Clinical scales in autoimmune encephalitis—A retrospective monocentric cohort study

IF 4.4 2区医学 Q1 CLINICAL NEUROLOGY Annals of Clinical and Translational Neurology Pub Date : 2023-08-06 DOI:10.1002/acn3.51865

Stefan Macher, Gabriel Bsteh, Romana Höftberger, Thomas Berger, Paulus Rommer, Tobias Zrzavy

{"title":"Clinical scales in autoimmune encephalitis—A retrospective monocentric cohort study","authors":"Stefan Macher, Gabriel Bsteh, Romana Höftberger, Thomas Berger, Paulus Rommer, Tobias Zrzavy","doi":"10.1002/acn3.51865","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Objective</h3>\n \n <p>Assessing severity of antibody-mediated encephalitis (AE) or paraneoplastic encephalitis (PE) requires valid and reliable scores to guide treatment decisions and predict outcome both in clinical routine and studies. We aimed to validate the prognostic value of the clinical assessment scale in autoimmune encephalitis (CASE) and the anti-NMDAR-encephalitis one-year functional status (NEOS) score in patients suffering from AE and PE in a large monocentric cohort.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>We retrospectively applied the CASE and NEOS score to patients with definite AE and PE treated at a tertiary hospital. Correlations were established between the CASE and NEOS score and the modified Rankin scale (mRs). Multivariable analyses were calculated to identify predictors of outcome.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Thirty-four patients (27 AE, 7 PE) were included. Correlations between mRS and CASE score were strongest in patients with AE compared to PE at all intervals, but in the subgroups (LGI1, NMDAR, GAD, miscellaneous surface antibodies, PE) the correlation was strongest in the interval after baseline. Patients with AE seemed to display better outcomes compared to PE, which was underlined by multivariable analysis. Improvement was mostly observed within 6–12 months after disease onset, after which little or no further improvement was noted with some exception for two patients with anti-NMDARE who recovered substantially even after 12 months of treatment. The NEOS score significantly predicted the outcome at last follow-up in patients with AE with a sensitivity of 79% at a cut-off value of 2 points (AUC 0.79, 95% CI 0.58–0.99, <i>p</i> = 0.04).</p>\n </section>\n \n <section>\n \n <h3> Interpretation</h3>\n \n <p>The CASE and NEOS score are suitable supplementary tools in addition to the mRS for capturing diverse symptoms, for grading and monitoring symptom severity.</p>\n </section>\n </div>","PeriodicalId":126,"journal":{"name":"Annals of Clinical and Translational Neurology","volume":"10 10","pages":"1768-1775"},"PeriodicalIF":4.4000,"publicationDate":"2023-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/acn3.51865","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Clinical and Translational Neurology","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/acn3.51865","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Objective

Assessing severity of antibody-mediated encephalitis (AE) or paraneoplastic encephalitis (PE) requires valid and reliable scores to guide treatment decisions and predict outcome both in clinical routine and studies. We aimed to validate the prognostic value of the clinical assessment scale in autoimmune encephalitis (CASE) and the anti-NMDAR-encephalitis one-year functional status (NEOS) score in patients suffering from AE and PE in a large monocentric cohort.

Methods

We retrospectively applied the CASE and NEOS score to patients with definite AE and PE treated at a tertiary hospital. Correlations were established between the CASE and NEOS score and the modified Rankin scale (mRs). Multivariable analyses were calculated to identify predictors of outcome.

Results

Thirty-four patients (27 AE, 7 PE) were included. Correlations between mRS and CASE score were strongest in patients with AE compared to PE at all intervals, but in the subgroups (LGI1, NMDAR, GAD, miscellaneous surface antibodies, PE) the correlation was strongest in the interval after baseline. Patients with AE seemed to display better outcomes compared to PE, which was underlined by multivariable analysis. Improvement was mostly observed within 6–12 months after disease onset, after which little or no further improvement was noted with some exception for two patients with anti-NMDARE who recovered substantially even after 12 months of treatment. The NEOS score significantly predicted the outcome at last follow-up in patients with AE with a sensitivity of 79% at a cut-off value of 2 points (AUC 0.79, 95% CI 0.58–0.99, p = 0.04).

Interpretation

The CASE and NEOS score are suitable supplementary tools in addition to the mRS for capturing diverse symptoms, for grading and monitoring symptom severity.

Abstract Image

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

自身免疫性脑炎的临床量表——一项回顾性单中心队列研究

目的评估抗体介导的脑炎（AE）或副肿瘤性脑炎（PE）的严重程度需要有效可靠的评分来指导临床常规和研究中的治疗决策和预测结果。我们旨在在一个大型单中心队列中验证自身免疫性脑炎（CASE）临床评估量表和抗NMDAR脑炎一年功能状态（NEOS）评分对AE和PE患者的预后价值。方法回顾性应用CASE和NEOS评分对在三级医院接受治疗的明确AE和PE患者进行评分。CASE和NEOS评分与改良的Rankin量表（mRs）之间建立了相关性。计算多变量分析以确定结果的预测因素。结果包括34例患者（27例AE，7例PE）。与PE相比，在所有时间间隔内，AE患者的mRS和CASE评分之间的相关性最强，但在亚组（LGI1、NMDAR、GAD、杂表面抗体、PE）中，基线后的时间间隔内相关性最强。与PE相比，AE患者似乎表现出更好的结果，多变量分析强调了这一点。改善主要发生在6-12 发病数月后，除两名抗NMDARE患者在12个月后基本康复外，几乎没有或根本没有进一步改善治疗数月。NEOS评分显著预测了AE患者最后一次随访的结果，在2分的临界值下，其敏感性为79%（AUC 0.79，95%CI 0.58–0.99，p = 0.04）。解释除了mRS之外，CASE和NEOS评分是捕捉不同症状、分级和监测症状严重程度的合适补充工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文去求助

来源期刊

Annals of Clinical and Translational Neurology Medicine-Neurology (clinical)

CiteScore

9.10

自引率

1.90%

发文量

218

审稿时长

8 weeks

期刊介绍： Annals of Clinical and Translational Neurology is a peer-reviewed journal for rapid dissemination of high-quality research related to all areas of neurology. The journal publishes original research and scholarly reviews focused on the mechanisms and treatments of diseases of the nervous system; high-impact topics in neurologic education; and other topics of interest to the clinical neuroscience community.