Autoimmune Encephalitis beyond NMDA-R Antibodies

Autoimmune Encephalitis beyond NMDA-R Antibodies Josep Dalmau (SJD Barcelona Children's Hospital, Spain)


March 27, 2021
  • Josep Dalmau
CPD/CME Credits

Autoimmune Encephalitis beyond NMDA-R Antibodies
Josep Dalmau (SJD Barcelona Children's Hospital, Spain)

Autoimmune encephalitis is a new category of diseases in which autoantibodies against neuronal cell surface and synaptic proteins cause a wide variety of syndromes and diseases resulting in neuropsychiatric manifestations. The spectrum of diseases, comorbidities and triggers is different between adults and children and symptoms vary according to the type of autoantibody. In children the most frequent autoimmune encephalitis is anti-NMDAR followed by a few others such as anti-MOG (myelin oligodendrocyte glycoprotein), anti-GABAaR, and other. In this presentation I will review the spectrum of these diseases in children, some of the underlying pathogenic mechanisms involved, and the approaches to treatment.

Learning Objectives

  • Clinically recognize anti-NMDA receptor and other autoimmune encephalitis
  • Optimally manage the initial treatment approach of anti-NMDAR encephalitis
  • Describe the underlying antibody-mediated pathogenic mechanisms in anti-NMDAR and other types of autoimmune encephalitis.

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  • This commment is unpublished.
    Georgios niotakis · 26 days ago
    Great talk. Thank you. In a patient with autoimmune encephalitis after hsv encephalitis, 2 y ago, never received 2nd line... with long standing disabilities... is there a point for delayed administration of rituximab?
  • This commment is unpublished.
    Hiroya Nishida · 26 days ago
    To whom should we start immunomodulatory therapies? The ones who fulfilled the criteria for autoimmune encephalitis, or should we start earlier? Hiroya Nishida, Tokyo, Japan.
  • This commment is unpublished.
    Parvaneh Karimzadeh · 26 days ago
    Because IGg subclasses can not pass the BBB some experts believe that serum is more effective for evaluation the ABs. Prof Parvaneh Karimzadeh, Iran
  • This commment is unpublished.
    Miraç Yıldırım · 26 days ago
    Which autoantibodies are more associated with autonomic dysfunction?
  • This commment is unpublished.
    PELAGIA VORGIA · 26 days ago
    The persistance of antii NMDAR in CSF after rituximad treatment is a biomarker to proceed to cyclophosfamide or we have to wait and how long? thank you very much.
  • This commment is unpublished.
    Jaime Silva · 26 days ago
    Bon dia. Plaer de coneixer-te.Forza Barca.I have a case of Herpes Simplex Type 2 (PCR) associated with NMDA encephalopathy.Can this virus have the same induction profile as the HSV type 1 because the type mostly causes meningitis?
  • This commment is unpublished.
    Dev Prakash Sharma · 26 days ago
    After how much interval you suggest follow up imaging in suspected but not proven autoimmune encephalitis?
  • This commment is unpublished.
    Sasan Saket · 26 days ago
    Thank you Dear Professor Dalmau for Excellent and applied Presentation
  • This commment is unpublished.
    Gopal Dash · 26 days ago
    how do you treat patients with facio brachial dystonic seizure ? Is there any evidence to use rituximab ? can we use mycophenolate to prevent relapses ? Dr Gopal , Bangalore, India
  • This commment is unpublished.
    Grael Dumallay · 26 days ago
    Good evening Sir. This is Grael Dumallay. PCMC - Phlippines. I would like to ask what medications do you give for Pediatric Anti-NMDAR cases who have insomnia? Or do you just observe? Thank you.
  • This commment is unpublished.
    Viviana Venegas · 26 days ago
    Thank you for your Talk Dr Dalmau, and thank you for your help with our patients, Greetings from Chile
  • This commment is unpublished.
    Milena Duric Nedeljk · 26 days ago
    Thank You for wonderfull lecture. How long do we have to follow the patient for anti NMDAR ab after finished active disease. Is it enough to check only the serum or CSF is the must?
  • This commment is unpublished.
    Jithangi Wanigasingh · 26 days ago
    Wonderful lecture. How do you expain the differnet presenations in different ages? Is it related to differential expression of NMDA R in different ages
  • This commment is unpublished.
    Dr. Kavita Srivastava · 26 days ago
    Where do we place ALERD? as it is mostly triggered by an infection..
  • This commment is unpublished.
    Morteza Heidari · 26 days ago
    It looks like the autoimmune encephalitis are a spectrum of diseases or a continuum. If the biomarkers are not available, do you recommend starting first line immunotherapy as steroids or IVIG on clinical criteria suggestive of autoimmune encephalitis ? Sahar Hassanein, professor of Pediatric neurology. Ain Shams University Cairo, Egypt
  • This commment is unpublished.
    Nandan Yardi · 26 days ago
    As in some patients of Anti NMDA encephitis ,do any of these have complex movemnent disorders?
  • This commment is unpublished.
    MINI · 26 days ago
    What is your experience on children with NMDA R who fail to respond to first line therapy with IVIG, IV methyl prednesolone, 2nd line Rituximab, Cyclophospahamide and PLEX and who donot have any tumors either Mini Sreedharan, India
  • This commment is unpublished.
    Morteza Heidari · 26 days ago
    Thanks for your nice presentation Professor. Which drug/drugs do you recommend for behavioral changes in patients with anti nmda encephalitis?
  • This commment is unpublished.
    Mr Sachin · 26 days ago
    EEG changes in this disease
  • This commment is unpublished.
    Robyn Whitney · 26 days ago
    What is your experience with the treatment of GAD65 in children who present with ataxia/epilepsy? Do you find that their response to immunotherapy is poor and outcomes/recovery are also poor? Thank you. Robyn Whitney, McMaster Children's Hospital, Canada