From the discovery of NMDA encephalitis by Josep Dalmau in 2007, autoimmune encephalitis has become an ever expanding group of diseases that is durably changing the landscape of modern neurosciences. These syndromes can initially present with acute or subacute behavior changes sometimes overshadowing subtle neurologic symptoms such as movement disorders or seizures. There is a variety of scenario in which patients with autoimmune encephalitis can, at least initially, be mistaken for patients with primary psychiatric diagnosis. While novel therapeutic approaches have greatly improved outcomes of patients with autoimmune encephalitis, delay in diagnosis remains a major obstacle. As the knowledge around autoimmune encephalitis continues to progress, first line clinicians should be more and more familiar with the specificities of this group of disease in order to close the gap between onset of symptoms and adequate treatment.
This presentation will feature:
- Basic neuroscientific concepts and outline of the latest discoveries in autoimmune encephalitis such as mechanism of autoantibodies (intracellular vs extracellular; effector vs biological marker), pathogenesis (infectious triggers, paraneoplastic syndromes).
- Main syndromes and their clinical presentation with emphasis on behavioral symptoms through clinic vignettes.
- Simplified diagnostic algorithm and decision tree, adapted from the 2016 consensus clinical criteria of autoimmune encephalitis.
- Symptomatic management of psychiatric symptoms presented by patients with autoimmune encephalitis and the difference with classic management.
- Outline of the neurologic workup: who needs an MRI, an EEG, CSF analysis, malignancy workup.
- Outline of the management of autoimmune encephalitis.
- Recovery and residual psychiatric symptoms and their management.
- Future considerations: will an autoimmune panel be sent for every patient in the psychiatric emergency room
Learning Objectives:
Recognize atypical presentations of behavioral emergencies that could suggest an autoimmune encephalitis.
Be familiar with the main autoimmune encephalitis syndromes and their mechanisms.
Know the outline of the workup, treatment, and psychiatric symptomatic management of autoimmune encephalitis.
