Abstract
Objectives Autoimmune encephalitis (AE) encompasses a spectrum of clinical syndromes that can be associated with diagnostic and therapeutic delays. Our aim was to determine whether delay to immunotherapeutic intervention in patients with AE leads to worse outcomes, as measured by the Clinical Assessment Scale in Autoimmune Encephalitis (CASE) score.1
Methods This retrospective cohort study examined medical records of all patients with AE2 treated with immunotherapy at two tertiary epilepsy centers. Early treatment was defined as immunotherapy within 90 days of symptom onset. CASE scores were determined at initiation of immunotherapy, and at 6 months and 12 months post treatment. Covariates included age, sex, AE type, exposure to second line treatment, and CASE score at start of immunotherapy.
Results Thirty patients met study inclusion criteria. Mean CASE score at start of immunotherapy was higher in patients treated early (10.7) compared to late (5.1, p=0.0059). However there was no difference between the two groups at 6 months (4 vs 2.7, p=0.06) and 12 months (3.6 vs 2.3, p=0.06). Patients treated early had a greater improvement in CASE score at 6 months (reduction of 6.7 vs 2, p=0.005) and 12 months (reduction of 7.7 vs 3.3, p=0.03). Regression modelling showed the only significant covariate associated with a greater change in score at 6 months was higher CASE score at start of treatment (p<0.001).
Conclusion Delayed immunotherapy in AE patients still provides clinical benefit. AE patients with a delayed diagnosis or subacute course should be considered for induction immunotherapy.
References
Lim JA, Lee ST, Moon J, et al. Development of the clinical assessment scale in autoim-mune encephalitis. Ann Neurol. 2019;85(3):352–358. doi:10.1002/ana.25421
Graus F, Titulaer MJ, Balu R, et al. A clinical approach to diagnosis of autoimmune en-cephalitis. Lancet Neurol. 2016;15(4):391–404. doi:10.1016/S1474-4422(15)00401-9
