Clinical Analysis of Autoimmune Encephalitis with Different Antineurotic Antibodies
Objective To summarize the clinical characteristics and prognosis of different autoimmune encephalitis(AE)patients with positive anti neural cell antibodies.Methods From January 2020 to June 2022,the clinical manifestations,imaging,antibody detection and treatment of 12 patients with different anti neurocyte antibody positive AE diagnosed and treated in Neurology were analyzed retrospectively.The modified Rankin scale(mRS)was used to evaluate the prognosis.Results There were 4 men and 8 women,aged 18-72 years old,3 cases of anti anti-N-methyl-D-aspartate receptor(NMDAR)antibody encephalitis,2 cases of anti contactin-associated protein 2(CASPR2)antibody encephalitis,5 cases of anti leucine rich glioma inactivated 1(LGI1)antibody encephalitis,1 case of anti glutamic acid decarboxylase 65(GAD65)antibody encephalitis,and 1 case of anti GAD65 antibody encephalitis γ anti NMDAR encephalitis with y aminobutyric acid-B receptor(GABABR)antibody positivity,combined with anti Hu antibody IgG positivity.Seven patients presented with Seizure,three with mental symptoms,two with facial arm dystonia,one with headache and memory loss,and one with abdominal twitch.MRI abnormalities of 9 imaging heads involved bilateral hippocampus,amygdala,basal ganglia,cerebral hemisphere and meninges.Ten cases had consistent serum and cerebrospinal fluid AE antibodies,1 case was inconsistent,and 1 case was only positive for cerebrospinal fluid antibodies.After immunotherapy,12 cases were all improved,of which 1 case was treated with methylprednisolone shock and sufficient human immunoglobulin,and the effect was poor.After treatment with the second-line immune drug rituximab,the symptoms did not improve.After treatment with the upgraded immune drug tocilizumab,the symptoms gradually improved.One case recurred after discontinuing the medication.The prognosis of all 12 patients was good(mRS≤2 points).Conclusion There are many types of antibodies in AE.Seizure is the most common clinical manifestation.Hippocampal involvement is the main imaging feature.Early diagnosis and early initiation of immunotherapy can lead to a good prognosis.
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