Consenso Argentino de Diagnóstico y Tratamiento de Encefalitis Autoinmune en Adultos (CARENAI)

Abstract

Introduction

Autoimmune encephalitis (AE) is a rapidly evolving field in neurology, with improved recognition due to advances in antibody detection. Despite its growing incidence, diagnostic and therapeutic challenges persist, including clinical heterogeneity, risk of misdiagnosis, and lack of standardized protocols. The Argentine Consensus on Diagnosis and Treatment of Autoimmune Encephalitis in Adults (CARENAI), endorsed by the Argentine Neurological Society, aims to establish management guidelines for AE in Argentina.

Methods

Seventeen experts from various neurological subspecialties were convened, using the RAND/UCLA method to evaluate diagnostic and therapeutic strategies. A systematic literature review informed the recommendations, focusing on clinical suspicion, antibody testing (in CSF and serum), neuroimaging (MRI, PET-FDG), EEG interpretation, and immunotherapeutic approaches.

Results

Diagnostic criteria emphasize subacute cognitive/psychiatric symptoms, exclusion of differential diagnoses, and inflammatory findings in CSF/MRI. First-line treatment includes corticosteroids, intravenous immunoglobulins (IVIG), or plasmapheresis, while refractory cases may require rituximab or cyclophosphamide. CARENAI addresses phenotype-specific management and emphasizes early tumor screening in paraneoplastic cases. Prognostic factors and relapse prevention are discussed, highlighting the importance of interdisciplinary follow-up.

Conclusion

CARENAI provides a framework to reduce diagnostic delays, optimize treatments, and improve outcomes, while acknowledging evidence gaps. It advocates for improved access to specialized testing and promotes future research to refine AE management in Argentina.