# Autoimmune Encephalitis with Neuronal Surface Autoantibodies and Other Suspected Cases of Autoimmune Etiology: A Single-Center Experience in Poland

## TL;DR

This study examines 65 patients with autoimmune encephalitis in Poland, highlighting the diverse symptoms and diagnostic challenges associated with antibody-positive and antibody-negative cases.

## Contribution

The study provides a detailed single-center analysis of AE cases in Poland, emphasizing diagnostic complexities and symptom-antibody associations.

## Key findings

- NMDAR, LGI1, and CASPR2 antibodies were most frequently detected in AE patients.
- Clinical presentations varied widely, including neuropsychiatric, cognitive, and seizure symptoms.
- Diagnostic challenges arise from overlapping symptoms with multiple sclerosis and dual-antibody cases.

## Abstract

Autoimmune encephalitis (AE) is an autoantibody-mediated central nervous system disorder with diverse neuropsychiatric and neurological manifestations, and should be considered in the differential diagnosis of acute and subacute neurological or psychiatric syndromes. In this retrospective study, we analyzed 65 patients: 54 with AE (47 antibody-positive, seven antibody-negative) and 11 antibody-positive without AE. The most frequently detected antibodies targeted N-methyl-D-aspartate receptor (NMDAR), leucine-rich glioma-inactivated protein 1 (LGI1), and contactin-associated protein-like 2 (CASPR2)—key synaptic and axonal membrane proteins involved in excitatory neurotransmission, neuronal signaling, and synaptic plasticity. Clinical presentations were heterogeneous, ranging from common neuropsychiatric, cognitive, and seizure manifestations to atypical brainstem or cerebellar features. Symptom distribution analysis further demonstrated distinct patterns among Ab-positive AE, Ab-negative AE, and Ab-positive non-AE groups, with specific symptom–antibody associations providing potential diagnostic clues. Diagnostic complexity was underscored by unusual age at onset, overlap with multiple sclerosis, cases preceded by herpes labialis, and dual-antibody detection. A subset of antibody-positive patients had alternative diagnoses, highlighting the need for careful clinical correlation and cautious interpretation of antibody results. These findings illustrate the diagnostic challenges and broad clinical spectrum of AE, emphasizing the importance of integrating serological, clinical, and imaging data to improve diagnostic accuracy and guide management.