Question:

Do all types of antibodies in AE work the same way?

Answer:

There are multiple types of antibodies in Autoimmune Encephalitis. They have different clinical presentations and syndromes and have different responses to treatment. We know from the immunology world that antibodies come in many shapes and forms. There is a growing list of antibodies in each category.

Autoimmune encephalitis may be divided into several groups of diseases: Those antibodies that can access the cell surface of an antibody or the synaptic receptor of an antibody that is accessible to the targeting antibody because it is exposed on the outside.

Cytoxic T-cell diseases associated with antibodies to intracellular antigens, and those associated with other autoimmune disorders.

Extracellular antibodies target the receptor on the outside surface of the cell. There, it binds to the receptor on the outside surface of the healthy neuronal cell.

As more cases appeared, and neuronal targets could not be identified, that lead researchers to discover that the unknown cell surface antigens were not cell surface antigens at all, but in fact were found to be synaptic receptors, including the N-methyl-D-aspartate receptor (NMDAR). This discovery led investigators to distinguish a new category of autoimmune encephalitis those where the offending antibody is actually targeting the synaptic receptors in the brain.

In the disorders investigated so far that occur with autoimmune encephalitis, researchers who have studied their underlying mechanisms have seen that the antibodies alter the structure or function of the antigen they have targeted and bonded too. This attacking antibody that the immune system has created, now causes the antibody it has attached itself to, to malfunction or die.

These attacks can occur throughout the brain. Symptoms wax and wane (come and go in severity, have a fluctuating course) as the attacks occur. At times, some symptoms may be more dominate and not so severe at other times. This is due to the fact that different areas of the brain may be under attack at different times.

Autoimmune Encephalitis is a complex diagnosis to make. It can mimic many other diseases. It is the fluctuation of symptoms and the vast array of symptoms the patient is experiencing that causes the neurologist unfamiliar with these disorders to fail in arriving at an accurate and timely diagnosis. This is a key reason we advocate that those suffering from Autoimmune Encephalitis to seek out a top expert in the field of autoimmune neurology.  Experience bares out that this leads to an accurate and expedited diagnosis and aggressive treatment plan that leads to the best outcome for the patient.