Multi-anti-neuronal Antibody-positive Autoimmune Encephalitis:2 Case Reports And Review Of Literature

Objective:To investigate the clinical features,treatment options and prognosis of autoimmune encephalitis with multiple neuronal antibody positive.Methods:The clinical features of 2 patients with multiple anti-neuronal antibody-positive autoimmune encephalitis were analyzed retrospectively and combined with literature analysis.Results:In this report collected from January 2013 to March 2018 in the first affiliated hospital of Guangxi Medical University in 107 cases of autoimmune encephalitis hospitalized in pediatrics,there were 2 cases of multiple anti-neuronal antibodies,of which 1 case Anti-NMDAR antibody and anti-GABABR antibody were positive,another case was anti-LGI1 antibody positive with anti-CASPR2 antibody,all were adult females;2 patients had onset of subacute,epileptic seizures as the first symptom;Example 1 Patients with anti-NMDAR antibodies and anti-GABABR antibodies were accompanied by severe mental and behavioral abnormalities,insomnia symptoms,and history of previous morbidities;anti-LGI1 antibodies combined with anti-CASPR2 antibody positive patients had close memory,decreased computational power,insomnia,and refractory low sodium.Symptoms of Hyperlipidemia and Language Disorders;Case 1 Brain MRI showed demyelinating lesions on both sides of lateral ventricle white matter.Example 2 Brain MRI showed T1 and long T2 flaky abnormal signals such as bilateral parietal lobes,occipital lobe,and hippocampus.FLAIR showed high signal,in which the top and the occipital lesions were basically symmetric.In the enhancement examination,local meningesclerosis was found on both sides of the occipital lobe.After treatment,the lesions were reduced.The electroencephalograms in both patients were abnormal in different degrees.There were extensive low-amplitude amplitudes and slow waves in the EEG.There were no delta brushes.Patient 1 was given high-dose steroids combined with immunoglobulin sequential shock and azathioprine treatment.Patient 2 was given high-dose steroids combined with immunoglobulin sequential pulse therapy.Two patients experienced complete remission of symptoms after treatment.Patient 1 was treated.The use of oxcarbazepine,topiramate,and risperidone is still being adhered to.Case 2 patients have been completely discontinued,and 2 patients have been followed up until now without recurrence.Conclusion:The probability of multiple anti-neuronal antibodies positive in autoimmune encephalitis is not high;the superposition of neuronal antibodies may also cause the superposition of clinical syndromes,but it is not a simple and complete superposition,and it needs to be based on specific antibody types and clinical manifestations.Analysis;The disease is ideal for immunotherapy,the prognosis is good.