Abstract
BackgroundData on encephalitis in Thailand have not been completely described. Etiologies remain largely unknown. We prospectively analyzed 103 Thai patients from 27 provinces for the causes of encephalitis using clinical, microbiological and neuroimaging indices; caseswithout a diagnosis were evaluated for autoimmune causes of encephalitis.MethodsPatients with encephalitis and/or myelitis were prospectively studied between October 2010 and August 2012. Cases associated with bacterial, rickettsial and mycobacterial diseases were excluded. Herpes viruses 1-6 and enteroviruses infection was diagnosed using PCR evaluation of CSF; dengue and JE viruses infection, by serology. The serum of test-negative patients was evaluated for the presence of autoantibodies.Results103 patients were recruited. Fifty-three patients (52%) had no etiologies identified. Twenty-five patients (24%) were associated with infections. Immune encephalitis was found in 25 (24%); neuropsychiatric lupus erythematosus (4), demyelinating diseases (3), Behcet’s disease (1) and the remaining had antibodies to NMDAR (5), ANNA-2 (6), Yo (2), AMPA (1), GABA (1), VGKC (1) and NMDA coexisting with ANNA-2 (1). Presenting symptoms in the autoimmune group included behavioral changes in 6/25 (versus 12/25 in infectious and 13/53 in unknown group) and as psychosis in 6/25 (versus 0/25 infectious and 2/53 unknown). Seizures were found in 6/25 autoimmune, 4/25 infectious and 19/53 unknown group. Two patients with anti-ANNA-2 and one anti-Yo had temporal lobe involvement by magnetic resonance imaging. Two immune encephalitis patients with antibodies to NMDAR and ANNA-2 had ovarian tumors.ConclusionsAutoantibody-associated encephalitis should be considered in the differential diagnosis and management algorithm regardless of clinical and neuroimaging features.
Highlights
Data on encephalitis in Thailand have not been completely described
Vincent et al reported another 10 cases with limbic encephalitis associated with low plasma sodium that were identified as potassium channel antibody-associated encephalopathy [5]
We prospectively studied 103 Thai patients between 2 and 85 years of age, presenting with clinically non-bacterial, non-rickettsial, non-TB, non-fungal and non-parasitic encephalitis and/or myelitis with normal or lymphocytic cerebrospinal fluid (CSF) profile who were evaluated by the Neurology service of King Chulalongkorn Memorial Hospital (KCMH) between October 2010 and August 2012
Summary
Data on encephalitis in Thailand have not been completely described. Etiologies remain largely unknown. Vincent et al reported another 10 cases with limbic encephalitis associated with low plasma sodium that were identified as potassium channel antibody-associated encephalopathy [5] These publications are among the earliest studies to emphasize the significance of neuronal autoantibodies in aseptic encephalitis. Ten of 20 encephalitis patients with unidentified etiologies in CEP (The California Encephalitis Project) were later found to have anti-NMDAR antibody [7]. These patients (6 females and 4 males) were young adults (mean age 18.5 year) who primarily presented with dyskinesia and psychiatric manifestations [7]. Language and autonomic dysfunctions, movement disorder and psychoses were predominating clinical features in these patients [9]
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