Neurobehavioral Manifestations and Outcomes in Autoimmune Encephalitis: A Retrospective Study
Notice bibliographique
Résumé
Abstract 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.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».