KUALA LUMPUR, Imagine a neurological disease that mimics what it feels like to inexplicably lose your mind.
One day, you are a healthy adult whose biggest concern is completing your projects at work and, the next day, you start having hallucinations and delusions.
In the realm of frequently misdiagnosed conditions, the relatively recent discovery of Autoimmune Encephalitis (AE), with almost two decades of history, stands out.
Defined as a group of related conditions where the body's immune system attacks the brain, AE manifests in progressive or relapsing-remitting forms, presenting various subtypes and, if left untreated, this condition can lead to permanent brain injury and, in severe cases, even death.
According to Sunway Medical Centre Velocity (SMCV) Consultant Neurologist and Internal Medicine Physician Dr Ellie Kok Huey Tean, AE is a spectrum of diseases that affects a person’s cognitive function which can lead to a disruption in judgment.
More often than not, its diagnosis is often hindered or delayed as its clinical symptoms mimic psychiatric conditions.
Dr Ellie highlights the challenge, stating: “AE is often misdiagnosed when a patient is presented with psychiatric symptoms such as hallucination, paranoid thoughts, delusion, behavioural and personality changes. Thus, sometimes, it can be confused with a psychiatric disorder.”
“The manifestations of AE encompass an array of other symptoms too, including headache, cognitive function decline, seizures and movement disorder,” she said in a statement today.
She said the causes of AE are diverse, spanning from exposure to specific viruses such as herpes simplex virus and the presence of certain cancers, with research indicating that AE predominantly impacts individuals from their early teenage years to age 50, with women being more susceptible to get the disease than men and specific phenotypes within AE may exhibit a higher prevalence in a certain age or gender groups.
“For example, N-methyl-D-aspartate receptor (NMDAR) encephalitis tends to be more commonly observed in adolescents and young adults.
“Within this specific phenotype, there is an elevated susceptibility observed in young women, particularly individuals with an underlying tumour, specifically Gonodal Teratoma (tumours situated in the reproductive organs) and can affect the brain cells,” she said.
Further explaining, for the elderly population, Dr Ellie mentioned that there is a distinct AE phenotype, known as paraneoplastic encephalitis, which arises when an elderly person has an occult (hidden) cancer, in which this abnormal cancer cells can trigger the immune system to generate specific antibodies that attack the brain, causing AE symptoms way before the manifestation of cancer.
“When neuropsychiatric manifestation occurs in elderly patients, neurologists can identify the cancer tumour through imaging tests. Most commonly, tumours originate from the lungs, while in female patients, they can be from the ovary or breast.
She advises family members or caretakers of the elderly to be vigilant for AE symptoms, especially given the elderly's susceptibility to infections - a primary cause of AE.
It is also crucial to monitor for symptoms of AE in the elderly such as memory decline, behavioural changes, seizures and gait problems, such as loss of balance while walking.
Dr Ellie said that to treat AE, doctors and consultants would need to follow specific criteria to diagnose AE, including differentiating between psychiatric conditions and neurological diseases.
This involves assessing short-term memory loss, psychiatric symptoms or other altered mental states within a three-month timeframe. Additional indicators include movement disorders and seizures.
For assisting in diagnosing this condition, specific tests would be an electroencephalogram (EEG), cerebrospinal fluid analysis and a brain MRI.
Dr Ellie said that it is wise to seek a neurologist’s opinion once a person has acute onset manifestation of psychiatric problems and once the diagnosis is confirmed, adding that with appropriate immunotherapy treatment, most patients can be cured of AE.
She said the treatment for AE is targeted to eliminate the auto-antibody that is detected in the body, and the usual immunotherapy treatment deployed comprises Intravenous immunoglobulin (IVIG), plasma exchange and immunosuppression agents.
However, she said there is a minority who may relapse within five years - therefore making follow-ups crucial to prevent or detect any such re-occurrence in the body.
Dr Ellie underscores the urgency of recognising the symptoms: “Whether it's AE or any other neurological condition, early intervention remains the cornerstone of effective treatment. For individuals experiencing symptoms indicative of AE, prompt consultation with healthcare professionals is crucial for accurate diagnosis and timely treatment.”
Source: BERNAMA News Agency