Autoinmune encephalitis: a series of cases
Encefalitis autoinmune: experiencia de una serie de casos
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Mariño, N., Triana, J., Nieto, V., Paul Vergara, J., Silva, M., & Palacios, E. (2019). Autoinmune encephalitis: a series of cases. Journal of Medicine and Surgery Repertoire, 28(1). https://doi.org/10.31260/RepertMedCir.v28.n1.2019.876
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Case Reports
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Abstract
Autoimmune limbic encephalitis is defined as a severe inflammatory neurological disease which causes a rapidly progressive encephalopathy, usually in less than six weeks. An association with autoantibodies to extracellular epitopes or antibodies to intracellular synaptic proteins has been described. Six cases of autoimmune encephalitis are here presented, including typical findings, imaging alterations, clinical features, inpatient stay complications and response to treatment. Two cases were confirmed by autoantibody testing. One patient died during hospitalization. Our experience show, high risk of sequelae and unresponsive states to treatment which depended on how soon the treatment was initiated.
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References
1. Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis. Journal of clinical neurology (Seoul, Korea). 2016;12(1):1-13.
2. Irani SR, Gelfand JM, Al-Diwani A, Vincent A. Cell-surface central nervous system autoantibodies: clinical relevance and emerging paradigms. Annals of neurology. 2014;76(2):168-84.
3. Guan HZ, Ren HT, Cui LY. Autoimmune Encephalitis: An Expanding Frontier of Neuroimmunology. Chinese medical journal. 2016;129(9):1122-7.
4. Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Annals of the New York Academy of Sciences. 2015;1338:94-114.
5. Dubey D, Sawhney A, Greenberg B, Lowden A, Warnack W, Khemani P, et al. The spectrum of autoimmune encephalopathies. Journal of neuroimmunology. 2015;287:93-7.
6. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. The Lancet Neurology. 2016;15(4):391-404.
7. Vollmer TL, McCarthy M. Autoimmune encephalitis: A more treatable tragedy if diagnosed early. Neurology. 2016;86(18):1655-6.
8. Bale JF, Jr. Virus and Immune-Mediated Encephalitides: Epidemiology, Diagnosis, Treatment, and Prevention. Pediatric neurology. 2015;53(1):3-12.
9. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. The Lancet Neurology. 2013;12(2):157-65.
10. Mittal MK, Rabinstein AA, Hocker SE, Pittock SJ, Wijdicks EF, McKeon A. Autoimmune Encephalitis in the ICU: Analysis of Phenotypes, Serologic Findings, and Outcomes. Neurocritical care. 2016;24(2):240-50.
11. Davis R, Dalmau J. Autoimmunity, seizures, and status epilepticus. Epilepsia. 2013;54 Suppl 6:46-9.
12. Sharma A, Dubey D, Sawhney A, Janga K. GAD65 Positive Autoimmune Limbic Encephalitis: A Case Report and Review of Literature. Journal of clinical medicine research. 2012;4(6):424-8.
13. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2010;30(17):5866-75.
14. Graus F, Saiz A, Dalmau J. Antibodies and neuronal autoimmune disorders of the CNS. Journal of neurology. 2010;257(4):509-17.
15. Ramanathan S, Mohammad SS, Brilot F, Dale RC. Autoimmune encephalitis: recent updates and emerging challenges. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2014;21(5):722-30.
16. Vernino S, Geschwind M, Boeve B. Autoimmune encephalopathies. The neurologist. 2007;13(3):140-7.
17. Wingfield T, McHugh C, Vas A, Richardson A, Wilkins E, Bonington A, et al. Autoimmune encephalitis: a case series and comprehensive review of the literature. QJM : monthly journal of the Association of Physicians. 2011;104(11):921-31.
18. Zuliani L, Graus F, Giometto B, Bien C, Vincent A. Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition. Journal of neurology, neurosurgery, and psychiatry. 2012;83(6):638-45.
19. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. The Lancet Neurology. 2008;7(12):1091-8.
20. Day GS, High SM, Cot B, Tang-Wai DF. Anti-NMDA-receptor encephalitis: case report and literature review of an under- recognized condition. Journal of general internal medicine. 2011;26(7):811-6.
21. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. The Lancet Neurology. 2011;10(1):63-74.
22. Irani SR, Vincent A. NMDA receptor antibody encephalitis. Curr Neurol Neurosci Rep. 2011;11(3):298-304.
23. Zandi MS, Irani SR, Follows G, Moody AM, Molyneux P, Vincent A. Limbic encephalitis associated with antibodies to the NMDA receptor in Hodgkin lymphoma. Neurology. 2009;73(23):2039-40.
24. Iizuka T, Hara A. [Anti-NMDA receptor antibody-mediated encephalitis/encephalopathy]. Rinsho byori The Japanese journal of clinical pathology. 2009;57(3):252-61.
25. Kleinig TJ, Thompson PD, Matar W, Duggins A, Kimber TE, Morris JG, et al. The distinctive movement disorder of ovarian teratoma-associated encephalitis. Movement disorders : official journal of the Movement Disorder Society. 2008;23(9):1256-61.
26. Smith JH, Dhamija R, Moseley BD, Sandroni P, Lucchinetti CF, Lennon VA, et al. N-methyl-D-aspartate receptor autoimmune encephalitis presenting with opsoclonus-myoclonus: treatment response to plasmapheresis. Archives of neurology. 2011;68(8):1069-72.
27. Sansing LH, Tuzun E, Ko MW, Baccon J, Lynch DR, Dalmau J. A patient with encephalitis associated with NMDA receptor antibodies. Nature clinical practice Neurology. 2007;3(5):291-6.
28. Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Annals of neurology. 2009;66(1):11-8.
29. Gabilondo I, Saiz A, Galan L, Gonzalez V, Jadraque R, Sabater L, et al. Analysis of relapses in anti-NMDAR encephalitis. Neurology. 2011;77(10):996-9.
30. Lai M, Huijbers MG, Lancaster E, Graus F, Bataller L, Balice- Gordon R, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. The Lancet Neurology. 2010;9(8):776-85.
31. Barber PA, Anderson NE, Vincent A. Morvan's syndrome associated with voltage-gated K+ channel antibodies. Neurology. 2000;54(3):771-2.
32. Irani S, Lang B. Autoantibody-mediated disorders of the central nervous system. Autoimmunity. 2008;41(1):55-65.
33. Irani SR, Alexander S, Waters P, Kleopa KA, Pettingill P, Zuliani L, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan's syndrome and acquired neuromyotonia. Brain : a journal of neurology. 2010;133(9):2734-48.
34. Striano P. Faciobrachial dystonic attacks: seizures or movement disorder? Annals of neurology. 2011;70(1):179-80; author reply 80.
35. Vincent A, Buckley C, Schott JM, Baker I, Dewar BK, Detert N, et al. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain : a journal of neurology. 2004;127(Pt 3):701-12.
36. Buckley C, Oger J, Clover L, Tuzun E, Carpenter K, Jackson M, et al. Potassium channel antibodies in two patients with reversible limbic encephalitis. Annals of neurology. 2001;50(1):73-8.
37. Pozo-Rosich P, Clover L, Saiz A, Vincent A, Graus F. Voltage-gated potassium channel antibodies in limbic encephalitis. Annals of neurology. 2003;54(4):530-3.
38. Jarius S, Hoffmann LA, Stich O, Clover L, Rauer S, Vincent A, et al. Relative frequency of VGKC and 'classical' paraneoplastic antibodies in patients with limbic encephalitis. Journal of neurology. 2008;255(7):1100-1.
39. Prosser HM, Gill CH, Hirst WD, Grau E, Robbins M, Calver A, et al. Epileptogenesis and enhanced prepulse inhibition in GABA(B1)-deficient mice. Molecular and cellular neurosciences. 2001;17(6):1059-70.
40. Heine J, Pruss H, Bartsch T, Ploner CJ, Paul F, Finke C. Imaging of autoimmune encephalitis--Relevance for clinical practice and hippocampal function. Neuroscience. 2015;309:68-83.
41. Wegner F, Wilke F, Raab P, Tayeb SB, Boeck AL, Haense C, et al. Anti-leucine rich glioma inactivated 1 protein and anti-N-methyl- D-aspartate receptor encephalitis show distinct patterns of brain glucose metabolism in 18F-fluoro-2-deoxy-d-glucose positron emission tomography. BMC neurology. 2014;14:136.
42. Tojo K, Nitta K, Ishii W, Sekijima Y, Morita H, Takahashi Y, et al. A Young Man with Anti-NMDAR Encephalitis following Guillain- Barre Syndrome. Case reports in neurology. 2011;3(1):7-13.
43. Maqbool M, Oleske DA, Huq AH, Salman BA, Khodabakhsh K, Chugani HT. Novel FDG-PET findings in anti-NMDA receptor encephalitis: a case based report. Journal of child neurology. 2011;26(10):1325-8.
44. Kotsenas AL, Watson RE, Pittock SJ, Britton JW, Hoye SL, Quek AM, et al. MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis. AJNR American journal of neuroradiology. 2014;35(1):84-9.
45. Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu H, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Annals of neurology. 2009;65(4):424-34.
46. Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, Raizer J, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. The Lancet Neurology. 2010;9(1):67-76.
47. Boronat A, Sabater L, Saiz A, Dalmau J, Graus F. GABA(B) receptor antibodies in limbic encephalitis and anti-GAD-associated neurologic disorders. Neurology. 2011;76(9):795-800.
48. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau
J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain : a journal of neurology. 2000;123 ( Pt 7):1481-94.
49. Lawn ND, Westmoreland BF, Kiely MJ, Lennon VA, Vernino S. Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis. Mayo Clinic proceedings. 2003;78(11):1363-8.
50. Ances BM, Vitaliani R, Taylor RA, Liebeskind DS, Voloschin A, Houghton DJ, et al. Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain : a journal of neurology. 2005;128(Pt 8):1764-77.
51. Scheid R, Lincke T, Voltz R, von Cramon DY, Sabri O. Serial 18F-fluoro-2-deoxy-D-glucose positron emission tomography and magnetic resonance imaging of paraneoplastic limbic encephalitis. Archives of neurology. 2004;61(11):1785-9.
52. Basu S, Alavi A. Role of FDG-PET in the clinical management of paraneoplastic neurological syndrome: detection of the underlying malignancy and the brain PET-MRI correlates. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging. 2008;10(3):131-7.
53. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti- NMDA receptor encephalitis. Neurology. 2012;79(11):1094-100.
54. Dale RC, Merheb V, Pillai S, Wang D, Cantrill L, Murphy TK, et al. Antibodies to surface dopamine-2 receptor in autoimmune movement and psychiatric disorders. Brain : a journal of neurology. 2012;135(Pt 11):3453-68.
55. Thakur KT, Motta M, Asemota AO, Kirsch HL, Benavides DR, Schneider EB, et al. Predictors of outcome in acute encephalitis. Neurology. 2013;81(9):793-800.
2. Irani SR, Gelfand JM, Al-Diwani A, Vincent A. Cell-surface central nervous system autoantibodies: clinical relevance and emerging paradigms. Annals of neurology. 2014;76(2):168-84.
3. Guan HZ, Ren HT, Cui LY. Autoimmune Encephalitis: An Expanding Frontier of Neuroimmunology. Chinese medical journal. 2016;129(9):1122-7.
4. Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Annals of the New York Academy of Sciences. 2015;1338:94-114.
5. Dubey D, Sawhney A, Greenberg B, Lowden A, Warnack W, Khemani P, et al. The spectrum of autoimmune encephalopathies. Journal of neuroimmunology. 2015;287:93-7.
6. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. The Lancet Neurology. 2016;15(4):391-404.
7. Vollmer TL, McCarthy M. Autoimmune encephalitis: A more treatable tragedy if diagnosed early. Neurology. 2016;86(18):1655-6.
8. Bale JF, Jr. Virus and Immune-Mediated Encephalitides: Epidemiology, Diagnosis, Treatment, and Prevention. Pediatric neurology. 2015;53(1):3-12.
9. Titulaer MJ, McCracken L, Gabilondo I, Armangue T, Glaser C, Iizuka T, et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. The Lancet Neurology. 2013;12(2):157-65.
10. Mittal MK, Rabinstein AA, Hocker SE, Pittock SJ, Wijdicks EF, McKeon A. Autoimmune Encephalitis in the ICU: Analysis of Phenotypes, Serologic Findings, and Outcomes. Neurocritical care. 2016;24(2):240-50.
11. Davis R, Dalmau J. Autoimmunity, seizures, and status epilepticus. Epilepsia. 2013;54 Suppl 6:46-9.
12. Sharma A, Dubey D, Sawhney A, Janga K. GAD65 Positive Autoimmune Limbic Encephalitis: A Case Report and Review of Literature. Journal of clinical medicine research. 2012;4(6):424-8.
13. Hughes EG, Peng X, Gleichman AJ, Lai M, Zhou L, Tsou R, et al. Cellular and synaptic mechanisms of anti-NMDA receptor encephalitis. The Journal of neuroscience : the official journal of the Society for Neuroscience. 2010;30(17):5866-75.
14. Graus F, Saiz A, Dalmau J. Antibodies and neuronal autoimmune disorders of the CNS. Journal of neurology. 2010;257(4):509-17.
15. Ramanathan S, Mohammad SS, Brilot F, Dale RC. Autoimmune encephalitis: recent updates and emerging challenges. Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2014;21(5):722-30.
16. Vernino S, Geschwind M, Boeve B. Autoimmune encephalopathies. The neurologist. 2007;13(3):140-7.
17. Wingfield T, McHugh C, Vas A, Richardson A, Wilkins E, Bonington A, et al. Autoimmune encephalitis: a case series and comprehensive review of the literature. QJM : monthly journal of the Association of Physicians. 2011;104(11):921-31.
18. Zuliani L, Graus F, Giometto B, Bien C, Vincent A. Central nervous system neuronal surface antibody associated syndromes: review and guidelines for recognition. Journal of neurology, neurosurgery, and psychiatry. 2012;83(6):638-45.
19. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. The Lancet Neurology. 2008;7(12):1091-8.
20. Day GS, High SM, Cot B, Tang-Wai DF. Anti-NMDA-receptor encephalitis: case report and literature review of an under- recognized condition. Journal of general internal medicine. 2011;26(7):811-6.
21. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. The Lancet Neurology. 2011;10(1):63-74.
22. Irani SR, Vincent A. NMDA receptor antibody encephalitis. Curr Neurol Neurosci Rep. 2011;11(3):298-304.
23. Zandi MS, Irani SR, Follows G, Moody AM, Molyneux P, Vincent A. Limbic encephalitis associated with antibodies to the NMDA receptor in Hodgkin lymphoma. Neurology. 2009;73(23):2039-40.
24. Iizuka T, Hara A. [Anti-NMDA receptor antibody-mediated encephalitis/encephalopathy]. Rinsho byori The Japanese journal of clinical pathology. 2009;57(3):252-61.
25. Kleinig TJ, Thompson PD, Matar W, Duggins A, Kimber TE, Morris JG, et al. The distinctive movement disorder of ovarian teratoma-associated encephalitis. Movement disorders : official journal of the Movement Disorder Society. 2008;23(9):1256-61.
26. Smith JH, Dhamija R, Moseley BD, Sandroni P, Lucchinetti CF, Lennon VA, et al. N-methyl-D-aspartate receptor autoimmune encephalitis presenting with opsoclonus-myoclonus: treatment response to plasmapheresis. Archives of neurology. 2011;68(8):1069-72.
27. Sansing LH, Tuzun E, Ko MW, Baccon J, Lynch DR, Dalmau J. A patient with encephalitis associated with NMDA receptor antibodies. Nature clinical practice Neurology. 2007;3(5):291-6.
28. Florance NR, Davis RL, Lam C, Szperka C, Zhou L, Ahmad S, et al. Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis in children and adolescents. Annals of neurology. 2009;66(1):11-8.
29. Gabilondo I, Saiz A, Galan L, Gonzalez V, Jadraque R, Sabater L, et al. Analysis of relapses in anti-NMDAR encephalitis. Neurology. 2011;77(10):996-9.
30. Lai M, Huijbers MG, Lancaster E, Graus F, Bataller L, Balice- Gordon R, et al. Investigation of LGI1 as the antigen in limbic encephalitis previously attributed to potassium channels: a case series. The Lancet Neurology. 2010;9(8):776-85.
31. Barber PA, Anderson NE, Vincent A. Morvan's syndrome associated with voltage-gated K+ channel antibodies. Neurology. 2000;54(3):771-2.
32. Irani S, Lang B. Autoantibody-mediated disorders of the central nervous system. Autoimmunity. 2008;41(1):55-65.
33. Irani SR, Alexander S, Waters P, Kleopa KA, Pettingill P, Zuliani L, et al. Antibodies to Kv1 potassium channel-complex proteins leucine-rich, glioma inactivated 1 protein and contactin-associated protein-2 in limbic encephalitis, Morvan's syndrome and acquired neuromyotonia. Brain : a journal of neurology. 2010;133(9):2734-48.
34. Striano P. Faciobrachial dystonic attacks: seizures or movement disorder? Annals of neurology. 2011;70(1):179-80; author reply 80.
35. Vincent A, Buckley C, Schott JM, Baker I, Dewar BK, Detert N, et al. Potassium channel antibody-associated encephalopathy: a potentially immunotherapy-responsive form of limbic encephalitis. Brain : a journal of neurology. 2004;127(Pt 3):701-12.
36. Buckley C, Oger J, Clover L, Tuzun E, Carpenter K, Jackson M, et al. Potassium channel antibodies in two patients with reversible limbic encephalitis. Annals of neurology. 2001;50(1):73-8.
37. Pozo-Rosich P, Clover L, Saiz A, Vincent A, Graus F. Voltage-gated potassium channel antibodies in limbic encephalitis. Annals of neurology. 2003;54(4):530-3.
38. Jarius S, Hoffmann LA, Stich O, Clover L, Rauer S, Vincent A, et al. Relative frequency of VGKC and 'classical' paraneoplastic antibodies in patients with limbic encephalitis. Journal of neurology. 2008;255(7):1100-1.
39. Prosser HM, Gill CH, Hirst WD, Grau E, Robbins M, Calver A, et al. Epileptogenesis and enhanced prepulse inhibition in GABA(B1)-deficient mice. Molecular and cellular neurosciences. 2001;17(6):1059-70.
40. Heine J, Pruss H, Bartsch T, Ploner CJ, Paul F, Finke C. Imaging of autoimmune encephalitis--Relevance for clinical practice and hippocampal function. Neuroscience. 2015;309:68-83.
41. Wegner F, Wilke F, Raab P, Tayeb SB, Boeck AL, Haense C, et al. Anti-leucine rich glioma inactivated 1 protein and anti-N-methyl- D-aspartate receptor encephalitis show distinct patterns of brain glucose metabolism in 18F-fluoro-2-deoxy-d-glucose positron emission tomography. BMC neurology. 2014;14:136.
42. Tojo K, Nitta K, Ishii W, Sekijima Y, Morita H, Takahashi Y, et al. A Young Man with Anti-NMDAR Encephalitis following Guillain- Barre Syndrome. Case reports in neurology. 2011;3(1):7-13.
43. Maqbool M, Oleske DA, Huq AH, Salman BA, Khodabakhsh K, Chugani HT. Novel FDG-PET findings in anti-NMDA receptor encephalitis: a case based report. Journal of child neurology. 2011;26(10):1325-8.
44. Kotsenas AL, Watson RE, Pittock SJ, Britton JW, Hoye SL, Quek AM, et al. MRI findings in autoimmune voltage-gated potassium channel complex encephalitis with seizures: one potential etiology for mesial temporal sclerosis. AJNR American journal of neuroradiology. 2014;35(1):84-9.
45. Lai M, Hughes EG, Peng X, Zhou L, Gleichman AJ, Shu H, et al. AMPA receptor antibodies in limbic encephalitis alter synaptic receptor location. Annals of neurology. 2009;65(4):424-34.
46. Lancaster E, Lai M, Peng X, Hughes E, Constantinescu R, Raizer J, et al. Antibodies to the GABA(B) receptor in limbic encephalitis with seizures: case series and characterisation of the antigen. The Lancet Neurology. 2010;9(1):67-76.
47. Boronat A, Sabater L, Saiz A, Dalmau J, Graus F. GABA(B) receptor antibodies in limbic encephalitis and anti-GAD-associated neurologic disorders. Neurology. 2011;76(9):795-800.
48. Gultekin SH, Rosenfeld MR, Voltz R, Eichen J, Posner JB, Dalmau
J. Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain : a journal of neurology. 2000;123 ( Pt 7):1481-94.
49. Lawn ND, Westmoreland BF, Kiely MJ, Lennon VA, Vernino S. Clinical, magnetic resonance imaging, and electroencephalographic findings in paraneoplastic limbic encephalitis. Mayo Clinic proceedings. 2003;78(11):1363-8.
50. Ances BM, Vitaliani R, Taylor RA, Liebeskind DS, Voloschin A, Houghton DJ, et al. Treatment-responsive limbic encephalitis identified by neuropil antibodies: MRI and PET correlates. Brain : a journal of neurology. 2005;128(Pt 8):1764-77.
51. Scheid R, Lincke T, Voltz R, von Cramon DY, Sabri O. Serial 18F-fluoro-2-deoxy-D-glucose positron emission tomography and magnetic resonance imaging of paraneoplastic limbic encephalitis. Archives of neurology. 2004;61(11):1785-9.
52. Basu S, Alavi A. Role of FDG-PET in the clinical management of paraneoplastic neurological syndrome: detection of the underlying malignancy and the brain PET-MRI correlates. Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging. 2008;10(3):131-7.
53. Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D. Extreme delta brush: a unique EEG pattern in adults with anti- NMDA receptor encephalitis. Neurology. 2012;79(11):1094-100.
54. Dale RC, Merheb V, Pillai S, Wang D, Cantrill L, Murphy TK, et al. Antibodies to surface dopamine-2 receptor in autoimmune movement and psychiatric disorders. Brain : a journal of neurology. 2012;135(Pt 11):3453-68.
55. Thakur KT, Motta M, Asemota AO, Kirsch HL, Benavides DR, Schneider EB, et al. Predictors of outcome in acute encephalitis. Neurology. 2013;81(9):793-800.