Síndromes neuropsiquiátricos como manifestación primaria en encefalitis autoinmune
DOI:
https://doi.org/10.35381/s.v.v10i19.4898Palabras clave:
Encefalitis autoinmune, Síndromes neuropsiquiátricos, Anti NMDAR, Anti LGI1, Inmunoterapia, (Fuente: DECS).Resumen
Introducción: Los síndromes neuropsiquiátricos suelen presentarse como manifestación inicial de la encefalitis autoinmune, dificultando el diagnóstico diferencial con trastornos psiquiátricos primarios. Objetivo: determinar el espectro de síndromes neuropsiquiátricos que pueden presentarse como manifestación primaria en la encefalitis autoinmune, que contribuyan al diagnóstico diferencial y al manejo clínico de estos pacientes. Método: Se realizó una revisión sistemática de la literatura reciente, incluyendo revisiones, cohortes, series de casos y guías, con extracción de datos clínicos, paraclínicos y terapéuticos. Resultados: Se identifican patrones serológicos diferenciados: anti‑NMDAR con inicio psiquiátrico florido, catatonia y disfunción autonómica; anti‑LGI1 con fenotipo límbico y amnesia anterógrada. Biomarcadores (FLCK, OCB) y CBA en LCR/suero mejoran la detección; EEG/RMN son útiles, pero a veces normales. La inmunoterapia temprana (esteroides, IVIG, PLEX) mejora la recuperación; ECT y terapias de segunda línea son eficaces en casos refractarios. Conclusiones: Se recomienda un diagnóstico presuntivo, pruebas dirigidas y tratamiento inmunomodulador precoz.
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Hansen N, Timäus C. Autoimmune encephalitis with psychiatric features in adults: historical evolution and prospective challenge. J Neural Transm (Vienna). 2021;128(1):1-14. https://doi.org/10.1007/s00702-020-02258-z
Cabrera-Maqueda JM, Planagumà, J., Guasp, M., & Dalmau, J. Autoimmune neuropsychiatric disorders manifesting with psychosis. J Clin Invest. 2025;135(20):e196507. https://doi.org/10.1172/JCI196507
Bertram D, Tsaktanis T, Berthele A, Korn T. The role of intrathecal free light chains kappa for the detection of autoimmune encephalitis in subacute onset neuropsychiatric syndromes. Sci Rep. 2023;13(1):17224. https://doi.org/10.1038/s41598-023-44427-6
Endres D, Lüngen E, Hasan A, Kluge M, Fröhlich S, Lewerenz J, Bschor T, Haußleiter IS, Juckel G, Then Bergh F, Ettrich B, Kertzscher L, Oviedo-Salcedo T, Handreka R, Lauer M, et al. Clinical manifestations and immunomodulatory treatment experiences in psychiatric patients with suspected autoimmune encephalitis: a case series of 91 patients from Germany. Mol Psychiatry. 2022;27(3):1479-1489. https://doi.org/10.1038/s41380-021-01396-4
Galioto R, Grezmak T, Swetlik C, Abbatemarco JR, Titulaer MJ, Finke C, Kunchok A. Neuropsychological testing in autoimmune encephalitis: a scoping review. Neurol Neuroimmunol Neuroinflamm. 2023;11(1):e200179. https://doi.org/10.1212/NXI.0000000000200179
Ko KY, Kazzi C, Seery N, Griffith S, Wesselingh R, Rushen T, Tan TH, Ford H, Meade C, O’Shea MF, McLaughlin L, Skinner G, Forcadela M, Halliday A, Duncan A, Butler EG, Der V, Kalincik T, D’Souza W, Seneviratne U. Subjective psychiatric symptoms in post-acute autoimmune encephalitis: findings from the Australian autoimmune encephalitis consortium. J Neurol. 2025;272(10):665. https://doi.org/10.1007/s00415-025-13353-0
Hansen N, Juhl AL, Grenzer IM, Rentzsch K, Wiltfang J, Fitzner D. Prevalence of anti-neural autoantibodies in a psychiatric patient cohort: paradigmatic application of criteria for autoimmune-based psychiatric syndromes. Front Psychiatry. 2022;13:864769. https://doi.org/10.3389/fpsyt.2022.864769
Hansen N, Lange C, Maass F, Hassoun L, Bouter C, Stöcker W, Schott BH, Wiltfang J, Fitzner D. Mild amnestic cognitive impairment and depressive symptoms in autoimmune encephalitis associated with serum anti-Neurexin 3α autoantibodies. Brain Sci. 2021;11(6):673. https://doi.org/10.3390/brainsci11060673
Vaux A, Robinson K, Saglam B, Cheuk N, Kilpatrick T, Evans A, Mastura M. Autoimmune encephalitis in long-standing schizophrenia: a case report. Front Neurol. 2022;12:810926. https://doi.org/10.3389/fneur.2021.810926
Abbatemarco JR, Yan C, Kunchok A, Rae‑Grant A. Antibody-mediated autoimmune encephalitis: a practical approach. Cleve Clin J Med. 2021 Aug;88(8):459-471. https://doi.org/10.3949/ccjm.88a.20122
Hahn C, Budhram A, Alikhani K, AlOhaly N, Beecher G, Blevins G, Brooks J, Carruthers R, Comtois J, Cowan J, de Robles P, Hébert J, Kapadia RK, Lapointe S, Mackie A, Mason W, McLane B, Muccilli A, Poliakov I, Smyth P. Canadian consensus guidelines for the diagnosis and treatment of autoimmune encephalitis in adults. Can J Neurol Sci. 2024;51:1-21. https://doi.org/10.1017/cjn.2024.16
Lee L, Leung J, Chan BM, Byrnes J, Kim H. Investigating health-related quality of life and clinical measures in autoimmune encephalitis: a systematic review. Orphanet J Rare Dis. 2025;20(1). https://doi.org/10.1186/s13023-025-03837-7
Mueller C, Elben S, Day GS, Alves P, Hebert J, Tang‑Wai DF, Holtmann O, Iorio R, Perani D, Titulaer MJ, Hansen N, Bartsch T, Johnen A, Illes Z, Borm L, Willison AG, et al. Review and meta-analysis of neuropsychological findings in autoimmune limbic encephalitis with autoantibodies against LGI1, CASPR2, and GAD65 and their response to immunotherapy. Clin Neurol Neurosurg. 2023;224:107559. https://doi.org/10.1016/j.clineuro.2022.107559
Roselló R, Girela-Serrano B, Gómez S, Baig B, Lim M, Taylor S. Characterizing the features and course of psychiatric symptoms in children and adolescents with autoimmune encephalitis. Eur Arch Psychiatry Clin Neurosci. 2022;272:477-482. https://doi.org/10.1007/s00406-021-01293-5
Patel A, Meng Y, Najjar A, Lado F, Najjar S. Autoimmune encephalitis: a physician's guide to the clinical spectrum, diagnosis and management. Brain Sci. 2022;12(9):1130. https://doi.org/10.3390/brainsci12091130
Marques FF, Nardi AE, Teixeira AL, Caixeta L. Immunopsychiatry: an update on autoimmune encephalitis for neuropsychiatrists. Expert Rev Neurother. 2022;22(2):155-167. https://doi.org/10.1080/14737175.2022.2038136
Jia Y, Li M, Hu S, Leng H, Yang X, Xue Q, Zhang M, Wang H, Huang Z, Wang H, Ye J, Liu A, Wang Y. Características psiquiátricas en la EA asociada a anticuerpos NMDAR y LGI1. Eur Arch Psychiatry Clin Neurosci. 2024; 274:1051-1061. https://doi.org/10.1007/s00406-023-01606-w
Rozenberg A, Shelly S, Vaknin-Dembinsky A, Friedman-Korn T, Benoliel-Berman T, Spector P, Yarovinsky N, Guber D, Gutter Kapon L, Wexler Y, Ganelin-Cohen E. Cognitive impairments in autoimmune encephalitis: the role of autoimmune antibodies and oligoclonal bands. Front Immunol. 2024;15:1405337. https://doi.org/10.3389/fimmu.2024.1405337
Liu Y, Wang J, Sun M, Liu Y, Wang L. Clinical characteristics and treatment of patients with overlapping MOG and anti-NMDAR encephalitis. BMC Neurol. 2025;25(1):472. https://doi.org/10.1186/s12883-025-04493-x
Yi Y, Zhao Y, Zhou H, Wang J. Identifying anti-LGI1 encephalitis in psychotic disorders: a clinically focused review. Gen Hosp Psychiatry. 2025;94:74-83. https://doi.org/10.1016/j.genhosppsych.2025.02.016
Wang W, Zhang L, Chi XS, He L, Zhou D, Li JM. Psychiatric symptoms of patients with anti-NMDA receptor encephalitis. Front Neurol. 2020;10:1330. https://doi.org/10.3389/fneur.2019.01330
Ongphichetmetha T, Swetlik C, Thompson N, Aboseif A, Punia V, Lapin B, Cohen JA, Galioto R, Kunchok A. Cognitive and patient-reported outcome measures in LGI1 IgG autoimmune encephalitis. Ann Clin Transl Neurol. 2025;12(8):1670-1679. https://doi.org/10.1002/acn3.70105
Beatino MF, Weiss F, Torrigiani S, Caruso V, Elefante C, Medda P, Brancati GE, Perugi G. Autoimmune encephalitis in catatonic and treatment-resistant psychotic patients referred to electroconvulsive therapy: two case reports and systematic review. J ECT. 2024. https://doi.org/10.1097/YCT.0000000000001092
Seery N, Butzkueven H, O’Brien TJ, Monif M. Contemporary advances in anti-NMDAR antibody-mediated encephalitis. Autoimmun Rev. 2022;21(4):103057. https://doi.org/10.1016/j.autrev.2022.103057
Simabukuro MM, Silva GD, Castro LHM, Lucato LT. A critical review and update on autoimmune encephalitis: understanding the alphabet soup. Arq Neuropsiquiatr. 2022;80(5 Suppl 1):143-158. https://doi.org/10.1590/0004-282X-ANP-2022-S122
Irani SR. Autoimmune encephalitis. Continuum (Minneap Minn). 2024;30(4):995-1020. https://doi.org/10.1212/CON.0000000000001448
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