Evaluation of multiple consensus criteria for autoimmune encephalitis and temporal analysis of symptoms in a pediatric encephalitis cohort

Tiffany Pointon; Ryan Ward; Anusha Yeshokumar; Amanda Piquet; Teri Schreiner; Ryan Kammeyer

doi:10.3389/fneur.2022.952317

Evaluation of multiple consensus criteria for autoimmune encephalitis and temporal analysis of symptoms in a pediatric encephalitis cohort

Front Neurol. 2022 Sep 27:13:952317. doi: 10.3389/fneur.2022.952317. eCollection 2022.

Authors

Tiffany Pointon¹, Ryan Ward², Anusha Yeshokumar³, Amanda Piquet⁴, Teri Schreiner^{1

4}, Ryan Kammeyer^{1

4}

Affiliations

¹ Section of Child Neurology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States.
² School of Medicine, University of Colorado, Aurora, CO, United States.
³ Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
⁴ Section of Neuroimmunology, Department of Neurology, University of Colorado School of Medicine, Aurora, CO, United States.

Abstract

Objective: To evaluate the sensitivity and specificity of current criteria for the diagnosis of autoimmune encephalitis (AE) and the temporal onset of neuropsychiatric symptoms (NP) in a pediatric encephalitis cohort.

Background: Multiple criteria for AE have been developed, including the Graus and pediatric-focused Cellucci consensus criteria, and the Determining Etiology in Encephalitis (DEE) score for patients with encephalitis. Early identification and treatment of AE is crucial to improve outcomes, but this can be difficult given the frequent overlap of clinical presentation between AE and infectious encephalitis (IE).

Design/methods: A retrospective review was conducted of patients seen at our institution from 2000 to 2021 with a final diagnosis of AE or IE. These were narrowed through multiple exclusions to etiology-confirmed IE or antibody-positive/negative AE. Time of onset or results of all symptoms and diagnostics were recorded. Sensitivity and specificity of each criterion under various clinical scenarios were calculated over the first month after initial NP symptom onset.

Results: A total of 23 antibody-positive AE, 9 antibody-negative AE and 23 IE patients were included in final analysis. Under an idealized scenario with rapid initial diagnostic evaluations, the sensitivity for pediatric AE by day 28 after onset of NP symptoms approached 90% for both Cellucci and Graus criteria. Specificity within these 28 days was low without infectious testing results, increasing the greatest with rapid PCR testing and second with infectious antibody testing-reaching ~90% with both. A DEE score of 3 provided a specificity of 100% in identifying IE, but low sensitivity (29%). Symptoms were noted to cluster within several days of onset in IE, but in AE were spread out. Personality/behavioral change, speech change, affective disorder, and sleep disturbance were noted more often in AE, while fever, elevated C-reactive protein or CSF protein, and abnormal MRI-Brain occurred more often in IE.

Conclusion: In this study, we provide the first evaluation of the Cellucci criteria and the first validation of the DEE score in the differentiation of pediatric AE and IE. Further refinement of AE criteria is needed to improve early detection and treatment of pediatric AE.

Keywords: autoimmune encephalitis; diagnostic criteria; infectious encephalitis; neuroimmune disease; pediatric neurology; temporal analysis and evaluation.