Autoimmune Encephalitis and Its Relation to Infection

Abstract Encephalitis, an inflammatory condition of the brain that results in substantial morbidity and mortality, has numerous causes. Over the past decade, it has become increasingly recognized that autoimmune conditions contribute significantly to the spectrum of encephalitis causes. Clinical suspicion and early diagnosis of autoimmune etiologies are of particular importance due to the need for early institution of immune suppressive therapies to improve outcome. Emerging clinical observations suggest that the most commonly recognized cause of antibody-mediated autoimmune encephalitis, anti-N-methyl-d-aspartate (NMDA) receptor encephalitis, may in some cases be triggered by herpes virus infection. Other conditions such as Rasmussen’s encephalitis (RE) and febrile infection-related epilepsy syndrome (FIRES) have also been posited to be autoimmune conditions triggered by infectious agents. This review focuses on emerging concepts in central nervous system autoimmunity and addresses clinical and mechanistic findings linking autoimmune encephalitis and infections. Particular consideration will be given to anti-NMDA receptor encephalitis and its relation to herpes simplex encephalitis.
Source: Current Neurology and Neuroscience Reports - Category: Neuroscience Source Type: research

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CONCLUSIONS: Our series demonstrated the dramatic efficacy of systematic ACV prophylaxis during all cranial surgeries. Moreover, our results on epilepsy, together with those of the literature, encourage more consideration regarding epilepsy surgery in this specific etiology. All types of surgical procedures (curative or palliative) can be offered to the patients, but in the case of focal surgery, due to the poor anatomical limits, invasive recordings are highly recommended. PMID: 32868196 [PubMed - as supplied by publisher]
Source: European Journal of Paediatric Neurology - Category: Neurology Authors: Tags: Eur J Paediatr Neurol Source Type: research
Monti and colleagues [1] described a patient who developed psychiatric symptoms followed by refractory status epilepticus caused by anti N-D-Methyl-Aspartate receptor (NMDAr) encephalitis. Despite the lack of lung involvement, the patient resulted positive for SARS-CoV-2 infection. Recently, another case of anti-NMDAr encephalitis with prominent psychiatric symptoms during symptomatic SARS-CoV-2 infection has been reported by Panariello and colleagues [2]. NMDAr encephalitis represents one of the most frequent cause of autoimmune encephalitis and, in a minority of patients, it may be triggered by viral infections, particul...
Source: Seizure: European Journal of Epilepsy - Category: Neurology Authors: Tags: Letter to the editor Source Type: research
ConclusionsIn appropriately selected patients, FDG-PET scans while in burst suppression may help dissect the underlying pathophysiologic cause of IIC findings observed on EEG and guide tailored therapy.
Source: Neurocritical Care - Category: Neurology Source Type: research
Conclusion: Post-herpetic anti-NMDAr AIE could arise several months after infection. Clinicians must be aware of this possibility, particularly if cognitive and/or psychiatric symptoms occurred after a remitting period. In our two cases, only rituximab was associated with clinical improvement.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
We report two adults infected with HIV presenting with encephalopathy and seizures. Case 1 had a monophasic encephalopathy with detection of NMDAR antibodies in the context of HIV CSF escape. There was a clinical response to immunotherapy and anti-retroviral therapy adjustment. Case 2 initially presented in non-convulsive status epilepticus associated with HIV CSF escape. He responded to treatment with anti-epileptic drugs and anti-retroviral therapy alteration, but had two further neurological relapses. NMDAR antibodies were detected during the relapses and a clinical response was observed following treatment with immunot...
Source: Journal of Neurology - Category: Neurology Source Type: research
CONCLUSION: The clinical presentation and imaging studies of MELAS in adults are variable and may mimic those of HSE. Antiviral therapy should be administered until the diagnosis of MELAS is definitive. Infection and metformin may have also precipitated MELAS manifestation in this patient. Clinicians should avoid potential mitochondrial-toxic drugs in these patients. PMID: 31867706 [PubMed - in process]
Source: Acta Neurologica Taiwanica - Category: Neurology Tags: Acta Neurol Taiwan Source Type: research
Conclusion: The patient's psychiatric symptoms were most likely caused by anti-NMDA receptor encephalitis. Her polymorphic psychotic symptoms first occurred after she had received a Tdap-IPV booster vaccination. Although the vaccination cannot have caused the initial antibody formation since IgG serum antibodies were detected only 3 days after administration of the vaccine, the vaccine may have exerted immunomodulatory effects. MRI, EEG, and CSF findings were non-specific; however, FDG-PET identified brain involvement consistent with anti-NMDA receptor encephalitis. This case shows the importance of implementing a multimod...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Central nervous system (CNS) infections are one of the leading causes of acquired epilepsy [1]. Patients with encephalitis have a risk of developing seizures at the acute stage, as well as later developing unprovoked seizures [2]. It is well recognized that the risk of developing unprovoked seizures in these patients is 7 to 16 times higher compared to the general population [3,4], especially in those with Herpes simplex virus and Japanese encephalitis (JE), and the odds ratio of subsequent epilepsy was reported to be 8.06 for JE [5].
Source: Seizure: European Journal of Epilepsy - Category: Neurology Authors: Source Type: research
AbstractHerpes simplex encephalitis relapses have been rarely reported, with only few cases occurring after neurosurgical interventions. A young man presented a late herpes simplex encephalitis relapse after left antero-mesial temporal resection for his refractory temporal lobe epilepsy. Eight days after surgery, he developed fever and aphasia. CSF PCR revealed more than 12,000 copies/ml of HSV-1 DNA. Intravenous acyclovir was immediately started with a complete recovery. Postoperative herpes simplex encephalitis can occur as primary infection or as relapse of previous infection. Surgical manipulation of brain parenchyma i...
Source: Journal of NeuroVirology - Category: Neurology Source Type: research
We present a case of relapsing herpes simplex encephalitis (HSE) as a newly reported and potentially fatal stimulation-related adverse effect following stimulation of the anterior thalamic nucleus (ANT-DBS) accompanied by fever, confusion, and cognitive impairment in a 32-year-old epileptic patient with a history of herpes meningoencephalitis 31 years earlier. The T2-weighted/FLAIR high-signal intensity in the temporal lobe developed at a “distance” from the stimulation target. The positive polymerase chain reaction of herpes virus deoxyribonucleic acid in the cerebrospinal fluid confirmed the diagnosis. The co...
Source: Stereotactic and Functional Neurosurgery - Category: Neurosurgery Source Type: research
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