiatria Vol. 82; no. 2; pp. 1 - 10
• Main Authors: Morillos, Matheus Bernardon, Borelli, Wyllians Vendramini, Noll, Giovani, Piccini, Cristian Daniel, Leite, Martim Bravo, Finkelsztejn, Alessandro, Bianchin, Marino Muxfeldt, Castilhos, Raphael Machado, Torres, Carolina Machado
• Format: Journal Article
• Language: English
• Published: Germany Arquivos de Neuro-Psiquiatria 01.02.2024; Thieme Revinter Publicações Ltda; Academia Brasileira de Neurologia - ABNEURO; Thieme Revinter Publicações
• Subjects: Autoantibodies; Autoanticorpos; Autoimmune diseases; Central nervous system; Cerebrospinal fluid; Convulsões; Diagnosis; EEG; Electronic medical records; Encefalite Límbica; Encephalitis; Epilepsy; Limbic Encephalitis; Mortality; Neuroimaging; Neurological complications; NEUROSCIENCES; Original; Paraneoplastic Syndromes, Nervous System; Patients; Phenotypes; PSYCHIATRY; Public health; Seizures; Síndromes Paraneoplásicas do Sistema Nervoso; Autoanticorpos; Autoantibodies; Síndromes Paraneoplásicas do Sistema Nervoso; Encefalite Límbica; Paraneoplastic Syndromes, Nervous System; Limbic Encephalitis; Convulsões; Seizures
• ISSN: 0004-282X; 1678-4227; 1678-4227
• DOI: 10.1055/s-0044-1779054

Background Autoimmune encephalitis (AE) consists of a group of acquired diseases that affect the central nervous system. A myriad of phenotypes may be present at the onset. Due to the heterogeneity of clinical presentations, it is difficult to achieve uniformity for the diagnostic and therapeutic processes and follow-up strategies. Objective To describe a series of patients diagnosed with AE in a resource-limited public hospital in southern Brazil and to analyze therapeutics and outcomes. Methods We retrospectively reviewed the electronic medical records of patients diagnosed with AE at the Hospital de Clínicas de Porto Alegre from 2014 to 2022. Data collected included clinical presentation, neuroimaging, cerebrospinal fluid testings, electroencephalogram, autoantibodies, treatments, outcomes, follow-up time, degree of neurological impairment, and mortality. Results Data from 17 patients were retrieved. Eleven cases were classified as definite AE and 6 as possible AE. Autoantibodies were identified in 9 patients. Timing for diagnosis was impacted by the high costs associated with autoantibody testing. Most patients became functionally dependent (82.4%) and most survivors remained with autoimmune-associated epilepsy (75%). Five patients died during hospitalization, and one after a 26-month of follow-up. Conclusion In this resource-limited hospital, patients with AE had a worse clinical outcome than that previously described in the literature. Development of epilepsy during follow-up and mortality were greater, whilst functional outcome was inferior. Autoantibody testing was initially denied in most patients, which impacted the definitive diagnosis and the use of second-line therapies.