Autoimmune encephalitis: chasing a moving target

In the past 15 years, autoimmune encephalitis has become increasingly recognised, driven by advances in the detection of neural autoantibodies that cause these disorders. 1 Dalmau J Graus F Antibody-mediated encephalitis. N Engl J Med. 2018; 378: 840-851 Crossref PubMed Scopus (589) Google Scholar , 2 Venkatesan A Michael BD Probasco JC Geocadin RG Solomon T Acute encephalitis in immunocompetent adults. Lancet. 2019; 393: 702-716 Summary Full Text Full Text PDF PubMed Scopus (58) Google Scholar Patients with autoimmune encephalitis can present with an array of complex neurological disorders, including rapidly progressive dementia or new-onset status epilepticus. Although a substantive disease-modifying therapy might not be available for the presenting disorder in some patients, autoimmune encephalitis is eminently treatable. Thus, the rapid identification of patients with autoimmune encephalitis is of high clinical relevance. Diagnostic criteria for autoimmune encephalitis: utility and pitfalls for antibody-negative diseaseIncreased awareness of autoimmune encephalitis has led to two unintended consequences: a high frequency of misdiagnoses and the inappropriate use of diagnostic criteria for antibody-negative disease. Misdiagnoses typically occur for three reasons: first, non-adherence to reported clinical requirements for considering a disorder as possible autoimmune encephalitis; second, inadequate assessment of inflammatory changes in brain MRI and CSF; and third, absent or limited use of brain tissue assays along with use of cell-based assays that include only a narrow range of antigens. Full-Text PDF