Understanding the Momentum in the Autoimmune Encephalitis Research Community

Divyanshu Dubey, MBBS

Autoimmune encephalitis represents a complex category of disease with diverse immunological associations and clinical manifestations, including multiple sclerosis (MS). At ACTRIMS Forum 2021, February 25–27, Divyanshu Dubey, MBBS, presented an invited talk on autoimmune encephalitis as part of a larger session of speakers focused on the spectrum of other non-MS diseases.

Dubey, an assistant professor of neurology at Mayo Clinic, touched upon recent research that found the prevalence and incidence of autoimmune encephalitis to be similar to infectious encephalitis, as well as noting the overall increase in prevalence. He also noted that gaining a better recognition of the clinical and paraclinical features associated with the condition could become critical for inpatient and outpatient neurology practice.

In the first half of an interview with NeurologyLive, Dubey discussed his presentation, some of the major topics surrounding autoimmune encephalitis research, and why there has been steady momentum within the field over the past few years.

NeurologyLive: Can you provide some background on your presented talk and why you chose to specifically focus on this subject?

Divyanshu Dubey, MBBS: This was an invited talk. ACTRIMS Forum asked me to talk about the clinical update on autoimmune encephalitis. It’s a topic of interest. Lately, a lot of research has been done in the area, especially the sheer number of biomarkers has expanded in the last few years. More and more people are interested in knowing about autoimmune encephalitis given it’s a treatable condition if diagnosed early. We have treatment options which can actually reverse the condition. Therefore, my talk is (was) going to be mostly about the clinical presentations of various autoimmune encephalitis and the various antibodies associated with them. That includes the ones that have been here for about 10 years, and the new ones which have been discovered in the past few years and then also understand their limitations, antibodies, and how to interpret them in terms of their specificity and sensitivity.

What is driving the sudden interest to research on autoimmune encephalitis?

I think it’s partly related to the fact that there was this big group of encephalitis cases where we tried to find and infection and could not. We did not nearly have an answer for why these patients were developing encephalitis, encephalopathy, or seizures. From some of the initial work done in Europe, Sloan Kettering, and here at Mayo Clinic, we were able to establish this area and the testing protocols for discovering and finding these antibodies. Over time, what we’ve seen is an exponential growth in the number of these antibodies, which has been like a chain reaction or a vicious circle, where discovery of more of these biomarkers has got more people interested in this area and has ultimately led to more input from researchers and clinicians. Additionally, the discovery of these patients and detection of these antibodies has helped improve our understanding about this field.

What value does discussing the spectrum of these sorts of non-MS inflammatory CNS diseases bring towards the MS field and the specialists and researchers within it?

Firstly, as we talk about the prevalence and epidemiology of these conditions, we have a better understanding and recognize that these are not as rare as we once thought they were. Secondly, MS is diagnosis of exclusion. We have to rule out some of the other things which look like MS, and many of the patients I see in autoimmune neurology clinic are initially diagnosed with MS and then they are treated with MS drugs and don’t get better. Then they are sent to use for a second opinion, we utilize our antibody panels and clinical judgment, and end up finding out they have something else. It is extremely important to understand the clinical radiological presentations of these non-MS inflammatory disorders, even for those who practice primarily in the field of MS. Therefore, inclusion of these non-MS topics is crucial for an MS focus.

Is there anything else that you'd like to mention about your presentation? Or about the meeting in general?

I would just like to highlight that we are learning that these non-MS inflammatory conditions such as autoimmune encephalitis are not as uncommon and rare as we once thought they were. Again, giving an example of an epidemiology study we did here in Homestead County, which estimated incidence and prevalence, we found autoimmune encephalitis to be as common as non-infectious encephalitis. Learning about these conditions and how to treat them is going to be important for our neurology practice, both inpatient as well as outpatient.

For more coverage of ACTRIMS 2021, click here.