Analysis Of Clinical And EEG Characteristics Of Different Subtypes Of Autoimmune Encephalitis

Objective:The clinical and EEG features of 36 cases of neuron surface antibody positive encephalitis（autoimmuneencephalitis,AE）were summarized and analyzed,and the influencing factors of EEG and the relationship between EEG and abnormal grading of EEG in patients with AE were further discussed,so as to improve our further understanding and understanding of the clinical features and EEG characteristics of AE,and provide reference suggestions and clinical basis for clinical work.Methods:Thirty-six patients diagnosed with autoimmune encephalitis and meeting the inclusion criteria were collected from January 2019 to December 2021 in the Department of Neurology,the First Affiliated Hospital of Dali University and the Department of Neurology,Shengjing Hospital of China Medical University.Data including general conditions（gender,age,ethnicity,residence,past medical history）,clinical symptoms（prodromal symptoms,main clinical symptoms）,auxiliary examinations（cranial imaging,electroencephalogram,cerebrospinal fluid biochemical routine etiology,autoimmune encephalitis antibody,tumor markers,thyroid function,blood biochemistry including serum sodium,blood routine,serum albumin）were collected and divided intoγ-aminobutyric acid-B receptor（GABABR）group,leucine-rich glioma inactivating protein 1（LGI1）group according to different antibody types,that is,GABABR group and LGI1 acid-NMDAR group.A retrospective analysis was performed in combination with the previous literature to summarize and summarize the clinical characteristics and EEG characteristics of the three subtypes of AE;then,according to the EEG results of the patients,the patients with the same antibody type were divided into the abnormal EEG group,and the clinical data of the two groups were analyzed;the influencing factors of EEG in patients with AE were explored,and the correlation between some indicators and the grade of abnormal EEG was selected for analysis.All data were statistically analyzed using R software（version 4.0.0）.Results:1.36 patients with AE were collected,including 18 cases of anti-NMDAR encephalitis（50%）,9 cases of anti-LGI1 antibody encephalitis and 9 cases of anti-GABABR antibody encephalitis.There were 5 males（27.78%）and 13 females（72.22%）in anti-NMDAR encephalitis,the age of onset was 19-49 years old,the median age was 31 years old,6 males（66.67%）and 3 females（33.33%）in anti-LGI1encephalitis,the age of onset was 50-65 years old,the median age was 56 years old.Anti-GABABR antibody encephalitis was found in 7 males（77.78%）and 2 females（22.22%）.The age of onset was 56-64 years old,and the median age was 62 years old.2.Prodromal symptoms were found in 13 patients（36.11%）.The occurrence rate of main clinical symptoms was abnormal mental behavior in 20 cases（55.56.%）,followed by seizures in 16 cases（44.44%）,disturbance of consciousness in 13 cases（36.11%）,cognitive decline in 12 cases（33.33%）,and memory impairment in 11 cases（30.56%）.The highest occurrence rate of anti-NMDAR encephalitis clinical symptoms was mental and behavioral abnormalities（55.56%10pm,18 cases）,and the highest occurrence rates of anti-GABABR encephalitis symptoms were seizures and mental and behavioral abnormalities（55.56%Encephalitis,9 cases）.It was found that there were significant differences in sleep disorders among anti-GABABR antibody encephalitis,anti-LGI1 antibody encephalitis and anti-NMDAR encephalitis groups（P<0.040）,and the proportion of sleep disorders in patients with anti-LGI1 antibody encephalitis was higher than that of the other two types of antibodies.3.12 patients had hyponatremia.There was significant difference in hyponatremia among the three groups（P<0.001）.The occurrence rate of hyponatremia in anti-LGI1 antibody encephalitis was higher.There was significant difference in the number of white blood cells in cerebrospinal fluid among the three groups（p=0.049）.The CSF white blood cell count in patients with anti-LGI1 antibody encephalitis was lower than that in the other two groups,and the median number of cerebrospinal fluid cells in anti-LGI1 antibody encephalitis was 3.950×10~6/L.The median number of cerebrospinal fluid cells in anti-NMDAR encephalitis and anti-GABABR antibody encephalitis was 20.500×10~6/L and 29.000×10~6/L.Among them,the proportion of lymphocytes increased mainly.4.There was no significant difference in EEG grading among the three groups（p>0.05）.In patients with anti-GABABR and NMDAR encephalitis,the white blood cell count in cerebrospinal fluid of abnormal EEG group was higher than that of normal EEG group,and the clinical manifestations of cognitive impairment and blood-brain barrier impairment were more likely to occur in patients with anti-LGI1 antibody encephalitis than in normal group（p<0.05）.5.Univariate analysis of the influencing factors of AE EEG showed that cognitive impairment and the number of leukocytes in cerebrospinal fluid in clinical symptoms were related to abnormal EEG,and the difference was statistically significant.Further multivariate logistic regression analysis,adjusted by age and sex,showed that cognitive impairment and the number of leukocytes in cerebrospinal fluid were still related to abnormal EEG,and there was significant statistical significance（p<0.05）.6.The grade of EEG was significantly correlated with cognitive impairment,white blood cell count of CSF and antibody titer of cerebrospinal fluid.（p<0.05）Conclusion:1.Anti-NMDAR encephalitis is more common in young women,anti-GABABR antibody encephalitis is more common in old men,anti-LGI1 antibody encephalitis is more common in middle-aged and old men,and is more prone to sleep disorders and hyponatremia.2.The white blood cell count in CSF cerebrospinal fluid of patients with anti-LGI1 antibody encephalitis was lower than that of anti-NMDAR encephalitis and anti-GABABR antibody encephalitis.3.In patients with anti-GABABR antibody encephalitis and anti-NMDAR encephalitis,the white blood cell count in cerebrospinal fluid of patients with abnormal EEG was higher than that of patients with normal EEG.4.Cognitive impairment and white blood cell count in cerebrospinal fluid are the influencing factors of EEG,and they are of good value in judging EEG.5.EEG grading in patients with AE was significantly correlated with CSF antibody titer,CSF leukocyte count and cognitive impairment,and positively correlated.