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Encephalitis: Diagnosis, management and recent advances in the field of encephalitides

Research output: Contribution to journalReview articlepeer-review

Ali M. Alam, Ava Easton, Timothy R. Nicholson, Sarosh R. Irani, Nicholas W.S. Davies, Tom Solomon, Benedict D. Michael

Original languageEnglish
Article number2022-141812
JournalPostgraduate Medical Journal
Early online date23 Jun 2022
DOIs
Accepted/In press25 Apr 2022
E-pub ahead of print23 Jun 2022

Bibliographical note

Funding Information: BDM is supported by the UKRI/MRC (MR/V03605X/1), the MRC/UKRI (MR/V007181//1), MRC (MR/T028750/1) and Wellcome (ISSF201902/3). Funding Information: SRI is an inventor on ‘Diagnostic strategy to improve specificity of CASPR2 antibody detection’ (PCT/G82019 /051257) and receives royalties on a licensed patent application for LGI1/CASPR2 testing as coapplicant (PCT/GB2009/051441) entitled ‘Neurological Autoimmune Disorders’. SRI is supported by a senior clinical fellowship from the Medical Research Council (MR/V007173/1), Wellcome Trust Fellowship (104079/Z/14/Z) and the BMA Research Grants—Vera Down grant (2013) and Margaret Temple (2017), Epilepsy Research UK (P1201), the Fulbright UK-US commission (MS-Society research award) and by the NIHR Oxford Biomedical Research Centre. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. SRI has received honoraria from UCB, Immunovant, MedImmun, Roche, Cerebral Therapeutics, ADC Therapeutics, Brain, Medlink Neurology and research support from CSL Behring, UCB and ONO Pharma. TS was Chair/Co-Chair of the UKRI/NIHR COVID-19 Rapid Response and Rolling Funding Initiatives (from March 2020), an Advisor to the UK COVID-19 Therapeutics Advisory Panel (UK-TAP, from August 2020) and a member of the MHRA COVID-19 Vaccines Benefit Risk Expert Working Group (from August 2020). He is also a trustee of the UK Academy of 19Medical Sciences (December 2021). TS is President of the Encephalitis Society. TS was an advisor to the GSK Ebola Vaccine programme and chaired a Siemens Diagnostics Clinical Advisory Board. TS was on the Data Safety Monitoring Committee of the GSK Study to Evaluate the Safety and Immunogenicity of a Candidate Ebola Vaccine in Children GSK3390107A (ChAd3 EBO-Z) vaccine. TS chaired the Siemens Healthineers Clinical Advisory Board. Data safety monitoring board: Study of Ebola vaccine and ChAd3-EBO-Z—commercial entity. Publisher Copyright: © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.

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Abstract

Encephalitis describes inflammation of the brain parenchyma, typically caused by either an infectious agent or through an autoimmune process which may be postinfectious, paraneoplastic or idiopathic. Patients can present with a combination of fever, alterations in behaviour, personality, cognition and consciousness. They may also exhibit focal neurological deficits, seizures, movement disorders and/or autonomic instability. However, it can sometimes present non-specifically, and this combined with its many causes make it a difficult to manage neurological syndrome. Despite improved treatments in some forms of encephalitides, encephalitis remains a global concern due to its high mortality and morbidity. Prompt diagnosis and administration of specific and supportive management options can lead to better outcomes. Over the last decade, research in encephalitis has led to marked developments in the understanding, diagnosis and management of encephalitis. In parallel, the number of autoimmune encephalitis syndromes has rapidly expanded and clinically characteristic syndromes in association with pathogenic autoantibodies have been defined. By focusing on findings presented at the Encephalitis Society's conference in December 2021, this article reviews the causes, clinical manifestations and management of encephalitis and integrate recent advances and challenges of research into encephalitis.

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