Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations

被引：2

作者：

Dutra, Livia Almeida ^{[1
]}

de Castro Silva, Pedro Victor ^{[1
]}

Ferreira, Joao Henrique Fregadolli ^{[1
]}

Marques, Alexandre Coelho ^{[1
]}

Toso, Fabio Fieni ^{[1
]}

Vasconcelos, Claudia Cristina Ferreira ^{[2
]}

Brum, Doralina Guimaraes ^{[3
]}

dos Apostolos Pereira, Samira Luisa ^{[4
]}

Adoni, Tarso ^{[4
]}

de Almeida Rocha, Leticia Januz ^{[5
]}

de Brito Sampaio, Leticia Pereira ^{[6
]}

de Carvalho Sousa, Nise Alessandra ^{[7
]}

Paolilo, Renata Barbosa ^{[6
]}

Dal Pizzol, Angelica ^{[8
]}

da Costa, Bruna Klein ^{[9
,10
]}

Disserol, Caio Cesar Diniz ^{[11
,12
]}

Pupe, Camila ^{[13
]}

do Valle, Daniel Almeida ^{[14
]}

Diniz, Denise Sisterolli ^{[15
]}

de Abrantes, Fabiano Ferreira ^{[16
]}

da Rocha Schmidt, Felipe ^{[17
]}

Cendes, Fernando ^{[18
]}

de Oliveira, Francisco Tomaz Meneses ^{[19
]}

Martins, Gabriela Joca ^{[20
]}

Silva, Guilherme Diogo ^{[4
]}

Lin, Katia ^{[21
]}

Pinto, Lecio Figueira ^{[4
]}

Santos, Mara Lucia Schimtz Ferreira ^{[14
]}

Goncalves, Marcus Vinicius Magno ^{[22
]}

Krueger, Mariana Braatz ^{[23
]}

Haziot, Michel Elyas Jung ^{[19
]}

Barsottini, Orlando Graziani Povoas

do Nascimento, Osvaldo Jose Moreira ^{[24
]}

Nobrega, Paulo Ribeiro ^{[25
]}

Proveti, Priscilla Mara ^{[26
]}

do Castilhos, Raphael Machado ^{[27
]}

Daccach, Vanessa ^{[28
]}

von Glehn, Felipe ^{[25
]}

机构：

[1] Hosp Israelita Albert Einstein, Inst Cerebro, Sao Paulo, SP, Brazil

[2] Univ Fed Estado Rio de Janeiro, Rio de Janeiro, RJ, Brazil

[3] Univ Estadual Paulista, Fac Med Botucatu, Dept Neurol Psicol & Psiquiatria, Botucatu, SP, Brazil

[4] Univ Sao Paulo, Hosp Clin, Fac Med, Dept Neurol & Neurocirurgia, Sao Paulo, SP, Brazil

[5] Univ Fed Alagoas, Hosp Univ, Maceio, AL, Brazil

[6] Univ Sao Paulo, Hosp Clin, Fac Med, Inst Crianca, Sao Paulo, SP, Brazil

[7] Univ Fed Amazonas, Manaus, Amazonas, Brazil

[8] Hosp Moinhos Vento, Dept Neurol, Porto Alegre, RS, Brazil

[9] Pontificia Univ Catolica Rio Grande do SUl, Porto Alegre, RS, Brazil

[10] Santa Casa Misericordia Porto Alegre, Porto Alegre, RS, Brazil

[11] Univ Fed Parana, Hosp Clin, Curitiba, PR, Brazil

[12] Inst Neurol Curitiba, Curitiba, PR, Brazil

[13] Univ Fed Fluminense, Niteroi, RJ, Brazil

[14] Hosp Pequeno Principe, Curitiba, PR, Brazil

[15] Univ Fed Goias, Goiania, Go, Brazil

[16] Univ Fed Sao Paulo, Sao Paulo, SP, Brazil

[17] Univ Estado Rio de Janeiro, Rio De Janeiro, RJ, Brazil

[18] Univ Estadual Campinas, Campinas, SP, Brazil

[19] Santa Casa Misericordia Sao Paulo, Sao Paulo, SP, Brazil

[20] Hosp Geral Fortaleza, Fortaleza, CE, Brazil

[21] Univ Fed Santa Catarina, Florianopolis, SC, Brazil

[22] Univ Regiao Joinville, Joinville, SC, Brazil

[23] Hosp Infantil Albert Sabin, Fortaleza, CE, Brazil

[24] Acad Nacl Med, Rio De Janeiro, RJ, Brazil

[25] Univ Fed Ceara, Fortaleza, CE, Brazil

[26] Univ Brasilia, Fac Med, Brasilia, DF, Brazil

[27] Hosp Clin Porto Alegre, Porto Alegre, RS, Brazil

[28] Univ Sao Paulo, Fac Med Ribeirao Preto, Ribeirao Preto, SP, Brazil

来源：

ARQUIVOS DE NEURO-PSIQUIATRIA | 2024年 / 82卷 / 07期

关键词：

Autoimmune Encephalitis; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Delphi Technique; Rituximab; Tocilizumab; NMDA-RECEPTOR ENCEPHALITIS; GLIOMA-INACTIVATED; COGNITIVE IMPAIRMENT; LIMBIC ENCEPHALITIS; MOG ANTIBODIES; LEUCINE-RICH; MANAGEMENT; RITUXIMAB; THERAPY; AUTOANTIBODIES;

D O I：

10.1055/s-0044-1788586

中图分类号：

Q189 [神经科学];

学科分类号：

071006 ;

摘要：

Background Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis. Objective With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method. Methods A total of 25 panelists, including adult and child neurologists, participated in the study. Results The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE). Conclusion The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.

引用

页码：1 / 15

页数：15

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