Prognostic value of acute cerebrospinal fluid abnormalities in antibody-positive autoimmune encephalitis

James Broadley; Robb Wesselingh; Udaya Seneviratne; Chris Kyndt; Paul Beech; Katherine Buzzard; Cassie Nesbitt; Wendyl D'souza; Amy Brodtmann; Richard Macdonell; Tomas Kalincik; Helmut Butzkueven; Terence J O'Brien; Mastura Monif; Australian Autoimmune Encephalitis Consortium

doi:10.1016/j.jneuroim.2021.577508

Prognostic value of acute cerebrospinal fluid abnormalities in antibody-positive autoimmune encephalitis

J Neuroimmunol. 2021 Apr 15:353:577508. doi: 10.1016/j.jneuroim.2021.577508. Epub 2021 Jan 30.

Authors

Affiliations

¹ Department of Neuroscience, Monash University, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, Australia.
² Department of Neuroscience, Monash University, Melbourne, Australia; Department of Neuroscience, Monash Health, Melbourne, Australia; Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
³ Department of Neurosciences, Eastern Health, Melbourne, Australia.
⁴ Department of Radiology, Alfred Health, Melbourne, Australia; Department of Radiology, Monash Health, Melbourne, Australia.
⁵ Department of Neurosciences, Eastern Health, Melbourne, Australia; Department of Neurology, Melbourne Health, Melbourne, Australia.
⁶ Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neuroscience, Barwon Health, Geelong, Australia.
⁷ Department of Medicine, St Vincent's Hospital, University of Melbourne, Melbourne, Australia.
⁸ Department of Neurosciences, Eastern Health, Melbourne, Australia; Department of Neurology, Melbourne Health, Melbourne, Australia; Department of Neurology, Austin Health, Melbourne, Australia.
⁹ Department of Neurology, Austin Health, Melbourne, Australia.
¹⁰ Department of Medicine, The University of Melbourne, Melbourne, Australia; CORe, The University of Melbourne, Melbourne, Australia.
¹¹ Department of Neuroscience, Monash University, Melbourne, Australia; Department of Neurology, Alfred Health, Melbourne, Australia; Department of Neurology, Melbourne Health, Melbourne, Australia; Department of Physiology, The University of Melbourne, Melbourne, Australia. Electronic address: Mastura.Monif@monash.edu.au.

PMID: 33588218
DOI: 10.1016/j.jneuroim.2021.577508

Abstract

Objective: To examine the prognostic value of CSF abnormalities in seropositive autoimmune encephalitis (AE).

Methods: We retrospectively studied 57 cases of seropositive AE. Primary outcomes were mortality and modified Rankin Scale, while secondary outcomes were first line treatment failure, ICU admission and relapse. Regression analysis was performed.

Results: CSF white cell count (WCC) was higher in the NMDAR group, while elevated protein was more common amongst other subtypes. We found an association between WCC >5 cells/mm³ and treatment failure (OR 16.0, p = 0.006)), and between WCC >20 cells/mm³ and ICU admission (OR 19.3, p = 0.026).

Conclusions: Different subsets of AE have characteristic CSF abnormalities, which may aid recognition during early evaluation. CSF WCC had prognostic significance in our study.

Keywords: Autoimmune encephalitis; Biomarker; CSF; Lymphocytosis; Prognosis.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Autoantibodies / immunology
Autoimmune Diseases / cerebrospinal fluid*
Autoimmune Diseases / drug therapy
Biomarkers / cerebrospinal fluid*
Cerebrospinal Fluid / cytology
Encephalitis / cerebrospinal fluid*
Encephalitis / drug therapy
Female
Humans
Immunologic Factors / therapeutic use
Lymphocytosis / cerebrospinal fluid*
Male
Prognosis
Retrospective Studies

Substances

Autoantibodies
Biomarkers
Immunologic Factors