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成人伴精神症状的自身免疫性脑炎:历史演变与前瞻性挑战。

Autoimmune encephalitis with psychiatric features in adults: historical evolution and prospective challenge.

机构信息

Department of Psychiatry and Psychotherapy, University of Goettingen, Von-Siebold-Str. 5, 37075, Goettingen, Germany.

出版信息

J Neural Transm (Vienna). 2021 Jan;128(1):1-14. doi: 10.1007/s00702-020-02258-z. Epub 2020 Oct 7.

Abstract

Our review aims to delineate the psychiatric spectrum of autoantibody-associated autoimmune encephalitis over time through its discoveries of antibodies. We searched in PubMed for appropriate articles depicting the first appearance and spectrum of psychiatric symptomatology in autoantibody-positive encephalitis for this narrative review. Memory impairment was first associated with autoantibodies against intracellular antigens such as anti-HuD antibodies in 1993. 8 years later, autoantibodies against cell membrane surface antigens such as voltage-gated potassium channels were described in conjunction with memory dysfunction. The spectrum of psychiatric syndromes was amplified between 1990 and 2020 to include disorientation, behavior, cognitive dysfunction, obsessive compulsive behavior and suicidality in encephalitis patients occurring together mainly with antibodies against surface antigens, less so against intracellular antigens. In general, we found no specific psychiatric symptoms underlying specific autoantibody-associated encephalitis. As fundamental data on this issue have not been systemically assessed to date, we cannot know whether our specific findings would remain from systematic studies, i.e., on the association between cerebrospinal fluid N-methyl-D-aspartate receptor antibodies in catatonia. The psychiatric symptomatology overlaps between psychiatric domains and occurs frequently in antibody-positive encephalitis. No specific psychiatric symptoms imply an underlying, specifically autoantibody-associated encephalitis. The psychiatric phenotypology associated with antibody-positive encephalitis has evolved tremendously recently, and this new evidence reveals its relevance for future diagnostic and treatment aspects of autoimmune encephalitis patients.

摘要

我们的综述旨在通过对自身抗体相关自身免疫性脑炎的发现,描绘出其精神病学特征随时间的演变。为此,我们在 PubMed 中搜索了描述自身抗体阳性脑炎中首次出现和精神病学症状谱的相关文章。1993 年首次发现抗 HuD 抗体等细胞内抗原自身抗体与记忆障碍有关。8 年后,描述了与记忆功能障碍相关的细胞膜表面抗原自身抗体,如电压门控钾通道自身抗体。1990 年至 2020 年期间,精神病综合征谱扩大,包括脑炎患者出现定向障碍、行为、认知功能障碍、强迫行为和自杀倾向,主要与表面抗原自身抗体有关,与细胞内抗原自身抗体关系较少。总的来说,我们没有发现特定的精神病症状与特定的自身抗体相关的脑炎有关。由于迄今为止尚未对这一问题的基本数据进行系统评估,我们无法知道我们的具体发现是否会来自系统研究,例如在与抗 NMDA 受体抗体相关的 catatonia 中。精神病学症状在精神病学领域之间存在重叠,并在抗体阳性脑炎中经常出现。没有特定的精神病症状意味着存在潜在的、特定的自身抗体相关脑炎。与抗体阳性脑炎相关的精神病表型最近发生了巨大变化,这一新证据揭示了其对自身免疫性脑炎患者未来诊断和治疗方面的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d214/7815593/4ee1e4547d3b/702_2020_2258_Fig1_HTML.jpg

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