Limbic Encephalitis: A Narrative Literature Review
DOI:
https://doi.org/10.17533/udea.iatreia.272Palabras clave:
Anticuerpos, Encefalitis Límbica, Enfermedades Autoinmunes, Manifestaciones Neurológicas, Síndromes Paraneoplásicos del Sistema NerviosoResumen
Limbic encephalitis is a disease included in the group of autoimmune encephalitis triggered by different factors, including paraneoplastic, infectious, and pharmacological, among others. The main symptoms are memory impairment, seizures, and psychiatric symptoms. This disease can cause severe neuropsychiatric and cognitive sequelae if not treated in a timely manner, and, if underdiagnosed, it can worsen the prognosis when an underlying unidentified tumor exists. Given the importance of this condition, we wrote this article to provide an update on the diagnostic and therapeutic approach for these patients, according to possible findings in imaging, serum, and cerebrospinal fluid studies. Antibody detection tests can be used to identify, according to the location of the antigen (cellular surface, intracelular or synaptic), the relationship with tumors, response to treatment and prognosis. In case of paraneoplastic encephalitis, the therapeutic approach includes specific oncological treatment, immunotherapy, and symptom management, generally simultaneously.
Descargas
Citas
(1) Catani M, Dell’acqua F, Thiebaut de Schotten M. A revised limbic system model for memory, emotion and behaviour. Neurosci Biobehav Rev [Internet]. 2013;37(8):1724-7. https://doi.org/10.1016/j.neubiorev.2013.07.001
(2) Rolls ET. Limbic systems for emotion and for memory, but no single limbic system. Cortex [Internet]. 2015;62:119-57. https://doi.org/10.1016/j.cortex.2013.12.005
(3) Vogt BA. Cingulate cortex in the three limbic subsystems. Handb Clin Neurol [Internet]. 2019;166:39-51. https://doi.org/10.1016/B978-0-444-64196-0.00003-0
(4) Rolls ET. The cingulate cortex and limbic systems for emotion, action, and memory. Brain Struct Funct [Internet]. 2019;224(9):3001-18. https://doi.org/10.1007/s00429-019-01945-2
(5) Heine J, Prüss H, Bartsch T, Ploner CJ, Paul F, Finke C. Imaging of autoimmune encephalitis--Relevance for clinical practice and hippocampal function. Neuroscience [Internet]. 2015;309:68-83. https://doi.org/10.1016/j.neuroscience.2015.05.037
(6) Ramanathan S, Mohammad SS, Brilot F, Dale RC. Autoimmune encephalitis: recent updates and emerging challenges. J Clin Neurosci [Internet]. 2014;21(5):722-30. https://doi.org/10.1016/j.jocn.2013.07.017
(7) Giacomantone EG. Encefalitis límbica: clínica, patogenia y problemas diagnósticos. Rev Hosp Ital B Aires [Internet]. 29 de diciembre de 2020;40(4):199-207. Disponible en: //ojs.hospitalitaliano.org.ar/index.php/revistahi/article/view/30
(8) Kyritsis AP, Markoula S, Alexiou G, Asimakopoulos A, Jabbour P, Fotopoulos A, et al. Diagnosis and treatment of limbic encephalitis in the cancer patient. Future Oncol [Internet]Lond Engl. agosto de 2020;16(22):1647-55. https://doi.org/10.2217/fon-2020-0080
(9) Kao YC, Lin MI, Weng WC, Lee WT. Neuropsychiatric Disorders Due to Limbic Encephalitis: Immunologic Aspect. Int J Mol Sci [Internet]. 31 de diciembre de 2020;22(1):E389. https://doi.org/10.3390/ijms22010389
(10) Budhram A, Leung A, Nicolle MW, Burneo JG. Diagnosing autoimmune limbic encephalitis. CMAJ [Internet]Can Med Assoc J J Assoc Medicale Can. 13 de mayo de 2019;191(19):E529-34. https://doi.org/10.1503/cmaj.181548
(11) Sosa-Torres B, Prieto-Bragado MJ, Domínguez-Quintero LÁ, Fernández-Arroyo P, Blasco-Ciscar E, Cantó-Pérez R. Limbic encephalitis: The great unknown. Med Intensiva [Internet]. julio de 2017;41(5):319-21. https://doi.org/10.1016/j.medin.2016.06.001
(12) da-Rocha AJ, Nunes RH, Maia ACM, do-Amaral LLF. Recognizing Autoimmune-Mediated Encephalitis in the Differential Diagnosis of Limbic Disorders. AJNR Am J Neuroradiol [Internet]. 2015;36(12):2196-205. https://doi.org/10.3174/ajnr.A4408
(13) Witt JA, Helmstaedter C. Neuropsychological Evaluations in Limbic Encephalitis. Brain Sci [Internet]. 2021;11(5):576. https://doi.org/10.3390/brainsci11050576
(14) Rosenfeld MR, Dalmau J. Central nervous system paraneoplastic disease. Handb Clin Neurol [Internet]. 2012;105:853-64. https://doi.org/10.1016/B978-0-444-53502-3.00027-6
(15) Asztely F, Kumlien E. The diagnosis and treatment of limbic encephalitis. Acta Neurol Scand [Internet]. 2012;126(6):365-75. https://doi.org/10.1111/j.1600-0404.2012.01691.x
(16) Costa-Fernandes J, Gama-Marques J. A scoping review on paraneoplastic autoimmune limbic encephalitis (PALE) psychiatric manifestations. CNS Spectr [Internet]. 2022;27(2):191-8. https://doi.org/10.1017/S1092852920001960
(17) Lascano AM, Vargas MI, Lalive PH. Diagnostic tools for immune causes of encephalitis. Clin Microbiol Infect [Internet]. 2019;25(4):431-6. https://doi.org/10.1016/j.cmi.2018.12.012
(18) Ismail FS, Spatola M, Woermann FG, Popkirov S, Jungilligens J, Bien CG, et al. Diagnostic challenges in patients with temporal lobe seizures and features of autoimmune limbic encephalitis. Eur J Neurol [Internet]. 2022;29(5):1303-10. https://doi.org/10.1111/ene.15026
(19) Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol [Internet]. 2016;15(4):391-404. https://doi.org/10.1016/S1474-4422(15)00401-9
(20) Ding JB, Dongas J, Hu K, Ding M. Autoimmune Limbic Encephalitis: A Review of Clinicoradiological Features and the Challenges of Diagnosis. Cureus [Internet]. 2021;13(8):e17529. https://doi.org/10.7759/cureus.17529
(21) Barrio AH, Salvador-Álvarez E, Martin-Medina P, Koren-Fernandez L, Martínez-Aragón de Calvo AMDA, González DAR. Encefalitis autoinmunes: todo lo que un radiólogo debe saber y no se atreve a preguntar. Seram [Internet]. 2021 [consultado 2022 Ago 9];1(1). Disponible en: https://www.piper.espacio-seram.com/index.php/seram/article/view/4461
(22) Dalmau J, Graus F. Antibody-Mediated Encephalitis. N Engl J Med [Internet]. 2018;378(9):840-51. https://doi.org/10.1056/NEJMra1708712
(23) Moise AM, Karakis I, Herlopian A, Dhakar M, Hirsch LJ, Cotsonis G, et al. Continuous EEG Findings in Autoimmune Encephalitis. J Clin Neurophysiol [Internet]. 2021;38(2):124-9. https://doi.org/10.1097/WNP.0000000000000654
(24) Collao-Parra JP, Romero-Urra C, Delgado-Derio C. Encefalitis autoinmunes: criterios diagnósticos y pautas terapéuticas. Rev Med Chile [Internet]. 2018;146(3):351-61. Disponible en: https://scielo.conicyt.cl/pdf/rmc/v146n3/0034-9887-rmc-146-03-0351.pdf
(25) Uy CE, Binks S, Irani SR. Autoimmune encephalitis: clinical spectrum and management. Pract Neurol [Internet]. 2021;21(5):412-23. https://doi.org/10.1136/practneurol-2020-002567
(26) Linnoila JJ, Rosenfeld MR, Dalmau J. Neuronal surface antibody-mediated autoimmune encephalitis. Semin Neurol [Internet]. 2014;34(4):458-66. https://doi.org/10.1055/s-0034-1390394
(27) Melzer N, Budde T, Stork O, Meuth SG. Limbic Encephalitis: Potential Impact of Adaptive Autoimmune Inflammation on Neuronal Circuits of the Amygdala. Front Neurol [Internet]. 2015;6:171. https://doi.org/10.3389/fneur.2015.00171
(28) Ehling P, Melzer N, Budde T, Meuth SG. CD8(+) T Cell-Mediated Neuronal Dysfunction and Degeneration in Limbic Encephalitis. Front Neurol [Internet]. 2015;6:163. https://doi.org/10.3389/fneur.2015.00163
(29) Vogrig A, Muñiz-Castrillo S, Desestret V, Joubert B, Honnorat J. Pathophysiology of paraneoplastic and autoimmune encephalitis: genes, infections, and checkpoint inhibitors. Ther Adv Neurol Disord [Internet]. 2020;13:1756286420932797. https://doi.org/10.1177/1756286420932797
(30) Ismail II, Alnaser F, Al-Hashel JY. Seronegative limbic encephalitis manifesting as subacute amnestic syndrome: a case report and review of the literature. J Med Case Reports [Internet]. 2021;15(1):130. https://doi.org/10.1186/s13256-021-02742-4
(31) Greenlee JE, Carlson NG, Abbatemarco JR, Herdlevær I, Clardy SL, Vedeler CA. Paraneoplastic and Other Autoimmune Encephalitides: Antineuronal Antibodies, T Lymphocytes, and Questions of Pathogenesis. Front Neurol [Internet]. 2021;12:744653. https://doi.org/10.3389/fneur.2021.744653
(32) Navarro-Pérez MP, Bellosta-Diago E, Pérez-Lázaro C, Santos-Lasaosa S, Mauri-Llerda JÁ, Navarro-Pérez MP, et al. Encefalitis límbica autoinmune asociada a anticuerpos LGI1: presentación de un caso y revisión de la bibliografía. Rev Ecuat Neurol [Internet]. 2020;29(1):161-4. Disponible en: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1058483
(33) Bing-Lei W, Jia-Hua Z, Yan L, Zan Y, Xin B, Jian-Hua S, et al. Three cases of antibody-LGI1 limbic encephalitis and review of literature. Int J Neurosci [Internet]. 2019;129(7):642-8. https://doi.org/10.1080/00207454.2018.1512985
(34) Rodriguez A, Klein CJ, Sechi E, Alden E, Basso MR, Pudumjee S, et al. LGI1 antibody encephalitis: acute treatment comparisons and outcome. J Neurol Neurosurg Psychiatry [Internet]. 2022;93(3):309-15. https://doi.org/10.1136/jnnp-2021-327302
(35) Jia Y, Li M, Wang H, Zhang M, Wang Y. The Peculiar Clinical Symptoms and Treatment of Limbic Encephalitis Associated with AMPA Receptor Antibody. Eur Neurol [Internet]. 2021;84(3):206-11. https://doi.org/10.1159/000515592
(36) Zhang X, Lang Y, Sun L, Zhang W, Lin W, Cui L. Clinical characteristics and prognostic analysis of anti-gamma-aminobutyric acid-B (GABA-B) receptor encephalitis in Northeast China. BMC Neurol [Internet]. 2020;20(1):1. https://doi.org/10.1186/s12883-019-1585-y
(37) Cui J, Bu H, He J, Zhao Z, Han W, Gao R, et al. The gamma-aminobutyric acid-B receptor (GABAB) encephalitis: clinical manifestations and response to immunotherapy. Int J Neurosci [Internet]. 2018;128(7):627-33. https://doi.org/10.1080/00207454.2017.1408618
(38) McKeon A. Autoimmune Encephalopathies and Dementias. Contin (Minneap Minn) [Internet]. 2016;22(2 Dementia):538-58. https://doi.org/10.1212/CON.0000000000000299
(39) Leypoldt F, Armangue T, Dalmau J. Autoimmune encephalopathies. Ann N Y Acad Sci [Internet]. 2015;1338(1):94-114. https://doi.org/10.1111/nyas.12553
(40) Vrillon A, Carle G, Berzero G, Honnorat J, Huberfeld G, Psimaras D, et al. Psychiatric symptoms in anti glutamic acid decarboxylase associated limbic encephalitis in adults: a systematic review. Neurosci Biobehav Rev [Internet]. diciembre de 2020;119:128-37. https://doi.org/10.1016/j.neubiorev.2020.08.015
(41) Restrepo-Martínez M, Espinola-Nadurille M, López-Hernández JC, Martínez V, Téllez-Martínez JA, Bustamante-Gómez PA, et al. Aspectos neuropsiquiátricos de la encefalitis por anticuerpos contra el receptor NMDA. Rev Alerg México [Internet]. 2021;68(4):251-63. https://doi.org/10.29262/ram.v68i4.953
(42) Barry H, Byrne S, Barrett E, Murphy KC, Cotter DR. Anti-N-methyl-d-aspartate receptor encephalitis: review of clinical presentation, diagnosis and treatment. BJPsych Bull [Internet]. 2015;39(1):19-23. https://doi.org/10.1192/pb.bp.113.045518
(43) Ryan N. Anti-N-Methyl-D-Aspartate Receptor-Mediated Encephalitis: Recent Advances in Diagnosis and Treatment in Children. Curr Probl Pediatr Adolesc Health Care [Internet]. 2016;46(2):58-61. https://doi.org/10.1016/j.cppeds.2015.11.005
(44) Flanagan EP. Paraneoplastic disorders of the nervous system. J Neurol [Internet]. 2021;268(12):4899-907. https://doi.org/10.1007/s00415-021-10570-1
(45) Duong SL, Prüss H. Paraneoplastic Autoimmune Neurological Syndromes and the Role of Immune Checkpoint Inhibitors. Neurotherapeutics [Internet]. 2022;19(3):848-63. https://doi.org/10.1007/s13311-022-01184-0
(46) Lancaster E. The Diagnosis and Treatment of Autoimmune Encephalitis. J Clin Neurol [Internet]. 2016;12(1):1-13. Available From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712273/
(47) Venkatesan A, Murphy OC. Viral Encephalitis. Neurol Clin [Internet]. 2018;36(4):705-24. https://doi.org/10.1016/j.ncl.2018.07.001
(48) Lancheros-Pineda LM, Yasno-Arias DA, Zea-Rojas DI, Torres-Ballesteros V, Bernal-Pacheco O. Manifestaciones neurológicas por COVID-19. Reporte de casos en Hospital Militar Central Bogotá, Colombia, y revisión de la literatura. Rev Med [Internet]. 2021;29(1):57-76. https://doi.org/10.18359/rmed.5144
(49) Nabizadeh F, Balabandian M, Sodeifian F, Rezaei N, Rostami MR, Naser-Moghadasi A. Autoimmune encephalitis associated with COVID-19: A systematic review. Mult Scler Relat Disord [Internet]. 2022;62:103795. https://doi.org/10.1016/j.msard.2022.103795
(50) Ahmad SJ, Feigen CM, Vazquez JP, Kobets AJ, Altschul DJ. Neurological Sequelae of COVID-19. J Integr Neurosci [Internet]. 2022;21(3):77. https://doi.org/10.31083/j.jin2103077
(51) Maury A, Lyoubi A, Peiffer-Smadja N, de Broucker T, Meppiel E. Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians. Rev Neurol (Paris) [Internet]. 2021;177(1-2):51-64. https://doi.org/10.1016/j.neurol.2020.10.001
(52) Ariño H, Heartshorne R, Michael BD, Nicholson TR, Vincent A, Pollak TA, et al. Neuroimmune disorders in COVID-19. J Neurol [Internet]. junio de 2022;269(6):2827-39. https://doi.org/10.1007/s00415-022-11050-w
(53) Vogrig A, Muñiz-Castrillo S, Joubert B, Picard G, Rogemond V, Marchal C, et al. Central nervous system complications associated with immune checkpoint inhibitors. J Neurol Neurosurg Psychiatry [Internet]. 2020;91(7):772-8. https://doi.org/10.1136/jnnp-2020-323055
(54) Grativvol RS, Cavalcante WCP, Castro LHM, Nitrini R, Simabukuro MM. Updates in the Diagnosis and Treatment of Paraneoplastic Neurologic Syndromes. Curr Oncol Rep [Internet]. 2018;20(11):92. https://doi.org/10.1007/s11912-018-0721-y
(55) Ellul MA, Wood G, Tooren HVD, Easton A, Babu A, Michael BD. Update on the diagnosis and management of autoimmune encephalitis. Clin Med Lond Engl [Internet]. 2020;20(4):389-92. https://doi.org/10.7861/clinmed.2020-0241
(56) Marinas JE, Matveychuk D, Dursun SM, Baker GB. Neuroimmunological antibody-mediated encephalitis and implications for diagnosis and therapy in neuropsychiatry. Acta Neuropsychiatr [Internet]. 2020;32(4):177-85. https://doi.org/10.1017/neu.2019.50
(57) Yang J, Liu X. Immunotherapy for Refractory Autoimmune Encephalitis. Front Immunol [Internet]. 2021;12:790962. https://doi.org/10.3389/fimmu.2021.790962
(58) Porto FHG, Coutinho AMN, Lucato LT, Spíndola L, Ono CR, Brucki SMD, et al. Paraneoplastic limbic encephalitis with prominent neuropsychiatric apathy. J Neurol Sci [Internet]. 2014;337(1-2):224-7. https://doi.org/10.1016/j.jns.2013.11.038
(59) Hopkins SA, Moodley KK, Chan D. Autoimmune limbic encephalitis presenting as relapsing psychosis. BMJ Case Rep [Internet]. 2013;2013:bcr2013010461. https://doi.org/10.1136/bcr-2013-010461
(60) Monteiro VL, Barreto FJN, Rocha PMB, do Prado PHT, Garcia FD, Correa H, et al. Managing severe behavioral symptoms of a patient with anti-NMDAR encephalitis: case report and findings in current literature. Trends Psychiatry Psychother [Internet]. 2015;37(1):47-50. https://doi.org/10.1590/2237-6089-2014-0036
(61) Abboud H, Probasco J, Irani SR, Ances B, Benavides DR, Bradshaw M, et al. Autoimmune encephalitis: proposed recommendations for symptomatic and long-term management. J Neurol Neurosurg Psychiatry [Internet]. 2021;92(8):897-907. https://doi.org/10.1136/jnnp-2020-325302
(62) Perna R, Arenivas A. Limbic encephalitis and Post-Acute neuropsychology rehabilitation: A review and case examples. Appl Neuropsychol Adult [Internet]. 2022;29(4):874-80. https://doi.org/10.1080/23279095.2020.1796669
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2024 Iatreia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Los artículos publicados en la revista están disponibles para ser utilizados bajo la licencia Creative Commons, específicamente son de Reconocimiento-NoComercial-CompartirIgual 4.0 Internacional.
Los trabajos enviados deben ser inéditos y suministrados exclusivamente a la Revista; se exige al autor que envía sus contribuciones presentar los formatos: presentación de artículo y responsabilidad de autoría completamente diligenciados.