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Repositório Institucional da UFMG
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Universidade Federal de Minas Gerais (UFMG)
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Universidade Federal de Minas Gerais (UFMG)
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2023-06-22T21:49:59Z2023-06-22T21:49:59Z2021-08928897907http://dx.doi.org/10.1136/jnnp-2020-3253021468-330Xhttp://hdl.handle.net/1843/55236https://orcid.org/0000-0001-5346-8254https://orcid.org/0000-0003-2095-0786https://orcid.org/0000-0002-7667-9748https://orcid.org/0000-0003-3862-7397https://orcid.org/0000-0002-5630-8050https://orcid.org/0000-0003-1224-5243https://orcid.org/0000-0002-4885-0181https://orcid.org/0000-0002-6661-2910https://orcid.org/0000-0003-1917-9349https://orcid.org/0000-0002-4255-9617https://orcid.org/0000-0003-4767-7564https://orcid.org/0000-0001-9753-8816https://orcid.org/0000-0003-4494-0195https://orcid.org/0000-0003-1384-9794https://orcid.org/0000-0001-7799-8495https://orcid.org/0000-0002-6140-5584https://orcid.org/0000-0002-1033-3840The objective of this paper is to evaluate available evidence for each step in autoimmune encephalitis management and provide expert opinion when evidence is lacking. The paper approaches autoimmune encephalitis as a broad category rather than focusing on individual antibody syndromes. Core authors from the Autoimmune Encephalitis Alliance Clinicians Network reviewed literature and developed the first draft. Where evidence was lacking or controversial, an electronic survey was distributed to all members to solicit individual responses. Sixty-eight members from 17 countries answered the survey. The most popular bridging therapy was oral prednisone taper chosen by 38% of responders while rituximab was the most popular maintenance therapy chosen by 46%. Most responders considered maintenance immunosuppression after a second relapse in patients with neuronal surface antibodies (70%) or seronegative autoimmune encephalitis (61%) as opposed to those with onconeuronal antibodies (29%). Most responders opted to cancer screening for 4 years in patients with neuronal surface antibodies (49%) or limbic encephalitis (46%) as opposed to nonlimbic seronegative autoimmune encephalitis (36%). Detailed survey results are presented in the manuscript and a summary of the diagnostic and therapeutic recommendations is presented at the conclusion.O objetivo deste artigo é avaliar as evidências disponíveis para cada etapa do tratamento da encefalite autoimune e fornecer opinião de especialistas quando houver falta de evidências. O artigo aborda a encefalite autoimune como uma categoria ampla, em vez de focar em síndromes de anticorpos individuais. Os principais autores da Autoimmune Encephalitis Alliance Clinicians Network revisaram a literatura e desenvolveram o primeiro rascunho. Onde faltavam evidências ou havia controvérsias, uma pesquisa eletrônica foi distribuída a todos os membros para solicitar respostas individuais. Sessenta e oito membros de 17 países responderam à pesquisa. A terapia de ponte mais popular foi a redução gradual de prednisona oral escolhida por 38% dos respondentes, enquanto o rituximabe foi a terapia de manutenção mais popular escolhida por 46%. A maioria dos respondedores considerou imunossupressão de manutenção após uma segunda recaída em pacientes com anticorpos de superfície neuronal (70%) ou encefalite autoimune soronegativa (61%) em oposição àqueles com anticorpos onconeuronais (29%). A maioria dos respondedores optou pelo rastreamento do câncer por 4 anos em pacientes com anticorpos de superfície neuronal (49%) ou encefalite límbica (46%) em oposição à encefalite autoimune soronegativa não límbica (36%). Os resultados detalhados da pesquisa são apresentados no manuscrito e um resumo das recomendações diagnósticas e terapêuticas é apresentado na conclusão.Outra AgênciaengUniversidade Federal de Minas GeraisUFMGBrasilHCL - HOSPITAL DAS CLINICASMED - DEPARTAMENTO DE CLÍNICA MÉDICAJournal of Neurology, Neurosurgery and PsychiatryDoenças autoimunes do sistema nervosoRituximabTerapia de imunossupressãoAnticorposDetecção precoce de câncerEncefalite límbicaAutoimmune encephalitisOral prednisone taperRituximabMaintenance therapyMaintenance immunosuppressionNeuronal surface antibodiesSeronegative autoimmune encephalitisOnconeuronal antibodiesCancer screeningLimbic encephalitisAutoimmune encephalitis: proposed recommendations for symptomatic and long-term managementEncefalite autoimune: recomendações propostas para manejo sintomático e de longo prazoinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttps://jnnp.bmj.com/content/92/8/897Hesham AbboudJohn Calvin ProbascoSarosh R. IraniBeau AncesDavid R BenavidesMichael BradshawPaulo Pereira ChristoRussell C. DaleMireya Fernandez-FournierEoin P. FlanaganAvi GadothPravin GeorgeElena GrebenciucovaAdham JammoulSoon-Tae LeeYuebing LiMarcelo MatielloAnne Marie MorseAlexander Rae-GrantGaleno RojasIan RossmanSarah SchmittArun VenkatesanSteven VerninoSean J. PittockMaarten Titulaerapplication/pdfinfo:eu-repo/semantics/openAccessreponame:Repositório Institucional da UFMGinstname:Universidade Federal de Minas Gerais (UFMG)instacron:UFMGLICENSELicense.txtLicense.txttext/plain; charset=utf-82042https://repositorio.ufmg.br/bitstream/1843/55236/1/License.txtfa505098d172de0bc8864fc1287ffe22MD51ORIGINALAutoimmune encephalitis proposed recommendations for symptomatic and long-term management.pdfAutoimmune encephalitis proposed recommendations for symptomatic and long-term management.pdfapplication/pdf354810https://repositorio.ufmg.br/bitstream/1843/55236/2/Autoimmune%20encephalitis%20proposed%20recommendations%20for%20symptomatic%20and%20long-term%20management.pdf51a625e3f7a09f85d88e1d4cbb6a2bd0MD521843/552362023-06-22 18:49:59.482oai:repositorio.ufmg.br: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Repositório InstitucionalPUBhttps://repositorio.ufmg.br/oaiopendoar:2023-06-22T21:49:59Repositório Institucional da UFMG - Universidade Federal de Minas Gerais (UFMG)false
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