Suspected Autoimmune Encephalitis: Symptoms, Diagnosis, and Treatment

Is there a diagnosis of autoimmune encephalitis?

Hello Doctor, my sister was diagnosed with schizophrenia last September.
She has been taking medication at Hospital A for nearly a year, during which she gradually developed mild involuntary hand tremors and head tilting backward.
In June of this year, my family became concerned that her motor symptoms were becoming too severe, so they stopped all her medications, which led to a worsening of her symptoms.
She was later hospitalized, where CT and MRI scans showed no issues, and the hospital only mentioned possible nerve damage, after which she was discharged.
After being discharged from Hospital A, her motor symptoms remained severe.
The symptoms include: inability to sit or lie down on the sofa, sliding off when the movements are severe, involuntary twisting of her limbs and head, to the point of sweating and dehydration, her mouth remains open as if yawning, her left hand is stiff with twisted fingers resting beside her buttocks, her right hand is not as stiff, and her head also tilts backward.
Subsequently, she visited the emergency department at Hospital B, where she received two doses of muscle relaxants that were ineffective.
During this process, I researched online and discussed with the emergency physician the possibility of extrapyramidal symptoms.
However, the doctor stated that while psychiatric patients often experience extrapyramidal symptoms, none are as severe as my sister's.
Ultimately, she was diagnosed with tardive dystonia.
Two days later, she returned to the emergency room and decided to be hospitalized.
Blood tests, a lumbar puncture, and an EEG were performed, and the doctor reported that all tests were normal, except for a slightly elevated white blood cell count, leading to a diagnosis of suspected autoimmune encephalitis.
During her hospitalization, her medication was adjusted, and she was discharged after her motor symptoms resolved.
Last week, she returned to Hospital B, where the doctor adjusted her medication to reduce her stiffness.
However, after four days on the new medication, her symptoms flared up again.
Today, during a follow-up appointment, the doctor suggested reducing her medication, as it might be due to drug residue causing the flare-up.
Since her discharge, her medication regimen has been as follows:
- In the first week: Rifampicin 0.5 mg, Ening 5 mg, Betamethasone 10 mg, and Bisacodyl 12 mg.
- In the second week: Rifampicin 0.5 mg, Medoprol 200/50 mg, Betamethasone 10 mg, Bisacodyl 12 mg, Aishuteng 500 mg, and Rhythm Control 10 mg.
- This week: Betamethasone 10 mg, Rifampicin 0.5 mg, Bisacodyl 12 mg, and Rhythm Control 10 mg.
This summarizes my sister's situation.
Doctor, I would like to ask:
1.
Is it possible that she has autoimmune encephalitis? If so, what treatment should be pursued?
2.
Could it be another rare disease? The doctor's diagnosis also mentioned "suspected," so could it be another condition?
3.
What lifestyle recommendations or precautions should we consider?
4.
Would you recommend seeking traditional Chinese medicine treatment? Our current thought is to identify the underlying cause (though it may not be found) before pursuing traditional Chinese medicine treatment.

A Fei, 10~19 year old female. Ask Date: 2023/08/16

Dr. Peng Shiwei reply Neurology

Hello, the question you asked is very complex.
I am unable to answer it online.
I recommend that you take your sister to see a doctor for a consultation in person.
Thank you.

Reply Date: 2023/08/16

More Info

Understanding suspected autoimmune encephalitis involves a multifaceted approach, including recognizing symptoms, conducting appropriate diagnostic tests, and determining effective treatment options. Autoimmune encephalitis is a condition where the body's immune system mistakenly attacks healthy brain cells, leading to a range of neurological symptoms.

Symptoms
The symptoms of autoimmune encephalitis can vary widely but often include psychiatric symptoms (such as hallucinations or severe anxiety), cognitive dysfunction (memory loss, confusion), seizures, and movement disorders (such as tremors or rigidity). In your sister's case, the involuntary movements and muscle stiffness she is experiencing could indeed be indicative of this condition. The fact that her symptoms worsened after stopping medication and that she has been diagnosed with tardive dyskinesia suggests a complex interplay between her psychiatric condition and potential neurological issues.

Diagnosis
Diagnosing autoimmune encephalitis typically involves a combination of clinical evaluation, imaging studies (like MRI), and laboratory tests, including cerebrospinal fluid (CSF) analysis. The elevated white blood cell count in her CSF could suggest an inflammatory process, which is consistent with autoimmune encephalitis. However, it is essential to rule out other potential causes of her symptoms, including infections, metabolic disorders, and other neurological conditions.

Treatment
If autoimmune encephalitis is confirmed, treatment usually involves immunotherapy. Common approaches include corticosteroids (like prednisone), intravenous immunoglobulin (IVIG), and plasmapheresis (plasma exchange). The choice of treatment depends on the severity of the symptoms and the specific type of autoimmune encephalitis diagnosed. Since your sister has shown some improvement after hospitalization and medication adjustments, it may be beneficial to continue working closely with her healthcare team to find the most effective regimen.

Other Rare Diseases
While autoimmune encephalitis is a possibility, other rare diseases could also present with similar symptoms. Conditions such as paraneoplastic syndromes, where the immune response is triggered by a tumor elsewhere in the body, or other movement disorders, should also be considered. A thorough evaluation by a neurologist specializing in autoimmune disorders may provide further insights.

Lifestyle Recommendations
In terms of lifestyle modifications, it is crucial for your sister to maintain a stable routine, manage stress, and ensure she gets adequate rest. Engaging in light physical activity, if tolerated, may help improve her overall well-being. Additionally, a balanced diet rich in anti-inflammatory foods could support her health. It is also essential to monitor her symptoms closely and maintain regular follow-ups with her healthcare providers.

Traditional Chinese Medicine (TCM)
Regarding the consideration of Traditional Chinese Medicine (TCM), it can be a complementary approach but should not replace conventional medical treatment, especially in cases of autoimmune conditions. If you choose to explore TCM, it would be wise to consult with a practitioner who understands her medical history and current treatments to avoid any potential interactions with her medications.

In conclusion, while your sister's symptoms may align with autoimmune encephalitis, a comprehensive evaluation by a neurologist is crucial for an accurate diagnosis and effective treatment plan. Continuous monitoring and adjustments to her treatment regimen, along with supportive lifestyle changes, can significantly impact her recovery and quality of life.

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