Multimodal prognostication of autoimmune encephalitis: an Australian autoimmune encephalitis consortium study

J Neurol. 2025 Apr 25;272(5):361. doi: 10.1007/s00415-025-13069-1.

Abstract

Background and objectives: To identify factors predictive of a favourable modified Rankin score (mRS) at 12 months in patients with autoimmune encephalitis (AE). To evaluate predictors of a binary composite clinical-functional outcome measure, encompassing mRS, drug-resistant epilepsy (DRE) and memory impairment, at 12 months.

Methods: Univariable and multivariable logistic regression analyses for predictors of a favourable mRS (i.e. mRS ≤ 2) and a composite clinical-functional outcome at 12 months were used.

Results: A total of 231 patients with AE were recruited. Multivariable logistic regression identified factors predictive of reduced odds of favourable mRS at 12 months were older age (OR 0.97; 95% CI 0.95, 0.98; p < 0.001), T2/FLAIR hyperintensity on initial MRI (OR 0.27; 95% CI 0.13, 0.56; p < 0.001), RSE (OR 0.17; 95% CI 0.06, 0.52; p = 0.002) and first-line immunotherapy failure (OR 0.18; 95% CI 0.09, 0.37; p < 0.001). Anti-LGI1 antibody-mediated encephalitis relative to other subtypes (OR 4.46; 95% CI 1.55, 12.80; p = 0.006) was associated with a better 12-month mRS. We found concordant associations for a composite outcome at 12 months, with the addition of a diagnosis of definite autoimmune limbic encephalitis (AILE) predicting a poor outcome.

Discussion: Older age, MRI T2/FLAIR hyperintensity, RSE and first-line immunotherapy failure predicted worse mRS and composite clinical-functional outcome at 12 months, while a diagnosis of anti-LGI1 antibody-mediated encephalitis was associated with favourable outcomes. Our data highlight acute clinical factors predictive of a more severe clinical and functional course at 12 months.

Keywords: Autoimmune encephalitis; LGI1; Limbic encephalitis; Prognostication.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Australia
  • Autoantibodies
  • Autoimmune Diseases of the Nervous System* / diagnosis
  • Encephalitis* / diagnosis
  • Encephalitis* / diagnostic imaging
  • Encephalitis* / immunology
  • Encephalitis* / therapy
  • Female
  • Follow-Up Studies
  • Hashimoto Disease* / diagnosis
  • Hashimoto Disease* / diagnostic imaging
  • Hashimoto Disease* / therapy
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Prognosis
  • Young Adult

Substances

  • Autoantibodies

Supplementary concepts

  • Hashimoto's encephalitis