Jocelyn X Jiang
ICPMR, Australia
Posters & Accepted Abstracts: J Neurol Neurophysiol
Background: Autoimmune encephalitis is an important cause of encephalopathy, refractory epilepsy and unexplained movement
disorders in adults. Whilst there is an increasing identification of associated antibodies, there remains a group of patients with high
clinical probability for autoimmune encephalitis but no associated characterized autoantibody. These patients are a diagnostic and
therapeutic dilemma as a proportion respond to immunosuppression but often require intensive treatment(1). We reviewed current
diagnostic and novel (light chains and cytokines) investigations of cerebrospinal fluid (CSF) in patients with a high probability for
autoimmune encephalitis (hAE) to identify surrogate biomarkers indicative of neuroinflammation.
Methods: Over 18 months, hAE adult patients (as determined at the time of lumbar puncture) were recruited. Samples from patients
with polymerase chain reaction (PCR) confirmed viral encephalitis (viral-pos) and ??normal? patients (patients with non-inflammatory
central nervous system disease; or undergoing spinal anesthesia for orthopedic or obstetric procedures) were included as controls.
Serum and CSF were examined with standard investigations for encephalitis and novel markers (CSF cytokines; CSF light chains)
and any magnetic resonance imaging results (MRI) for her patients were collected. Studies of CSF novel markers were compared to
patients with infection or non-inflammatory disease.
Results: 32 hAE patients were recruited over 18 months; including 9 antibodies positive and 23 antibodies negative. 21 viral-pos
patient samples and 10 ??normal? patients were also included. In these cohorts, there was a trend for the presence of CSF monocytosis,
oligoclonal bands, neuronal immunofluorescence and MRI changes to be associated with autoimmune encephalitis, but these
investigations were not sensitive or specific. A ratio of the CSF cytokines IP-10 and IL-21 appeared promising in delineating between
viral infections and autoimmune encephalitis. This is, to our knowledge the first study of CSF cytokines in this setting in adults.
Further study with a larger patient cohort is required to confirm these results.
E-mail: jocelyn.jiang@health.nsw.gov.au
