Neuroimmunology of Autoimmune Encephalitis: From Antibody-Mediated Pathogenesis to Multidisciplinary Care

ანოტაცია

The complex neuroinflammatory disease known as autoimmune encephalitis (AE) is typified by the generation of autoantibodies that target different central nervous system receptors, proteins, and ion channels. In this review, neuroimmunology of AE is considered, and special attention will be paid to how it is caused, presented in clinical cases, diagnosed, and treated. The most common forms of AE are anti-NMDAR, LGI1 and CASPR2 encephalitis which are all associated with the different autoantibodies and clinical presentation. In paraneoplastic AE, there is the expression of non-paraneoplastic factors, post-infectious factors and mimicry of specific molecular entities that stimulate autoantibody production.  The clinical manifestations of AE include a wide variety of manifestations that can include mental disorders, cognition decline, epileptic disorders, movement, and autonomic dysfunction.  The multi-disciplinary diagnosis is achieved through neuroimaging, electroencephalography, cerebro spinal fluid analysis and autoantibody testing of which the autoantibody testing is the gold standard. Also, Corticosteroids, intravenous immunoglobulins, and plasmapheresis are the first-line immunotherapies of AE; second-line agents are cyclophosphamide and rituximab, which are applied in cases of refractory disease.  Immunotherapy needs to be initiated in an early manner so as to achieve better outcomes and prevent relapses.  Crucial part of management is tumor removal when there is suitability.  To assist patients with regard to quality of life and care, behavioral support, relapse prevention, and long-term monitoring operations are necessary. Since not all patients can obtain complete recovery of their cognitive and motor capacities, this retraces the importance of further developing research and standardizing practices, which is necessary to enhance knowledge and improvement of AE, which cannot be completed without constant research and development of antibody panels. Patient centered care, clinical awareness, and multi-disciplinary care are important in maximizing the outcomes of affected individuals due to this complex neuroimmunological disorder.