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Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children

OBJECTIVE: The main objective is to assess the challenges in diagnosis and treatment while managing seronegative cases of autoimmune encephalitis (AIE) in Indian children. METHODS: A cohort study of patients with AIE was done where clinical presentations, investigations, management were analyzed and...

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Autores principales: Sahoo, Bandya, Jain, Mukesh Kumar, Mishra, Reshmi, Patnaik, Sibabratta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Medknow Publications & Media Pvt Ltd 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311983/
https://www.ncbi.nlm.nih.gov/pubmed/30662228
http://dx.doi.org/10.4103/ijccm.IJCCM_98_18
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author Sahoo, Bandya
Jain, Mukesh Kumar
Mishra, Reshmi
Patnaik, Sibabratta
author_facet Sahoo, Bandya
Jain, Mukesh Kumar
Mishra, Reshmi
Patnaik, Sibabratta
author_sort Sahoo, Bandya
collection PubMed
description OBJECTIVE: The main objective is to assess the challenges in diagnosis and treatment while managing seronegative cases of autoimmune encephalitis (AIE) in Indian children. METHODS: A cohort study of patients with AIE was done where clinical presentations, investigations, management were analyzed and these patients were followed up to assess the evolution of the disease. RESULTS: Nine patients were included in the study. Four patients presented with super-refractory status epilepticus (SRSE). Other presentations were behavioral change, hemiplegia, and autonomic dysfunction. Initial magnetic resonance imaging brain was suggestive of AIE in two patients. Only two were seropositive for cerebrospinal fluid (CSF) autoimmune panel. Five patients responded to the first-line immunotherapy and four required the second-line immunotherapy. CONCLUSION: The possibility of autoimmune encephalitis should be considered in patients with super-refractory status epilepticus. A large proportion of children with suspected AE may be “seronegative.” A trial of immunotherapy should be given to these children when there is a strong clinical suspicion of autoimmune encephalitis even in the absence of cerebrospinal fluid autoantibodies.
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spelling pubmed-63119832019-01-18 Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children Sahoo, Bandya Jain, Mukesh Kumar Mishra, Reshmi Patnaik, Sibabratta Indian J Crit Care Med Brief Communication OBJECTIVE: The main objective is to assess the challenges in diagnosis and treatment while managing seronegative cases of autoimmune encephalitis (AIE) in Indian children. METHODS: A cohort study of patients with AIE was done where clinical presentations, investigations, management were analyzed and these patients were followed up to assess the evolution of the disease. RESULTS: Nine patients were included in the study. Four patients presented with super-refractory status epilepticus (SRSE). Other presentations were behavioral change, hemiplegia, and autonomic dysfunction. Initial magnetic resonance imaging brain was suggestive of AIE in two patients. Only two were seropositive for cerebrospinal fluid (CSF) autoimmune panel. Five patients responded to the first-line immunotherapy and four required the second-line immunotherapy. CONCLUSION: The possibility of autoimmune encephalitis should be considered in patients with super-refractory status epilepticus. A large proportion of children with suspected AE may be “seronegative.” A trial of immunotherapy should be given to these children when there is a strong clinical suspicion of autoimmune encephalitis even in the absence of cerebrospinal fluid autoantibodies. Medknow Publications & Media Pvt Ltd 2018-12 /pmc/articles/PMC6311983/ /pubmed/30662228 http://dx.doi.org/10.4103/ijccm.IJCCM_98_18 Text en Copyright: © 2018 Indian Journal of Critical Care Medicine http://creativecommons.org/licenses/by-nc-sa/4.0 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Brief Communication
Sahoo, Bandya
Jain, Mukesh Kumar
Mishra, Reshmi
Patnaik, Sibabratta
Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children
title Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children
title_full Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children
title_fullStr Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children
title_full_unstemmed Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children
title_short Dilemmas and Challenges in Treating Seronegative Autoimmune Encephalitis in Indian Children
title_sort dilemmas and challenges in treating seronegative autoimmune encephalitis in indian children
topic Brief Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6311983/
https://www.ncbi.nlm.nih.gov/pubmed/30662228
http://dx.doi.org/10.4103/ijccm.IJCCM_98_18
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