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CLINICAL PROFILE OF AUTOIMMUNE ENCEPHALITIS IN WESTERN INDIA

INTRODUCTION: Autoimmune encephalitis(AE) is recognized as frequent cause of encephalopathy in the pediatric strata but a significant number of patients may not have detectable known antibodies,which can create diagnostic dilemma.

METHODOLOGY: This is a retrospective cross-sectional study of 17 patients diagnosed with from Jan 2020-dec 2021.Patients with rapid decline in cognition,autonomic instability,gait disorder,seizures or CSF s/o inflammation in absence of infection have been taken for further evaluation.Details of clinical history,CSF study,EEG and MRI finding were analyzed.

RESULT: Most common initial presentation was fever(70%) with average duration of 5-10 days, followed by seizures(80%),behavioral abnormalities(70%),sleep abnormalities(23%),language issues(10%),altered sensorium(10%), gait deviation(6%) and status epilepticus(5%). Seropositivity was noted in 50% patients with clinically diagnosed AE as anti-NMDA(23%) followed by MOG(17%).In recent pandemic,28% had COVID-antibody positive.CSF study revealed 23% have raised protein and 35% with raised IgG. MRI and EEG study revealed 23% had mesial temporal lobe involvement and 30% diffuse-background-slowing with intermittent-epileptiform-discharges as most common findings.As per standard treatment guidelines, 50% required MPS alone, 23% required MPS and IvIg both and rest 28% landing up to combination therapy. All the patients have been scored as per Rankin scoring which shown 35% were slightly-disabled,23% were moderately-disabled and average stay was 16 days(7-30 days).

CONCLUSION: The identification of newer antibodies against CNS resulted in increased number of AIE patients,whom were missed or misdiagnosed earlier.Newer modalities of treatment with immunotherapy,steroids,plasmapheresis or combination of all are being used and showing results with improvement in both cognitive and behavioral abnormalities.
Keywords: autoimmune antibody, behavioural issues, cognitive decline, rituximab, Methylprednisolone

Shubham Kaudinya
Bai Jerbai Wadia Hospital for children
India

SHILPA KULKARNI
Bai Jerbai Wadia Hospital for children
India

KONIKA BANSAL
Bai Jerbai Wadia Hospital for children
India

 

 


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