Diagnostic and therapeutic strategies for management of autoimmune encephalopathies

ABSTRACT

Introduction: The understanding of the etio-pathogenesis of autoimmune encephalopathy syndromes has grown significantly in recent years. These are potentially reversible conditions, with variable clinical presentation and potential dramatic response to immunotherapy.

Areas covered: In this article we review various diagnostic techniques and therapeutic options for management of autoimmune encephalopathy. We also review medication adverse effects and monitoring strategies.

Expert commentary: Early diagnosis and immunomodulatory treatment remains the cornerstone of management, to halt the underlying neuro-inflammatory process and prevent permanent neuronal injury. The availability of serological testing and various imaging modalities has further improved detection of these immune-mediated neurological disorders. Understanding the mechanisms and potential adverse effects of immunomodulatory therapies will help physicians to choose the most favorable therapeutic strategy for each patient.

KEYWORDS:

• Encephalitis
• limbic encephalitis
• autoimmune disease
• paraneoplastic
• epilepsy
• immunotherapy

Declaration of interest

B Greenberg has received consulting fees from EMD Serono, Novartis and Medimmune. O Stuve serves on the editorial boards of JAMA Neurology, Multiple Sclerosis Journal, and Therapeutic Advances in Neurological Disorders. Dr. Stuve has served on data monitoring committees for Pfizer and Sanofi-Aventis without monetary compensation. Dr. Stuve has served on an advisory board for Sanofi Genzyme and Genentech, and he has advised Huron Life Sciences and Navigant Consulting. Dr. Stuve counselled Novartis in front of a Scientific Advisory Group at the European Medicines Agency (EMA). Dr. Stuve currently receives grant support from Teva Pharmaceuticals and Opexa Therapeutics. Dr. Stuve received travel support from Pfizer. Dr. Stuve is funded by a Merit grant from the US. S Vernino receives personal compensation as a scientific consultant for Athena diagnostics and on speaker bureau for Lundbeck. The other authors report no conflicts of interest in this work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.