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Master Thesis

Syndrome et pronostic de l'encéphalite limbique de type séronégatif

Abstract : Objective. To discuss potential differences in patients that presented with autoimmune seronegative encephalitis and their seropositive counterparts. Secondly, to highlight the presence - or absence - of particular profiles in seronegative patients as well as among those whose presence of atypical neuronal cell-surface marking has been noted. Methods. The cohort analyzed consisted of 47 patients over 15 years of age who had been diagnosed (and / or treated) with limbic encephalitis of established autoimmune mechanism at Bordeaux Teaching Hospital between January 2010 and June 2018. A comparative study between seronegative patients (SN) and seropositive patients was performed based on descriptive statistical analyzes of the cohort. Among the seropositive patients, four subgroups were distinguished: atypical anti-neuronal cell-surface antigens (ANA), anti-neuronal cell-surface antigens (ANM), anti-glutamate acid decarboxylase (GAD65), and anti- neuronal intracellular antigens (ANI). A case-by-case study was then conducted to highlight the presence of specific profiles in seronegative patients, as well as among patients with atypical neuronal cell-surface markings. Results. The seronegative patient profile corresponds to that of the cohort for several criteria, namely sex, the presence of intrathecal synthesis and abnormalities on the medio-temporal regions of the T2-FLAIR sequence and the electroencephalogram (EEG ). As regards the other criteria studied, the ANM profile is the closest to that of seronegative patients, for the modified Rankin score (mRS), pleiocytosis in CSF or epileptic EEG. In addition, the initial symptomatology of seronegative patients is different from that of other subpopulations, and their one-year clinical course of treatment is among the most unfavorable. Finally, the case-by-case analysis reveals a heterogeneity of clinical, paraclinical, and evolutionary profiles in seronegative patients, as well as among ANA. Conclusion. Despite the recent discovery of new antibodies, a significant portion of autoimmune limbic encephalitis is diagnosed as seronegative, or with atypical marking. The heterogeneous profiles observed in these two subgroups imply different immunological mechanisms. Progress in terms of antibody detection techniques would enable these profiles to be identified in order to better adapt patient care.
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Théo Michaud. Syndrome et pronostic de l'encéphalite limbique de type séronégatif. Sciences du Vivant [q-bio]. 2019. ⟨dumas-02549273⟩

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