How Researchers Used Multiple Sclerosis to Understand Autoimmune Encephalitis

 

Autoimmune encephalitis is a group of diseases that was only identified about a decade ago. The newness of this condition makes it difficult to completely understand it. Dr Robb Wesselingh, a neurologist, took it upon himself to create a better understanding of this disease in order to better the lives of those with it. He wanted to conduct research in order to increase the level of knowledge that exists so that better treatment options will eventually become available. He did so through using multiple sclerosis as a model, as it is also a central nervous system disorder. He found that his research investigated a gap in the knowledge, and that more research still needs to be conducted.

About Autoimmune Encephalitis

Autoimmune encephalitis is a group of disorders that are characterized by the immune system attacking healthy brain cells. This attack leads to inflammation of the brain. This inflammation can eventually lead to loss of consciousness or even comas.

This disorder is often caused by antibodies to proteins on the surface of or within nerve cells. The proteins are involved with passing signals between the various nerve cells. Other cases involve cancer, and autoimmune encephalitis occurs in association. There is not generally a family history of this disorder and it tends to happen sporadically. As it such a newly discovered disease, there is still research being conducted to figure out why antibodies attack the nerve cells.

Symptoms of this disease include impaired memory and cognition, seizures, abnormal movements, and problems with balance, speech, and vision. Along with these neurological symptoms, there are also psychiatric effects. These include aggression, psychosis, panic attacks, compulsive behaviors, euphoria, fear, and inappropriate sexual behavior. These symptoms may change, but they tend to progress over a few days to a few weeks.

Three criteria need to be met in order for one to be diagnosed with autoimmune encephalitis. First, short-term memory loss, altered mental status, or psychiatric symptoms must be rapidly progressing, which means within three months. Next, either new focal central nervous system findings, seizures that cannot be linked to known seizure disorders, CSF pleocytosis, or MRI features that suggest this disorder must be found. Only one of these things need to be present in order for this second condition to be met. Lastly, other conditions need to be ruled out.

After a diagnosis is obtained, treatment should begin as soon as possible. The earlier that treatment is started, the less likely it is that there will be long-term complications or that one will have relapses. It also quickens recovery time. Treatment options include immunosuppressive therapy and tumor removal if that is applicable. Without treatment, neurological deterioration or even loss of life can occur.

About Multiple Sclerosis (MS)

Multiple sclerosis (MS) is also a central nervous system condition. It affects the communication between the brain and the rest of the body. There are two types of this condition: relapsing and remitting or progressive. The former is characterized by periods of remission followed by periods of intense symptoms. The latter does not have these periods of remission; instead there are constant symptoms which can result in the loss of daily life function. Due to the amount of people who are misdiagnosed or do not receive a diagnosis at all, it is difficult to estimate the number of people who have this disease. It is thought to be about 2.3 million people worldwide.

The exact cause of MS is unknown. It is known that the immune system attacks myelin, which is the protective coating of nerve cells. When this covering is gone, neuro messages are slowed or blocked altogether. While there may be a hereditary component, it is suspected that it is a combination of environmental factors and genetics. It is more prevalent in women, and it also tends to affect those aged 15 to 60.

Symptoms of MS can affect all parts of the body. The eyes and muscles within the extremities are most commonly affected. Symptoms can present themselves in a variety of ways, but the most common are weakness, numbness, loss of coordination, balance, and problems with vision, speech, and bladder control. These symptoms tend to first appear between the ages of 20 and 40. There is no cure for this condition, but the symptoms can be treated.

About Dr. Wesselingh’s Research

Dr. Rob Wesselingh is a neurologist at Alfred Hospital. He noticed the effects of autoimmune encephalitis on his patients and wanted to help them. The role of the innate immune system, which is the first line of defense to pathogens, has not been heavily researched, so he decided to take on an investigation in order to better the lives of his patients and others with this condition. Despite the adaptive responses that are driven by the innate immune system, there has not been substantial research into its role. A more well known condition, multiple sclerosis, has been more heavily researched. Because it is also a central nervous system disorder that involves the immune system, it was a good model to study autoimmune encephalitis. Using mouse models of MS, Wesselingh was able to see that cells associated with the innate immune system had infiltrated the CNS and broken the blood-brain barrier. He discovered that suppressing these cells could also suppress autoimmune encephalitis as well.

While most treatments have to do with the adaptive immune system, there are some emerging that deal with the innate immune system. Dr. Wesselingh hopes that his research, and hopefully further research, will lead to more developments of treatment.

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