Lívia Almeida Dutra, Pedro Victor de Castro Silva, João Henrique Fregadolli Ferreira, Alexandre Coelho Marques, Fabio Fieni Toso, Claudia Cristina Ferreira Vasconcelos, Doralina Guimarães Brum, Samira Luisa Dos Apóstolos Pereira, Tarso Adoni, Leticia Januzi de Almeida Rocha, Leticia Pereira de Brito Sampaio, Nise Alessandra de Carvalho Sousa, Renata Barbosa Paolilo, Angélica Dal Pizzol, Bruna Klein da Costa, Caio César Diniz Disserol, Camila Pupe, Daniel Almeida do Valle, Denise Sisterolli Diniz, Fabiano Ferreira de Abrantes, Felipe da Rocha Schmidt, Fernando Cendes, Francisco Tomaz Meneses de Oliveira, Gabriela Joca Martins, Guilherme Diogo Silva, Katia Lin, Lécio Figueira Pinto, Mara Lúcia Schimtz Ferreira Santos, Marcus Vinícius Magno Gonçalves, Mariana Braatz Krueger, Michel Elyas Jung Haziot, Orlando Graziani Povoas Barsottini, Osvaldo José Moreira do Nascimento, Paulo Ribeiro Nóbrega, Priscilla Mara Proveti, Raphael Machado do Castilhos, Vanessa Daccach, Felipe von Glehn
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The patients are predominantly young, and delays in treatment are associated with worse prognosis.</p><p><strong>Objective: </strong> With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method.</p><p><strong>Methods: </strong> A total of 25 panelists, including adult and child neurologists, participated in the study.</p><p><strong>Results: </strong> The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE).</p><p><strong>Conclusion: </strong> The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.</p>","PeriodicalId":8694,"journal":{"name":"Arquivos de neuro-psiquiatria","volume":"82 7","pages":"1-15"},"PeriodicalIF":1.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations.\",\"authors\":\"Lívia Almeida Dutra, Pedro Victor de Castro Silva, João Henrique Fregadolli Ferreira, Alexandre Coelho Marques, Fabio Fieni Toso, Claudia Cristina Ferreira Vasconcelos, Doralina Guimarães Brum, Samira Luisa Dos Apóstolos Pereira, Tarso Adoni, Leticia Januzi de Almeida Rocha, Leticia Pereira de Brito Sampaio, Nise Alessandra de Carvalho Sousa, Renata Barbosa Paolilo, Angélica Dal Pizzol, Bruna Klein da Costa, Caio César Diniz Disserol, Camila Pupe, Daniel Almeida do Valle, Denise Sisterolli Diniz, Fabiano Ferreira de Abrantes, Felipe da Rocha Schmidt, Fernando Cendes, Francisco Tomaz Meneses de Oliveira, Gabriela Joca Martins, Guilherme Diogo Silva, Katia Lin, Lécio Figueira Pinto, Mara Lúcia Schimtz Ferreira Santos, Marcus Vinícius Magno Gonçalves, Mariana Braatz Krueger, Michel Elyas Jung Haziot, Orlando Graziani Povoas Barsottini, Osvaldo José Moreira do Nascimento, Paulo Ribeiro Nóbrega, Priscilla Mara Proveti, Raphael Machado do Castilhos, Vanessa Daccach, Felipe von Glehn\",\"doi\":\"10.1055/s-0044-1788586\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong> Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. 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引用次数: 0
摘要
背景：自身免疫性脑炎（AIE）是一组炎症性疾病，其特点是存在针对神经元和神经胶质抗原的抗体，导致亚急性精神症状、记忆障碍和运动障碍。患者以年轻人为主，延误治疗会导致预后恶化：在巴西神经病学学会（Academia Brasileira de Neurologia, ABN）和巴西儿童神经病学学会（Sociedade Brasileira de Neurologia Infantil, SBNI）的支持下，采用德尔菲法就巴西 AIE 的诊断和治疗达成了共识：共有 25 位专家组成员参加了研究，其中包括成人和儿童神经学家：结果：专家小组成员一致认为，应使用组织检测法（TBA）和细胞检测法（CBA）对符合可能的AIE标准的患者进行血清和脑脊液（CSF）抗神经元抗体筛查。此外，还应对儿童进行抗髓鞘少突胶质蛋白抗体（抗 MOG）筛查。治疗应在出现症状的最初 4 周内开始。一线治疗方案是甲基强的松龙加静脉注射免疫球蛋白（IVIG）或血浆置换术，二线治疗方案包括利妥昔单抗和/或环磷酰胺，三线治疗方案是硼替佐米和托珠单抗。AIE 中的大多数癫痫发作都是无症状的，急性期过后可以停用抗癫痫药物。对于抗 N-甲基-D-天冬氨酸受体（anti-NMDAR）脑炎，专家小组成员一致认为不应使用口服免疫抑制剂。在急性期和急性期后阶段，应使用功能和认知量表对患者进行评估，如小型精神状态检查（MMSE）、蒙特利尔认知评估（MoCA）、改良朗肯量表（mRS）和自身免疫性脑炎临床评估量表（CASE）：本研究为巴西医疗系统有效管理自身免疫性脑炎患者提供了切实证据。
Brazilian consensus recommendations on the diagnosis and treatment of autoimmune encephalitis in the adult and pediatric populations.
Background: Autoimmune encephalitis (AIE) is a group of inflammatory diseases characterized by the presence of antibodies against neuronal and glial antigens, leading to subacute psychiatric symptoms, memory complaints, and movement disorders. The patients are predominantly young, and delays in treatment are associated with worse prognosis.
Objective: With the support of the Brazilian Academy of Neurology (Academia Brasileira de Neurologia, ABN) and the Brazilian Society of Child Neurology (Sociedade Brasileira de Neurologia Infantil, SBNI), a consensus on the diagnosis and treatment of AIE in Brazil was developed using the Delphi method.
Methods: A total of 25 panelists, including adult and child neurologists, participated in the study.
Results: The panelists agreed that patients fulfilling criteria for possible AIE should be screened for antineuronal antibodies in the serum and cerebrospinal fluid (CSF) using the tissue-based assay (TBA) and cell-based assay (CBA) techniques. Children should also be screened for anti-myelin oligodendrocyte glucoprotein antibodies (anti-MOG). Treatment should be started within the first 4 weeks of symptoms. The first-line option is methylprednisolone plus intravenous immunoglobulin (IVIG) or plasmapheresis, the second-line includes rituximab and/or cyclophosphamide, while third-line treatment options are bortezomib and tocilizumab. Most seizures in AIE are symptomatic, and antiseizure medications may be weaned after the acute stage. In anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, the panelists have agreed that oral immunosuppressant agents should not be used. Patients should be evaluated at the acute and postacute stages using functional and cognitive scales, such as the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), the Modified Rankin Scale (mRS), and the Clinical Assessment Scale in Autoimmune Encephalitis (CASE).
Conclusion: The present study provides tangible evidence for the effective management of AIE patients within the Brazilian healthcare system.
期刊介绍：
Arquivos de Neuro-Psiquiatria is the official journal of the Brazilian Academy of Neurology. The mission of the journal is to provide neurologists, specialists and researchers in Neurology and related fields with open access to original articles (clinical and translational research), editorials, reviews, historical papers, neuroimages and letters about published manuscripts. It also publishes the consensus and guidelines on Neurology, as well as educational and scientific material from the different scientific departments of the Brazilian Academy of Neurology.
The ultimate goals of the journal are to contribute to advance knowledge in the areas of Neurology and Neuroscience, and to provide valuable material for training and continuing education for neurologists and other health professionals working in the area. These goals might contribute to improving care for patients with neurological diseases. We aim to be the best Neuroscience journal in Latin America within the peer review system.
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