The most common type of Autoimmune Encephalitis, anti-NMDA receptor Autoimmune Encephalitis (ANMDARE) which accounts for 20% of cases, was identified in 2005. Even though The California Encephalitis Project 2007-2011 showed this variant of autoimmune encephalitis occurred more commonly than other etiologies of encephalitis such as enterovirus encephalitis, HSV-1, West Nile Virus or Varicella zoster virus (VZV), many Emergency Department physicians are not familiar with it. Given that it is such a newly recognized disorder; it is not yet taught in medical schools. Emergency Departments do evaluate for encephalitis and meningitis but autoimmune encephalitis often goes unrecognized.
Given that Autoimmune Encephalitis is more common than originally thought, Emergency Department Staff, would be well advised to keep autoimmune encephalitis as a differential diagnosis for patients presenting with acute psychosis or encephalitis. This may be particularly important in patients with new onset psychosis being referred to a psychiatric facility, especially if they presented with any neurological symptoms! Psychiatrists and Emergency Room Physicians are often the first to see these patients, data shows that due to the wide spectrum of initial symptoms in AE patients, the correct diagnosis of these patients is often missed or delayed. Therefore, lumbar puncture should be offered to ALL patients with new onset psychosis as part of the broader evaluation for their mental and physical health.
Autoimmune encephalitis is a treatable disease, and it responds better to early treatment. There are numerous co-hort studies and case reports of patients who demonstrated improvement immediately following immunosuppressant therapy or tumor removal. Studies have found that favorable outcome is associated with early treatment. To learn more about Autoimmune encephalitis masquerading as psychosis/psychiatric illness, we highly recommend Psychiatrists, ER physicians and those learning about these disorders review the research under AE -Psychiatric presentation.
Recent advances in Psychiatry
Growing evidence derived from cerebrospinal fluid (CSF), neuropathological, imaging, genetic, and epidemiological studies link neuroinflammation and immune dysregulation to a subset of individuals with a variety of severe mental disorders (SMDs), including affective and non-affective psychotic disorders.
- Diagnostic tools for immune Encephalitis-2018
- Antibody-Mediated Encephalitis-2018
- New Treatments for Refractory Cases
- Common Immunotherapies used in CNS disease
- Treatable Immune System Disorder Could Be Mistaken For Schizophrenia or Bipolar Disorder
- Autoimmune Encephalitis: Current concepts 2017
- A clinical approach to diagnosis of autoimmune encephalitis
- AE Treatment Strategies
- The Laboratory Diagnosis of Autoimmune Encephalitis
- Clinical Reasoning: A middle-aged man with new onset seizures and myoclonic jerks
- The Diagnosis and Treatment of Autoimmune Encephalitis
- Symptoms associated with antibody-mediated Autoimmune Encephalitis
- Red Flags: Clinical Signs for Identifying Autoimmune Encephalitis in Psychiatric Patients
- Phases of Autoimmune Encephalitis
- Recognizing Autoimmune-Mediated Encephalitis
- Autoimmune Encephalitis: A need for increased awareness among Psychiatrists
AI-Driven Antibody Search. Let our AI decode the literature to provide antibody usage data that’s unbiased and experiment-specific
One-Year Functional Status (NEOS) score
AE is refractory to Antipsychotics
Antibody Mediated Psychosis
Treatment of Autoimmune brain disorders
Commercial tests for autoantibodies to NMDAR, LGI1, Caspr2, AMPAR (GluR1, GluR2 subunits), and GABA-B-R are widely available. Newer cell surface antigens like GABAA-R and DPPX are more difficult to test clinically. Contact Mayo Clinic Rochester, MN to inquire about antibody testing through research resources. It is important to test both the serum and the Cerebral spinal fluid (CSF) because of false positives with these antibodies.
Dr David Carr
Anti-NMDA receptor Encephalitis
A must know diagnosis for all
emergency medicine practitioners
Andrew McKeon, M.B., B.Ch., M.D.,
Mayo Clinic Webinar:
The Spectrum of Autoimmune CNS
Disorders June, 2017
Clinical Approach to Diagnois of Autoimmune Encephalitis
Autoimmune Encephalitis &
the Role of Antibody Testing