Neuroimmunology - Parainfections and Seronegative Autoimmune Encephalitis in Children: Updates and Controversies

Course Description
Encephalitis in children are most frequently infectious, parainfectious or autoimmune in etiology. CSF profile, next generation sequencing, and neuroimaging, can help differentiate infectious versus autoimmune causes in some cases, but the etiology remains uncertain in more than half of the patients. Even when autoimmune encephalitis (AE) is greatly suspected, CSF antibodies are encountered in less than 50% of the cases. Furthermore, viruses can trigger autoimmune responses. Thus, differentiating infectious versus parainfectious and seronegative AE are common challenges encountered in clinical practice, and treatment strategies frequently overlap.

In this symposium we will dive into the parainfectious phenomenon through 2 examples: the pathophysiology of ADEM and the post-herpetic NMDA R ab encephalitis. We will also discuss controversies regarding management of seronegative AE and the escalation of immune therapy.

Learning Objectives

1. Acquire tools to help differentiating infectious versus non-infectious AE in the clinical practice.
2. Acknowledge the diagnostic challenges and controversies in the management of encephalitis in children and determine which encephalitic processes may benefit from escalation in immune therapy.

Impact Statements

• Adequate management of Acute Encephalitis in children
• Appropriate use of immunotherapy in Seronegative autoimmune encephalitis.

Organizer: Cristina Fernandez-Carbonell, MD; Cohen’s Children Medical Center, Lake Success, New York, USA

Introduction: Infectious, Parainfectious and Autoimmune Encephalitis. Challenges in Clinical Practice
Cristina Fernandez-Carbonell, MD

Parainfectious Encephalitis and ADEM. Updates and Controversies
Silvia Tenembaum, MD
National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentin