Clinical analysis of patients with autoimmune encephalitis with invisible mental symptoms

Abstract

Objective To study the clinical characteristics of patients with autoimmune encephalitis (AE) with negative psychiatric symptoms, improve the understanding of the disease, and optimize its treatment. Methods 40 patients diagnosed with AE admitted to the Department of Neurology, Renmin Hospital of Wuhan University from January 2018 to December 2021 were collected, 4 of whom had no abnormal mental behavior. Abnormal mental behavior manifests as gibberish, hallucinations, irritability, aggressive behavior, and personality changes. The 36 patients with abnormal mental behavior were divided into negative mental symptom group (N group, 9 cases) and non-negative mental symptom group (P group, 27 cases). The clinical manifestations, laboratory tests, imaging features, treatment and prognosis were compared between the two groups. Results Anti-NMDAR encephalitis was the most common in 40 patients, 32 cases (80%); anti-LGI1 encephalitis 4 cases (10%); anti-GABABR encephalitis 2 cases (5%); anti-CASPR2 encephalitis 1 case (2.5%) %); anti-NMDAR encephalitis combined with anti-MOG encephalitis antibody was positive in 1 case (2.5%). Common clinical manifestations of the 40 AE patients included mental and behavioral abnormalities in 36 cases (90%), epileptic seizures in 20 cases (50%), motor dysfunction in 4 cases (10%), cognitive impairment in 7 cases (17.5%), and speech impairment. 6 cases (15%), 8 cases (20%) with impaired consciousness, etc. All 40 AE patients received first-line immunotherapy, 23 patients (57.5%) received hormone pulse therapy alone, 15 patients (37.5%) received hormone pulse therapy combined with intravenous immunoglobulin (IVIg), and 2 patients received hormone + IVIg + plasma exchange therapy. example (5%). Prodromal headaches were less common in group N (P<0.05). There were statistically significant differences in white blood cell and neutrophil counts between group N and group P (P<0.05). All 9 patients in group N had good prognosis; 22 patients (81.5%) in group P had good prognosis, and 5 patients had poor prognosis. Conclusion Autoimmune encephalitis can manifest complex and diverse psychiatric symptoms. Screening for negative psychiatric symptoms should be carried out in the early stage of diagnosis, and individualized treatment plans should be formulated as early as possible in order to improve the prognosis. [International Journal of Neurology and Neurosurgery, 2022, 49(6):1-6]