Neurobehavioral Manifestations and Outcomes in Autoimmune Encephalitis: A Retrospective Study
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".