Autoimmune encephalitis: What has changed during the past 15 years?

Non-infectious encephalitis has been a recognized entity for many years; however, its pathophysiology was not fully understood. Patients (usually women) presented with acute behavioral changes and were admitted to mental hospitals, without a correct diagnosis. With the new advances on antibody detection, the non-infectious encephalitis panorama has been changing. Immune-mediated diseases of the central nervous system encompass a variety of disorders, including the classic paraneoplastic encephalitis and the more recently discovered autoimmune encephalitis. Recognition of the new syndromes and antigens, in addition to the advances in diagnostic methods, such as antibody detection and imaging, and early implementation of immunotherapy, have changed the field of autoimmune encephalitis significantly over the past two decades. The best recognized form of autoimmune encephalitis is anti-N-methyl-D-aspartate receptor encephalitis, which usually presents with neuropsychiatric changes, seizures, autonomic dysfunction and usually a decreased level of consciousness. Nevertheless, the panorama for other types of receptors, such as anti-α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, anti-gamma-aminobutyric acid and, most recently, anti-glycine receptor, anti-metabotropic glutamate receptor 5, dopamine receptor D2 and dipeptidyl-peptidase-like protein 6, which can present clinically as encephalitis, is currently changing, meaning that the panorama for diagnosis and treatment is broadening every day.