Editors' note: Hashimoto encephalopathy in the 21st century

Abstract

In “Hashimoto encephalopathy in the 21st century,” Mattozzi et al. reported that patients who meet the present criteria for Hashimoto encephalopathy (1) have a diverse range of presenting symptoms, (2) respond variably to steroids, and (3) are just as likely as controls to have NH2-α-enolaseAb detected. Furthermore, they noted the frequency of serum thyroid peroxidase antibodies (TPOAbs) is similar among patients with autoimmune encephalitis and controls. The authors concluded that it is time to establish a new definition of Hashimoto encephalopathy. Shubharkaran noted that in a series of 73 patients with noncompressive myelopathy and neuromyelitis optica spectrum disorder, 2 had positive TPOAb and developed recurrent myelitis that required treatment with disease-modifying therapies prompting conclusion that TPOAb may be a marker of disease recurrence. However, Graus and Dalmau—on behalf of the authors—responded that the frequency of positive TPOAb in this series was similar to that in the general population and suggested the presence of TPOAb neither explains the etiology for myelitis in these patients nor necessitates treatment with disease-modifying therapies. Additional work is needed to understand the clinical significance of a positive TPOAb and the circumstances in which this finding should impact management. Hashimoto encephalopathy may not represent a single entity and it is important to consider the possibility of coexisting autoimmune disorders. In “Hashimoto encephalopathy in the 21st century,” Mattozzi et al. reported that patients who meet the present criteria for Hashimoto encephalopathy (1) have a diverse range of presenting symptoms, (2) respond variably to steroids, and (3) are just as likely as controls to have NH2-α-enolaseAb detected. Furthermore, they noted the frequency of serum thyroid peroxidase antibodies (TPOAbs) is similar among patients with autoimmune encephalitis and controls. The authors concluded that it is time to establish a new definition of Hashimoto encephalopathy. Shubharkaran noted that in a series of 73 patients with noncompressive myelopathy and neuromyelitis optica spectrum disorder, 2 had positive TPOAb and developed recurrent myelitis that required treatment with disease-modifying therapies prompting conclusion that TPOAb may be a marker of disease recurrence. However, Graus and Dalmau—on behalf of the authors—responded that the frequency of positive TPOAb in this series was similar to that in the general population and suggested the presence of TPOAb neither explains the etiology for myelitis in these patients nor necessitates treatment with disease-modifying therapies. Additional work is needed to understand the clinical significance of a positive TPOAb and the circumstances in which this finding should impact management. Hashimoto encephalopathy may not represent a single entity and it is important to consider the possibility of coexisting autoimmune disorders.