Diagnostik und Therapie von autoantikörpervermittelten Enzephalomyelitiden

Zusammenfassung

Bei Patienten mit autoimmunmediierter Enzephalitis ist der Nachweis spezifischer antineuronaler Autoantikörper nicht nur von diagnostischer Bedeutung, sondern hat eine starke Assoziation zur Prognose und zur potenziellen Therapieresponse. Neben dem laborchemischen Antikörpernachweis ist die Liquordiagnostik zum Ausschluss einer infektiösen Enzephalitis von herausragender Bedeutung, während bildgebende Verfahren vor allem zur Verlaufskontrolle und zur Abgrenzung von malignen Prozessen relevante Zusatzinformationen liefern. Die vorliegende Arbeit gibt einen Überblick zum Verlauf und zu typischen paraklinischen Befunden bei wichtigen autoimmunvermittelten Enzephalitiden und fasst die Eckpunkte des therapeutischen Vorgehens zusammen.

Abstract

The results of laboratory tests for antineuronal antibodies in immune-mediated encephalitis nowadays are not only relevant for diagnostic purposes but are instead closely connected to outcome measures and treatment response. Besides the mere detection of antibodies, investigating the cerebrospinal fluid is indispensible to rule out an infectious etiology of encephalitis prior to the initiation of immunosuppressive treatment, whereas imaging studies are relevant to gain information on the temporal course of disease and for ruling out other etiologies, e. g. hippocampal gliomas. This work gives an overview on the clinical course and findings of laboratory, electroencephalography (EEG) and imaging studies in relevant types of autoimmune mediated encephalitis. Furthermore, it gives a synopsis on contemporary treatment strategies.

Schlüsselwörter

autoimmunmediierte Enzephalitis - antineuronale Antikörper - Limbische Enzephalitis - NMDA-Rezeptor-Antikörper - paraneoplastische Syndrome - Rituximab - Glukokortikosteroide

Key words

autoimmune encephalitis - antineuronal antibodies - limbic encephalitis - NMDA-receptor antibodies - paraneoplastic syndromes - rituximab - glucocorticosteroids

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