Autoimmune encephalitis in Intensive Care Unit: A Review Article

Abstract

Background: Autoimmune encephalitis (AE) is a group of immunologic diseases affecting the central nervous system (CNS). It is now considered a common cause of encephalitis and often requires intensive care unit (ICU) level care. Aims: This review aims to provide intensivists with a toolkit to better recognize, diagnose, and manage patients with AE in the ICU. Sources: A search of online databases using relevant keywords yielded papers discussing the epidemiology, diagnosis, management, and outcome of AE in the ICU setting. Content: Due to the development of new antibody testing toolkits, the prevalence of AE has been on the rise during the past few decades. Timely recognition and diagnosis of AE in the ICU can significantly improve patient outcomes. Diagnostic criteria help classify patients into possible, probable, or definite AE categories based on clinical and paraclinical findings. Management of AE involves immunomodulatory and immunosuppressive therapies, along with targeting associated neoplastic processes or triggers. First-line treatments include corticosteroids, intravenous immunoglobulin (IVIg), and plasma exchange (PLEX), while second-line therapies may be required for refractory cases. AE can result in seizures, movement disorders, dysautonomia, respiratory failure, altered mental status, and psychosis. These complications require a combination of immunotherapy and symptomatic treatment for effective management. Prognosis varies but timely and appropriate management significantly improves outcomes. Keywords: Autoimmune Encephalitis, ICU, Intensive Care, Diagnosis, Management, Prognosis