53.: Autoimmune encephalitides in a regional centre: Presentation and implications for management

Abstract

Autoimmune encephalitides (AIE) are increasingly recognised as the cause of a range of clinical presentations including confusional state, new onset psychosis and seizures. Early diagnosis and institution of appropriate immunotherapy are thought to improve clinical outcomes in these patients. We report the presentation and clinical outcomes of AIE diagnosed though a newly established regional neurology centre and consider implications for clinical practice. All patients with AIE seen through the centre in 2012–2013 were identified. Further cases were sought via statewide immunology reference laboratory records (for voltage-gated potassium channel [VGKC], NMDA and related antibody requests) from 2010–2013. Five AIE patients presenting in 2012–2013 were identified from centre records. No additional patients could be identified in the region covered from reference laboratory samples. Two “false positive” antibody results, both in 2012, were noted (cryptococcal meningitis and normal pressure hydrocephalus). The five patients presented initially to general physicians (n = 3) or psychiatrists (n = 2). In each case a clinical diagnosis of AIE and institution of appropriate immunotherapy occurred only following neurology consultation. Clinical presentations and outcomes will be presented. In a regional setting, patients with AIE are likely to present to non-neurologists. The absence of requests for and/or positive results for VGKC/NMDA in the 2 years preceding establishment of a viable neurology service in the region would suggest such patients were not diagnosed by non-neurologists with likely consequent morbidity. Education of psychiatrists, general, infectious diseases and intensive care unit physicians with regard to the clinical features of these rare disorders will be key to their early recognition and institution of appropriate management.