J Clin Neurol.
2022 Nov;18(6):692-710. 10.3988/jcn.2022.18.6.692.
AI-CoV Study: Autoimmune Encephalitis Associated With COVID-19 and Its Vaccines—A Systematic Review
- Samim M
1 - Dhar D1
- Goyal S1
- Dey T2
- Parvin N3
- Shah RD4
- Singh V1
- Chowdhury S5
- Lal BM6
- Varghese N1
- Gohel A1
- Chowdhury A7
- Chatterjee A8
- Siddiqui S9
- Affiliations
-
- 1Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
- 2Department of Radiation Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
- 3Department of Pediatrics, Lady Hardinge Medical College and Hospital, New Delhi, India
- 4Department of Neurology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
- 5Departments of Neurology, All India Institute of Medical Sciences, New Delhi, India
- 6Departments of General Medicine, All India Institute of Medical Sciences, New Delhi, India
- 7Department of Neuropathology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
- 8Centre For Biosystems Science and Engineering, Indian Institute of Science, Bangalore, Karnataka, India
- 9Consultant Neuroradiologist, Department of Neuroimaging and Interventional Radiology, STAT Institute of Neurosciences, Hyderabad, India
- KMID: 2534731
- DOI: http://doi.org/10.3988/jcn.2022.18.6.692
Abstract
- Background and Purpose
Autoimmune encephalitis (AIE) following coronavirus disease 2019 (COVID-19) is an underexplored condition. This study aims to systematically review the clinico-investigational and pathophysiologic aspects of COVID-19 and its vaccines in association with AIE, and identify the factors predicting neurological severity and outcomes.
Methods
Relevant data sources were searched using appropriate search terms on January 15, 2022. Studies meeting the criteria for AIE having a temporal association with COVID-19 or its vaccines were included.
Results
Out of 1,894 citations, we included 61 articles comprising 88 cases: 71 of COVID-19-associated AIE, 3 of possible Bickerstaff encephalitis, and 14 of vaccine-associated AIE. There were 23 definite and 48 possible seronegative AIE cases. Anti-NMDAR (N-methyl-D-aspartate receptor; n=12, 16.9%) was the most common definite AIE. Males were more commonly affected (sex ratio=1.63) in the AIE subgroup. The neurological symptoms included altered mental state (n=53, 74.6%), movement disorders (n=28, 39.4%), seizures (n=24, 33.8%), behavioural (n=25, 35.2%), and speech disturbances (n=17, 23.9%). The median latency to AIE diagnosis was 14 days (interquartile range=4–22 days). Female sex and ICU admission had higher risks of sequelae, with odds ratio (OR) of 2.925 (95% confidence interval [CI]=1.005–8.516) and 3.515 (95% CI=1.160–10.650), respectively. Good immunotherapy response was seen in 42/48 (87.5%) and 13/13 (100%) of COVID-19-associated and vaccine-associated AIE patients, respectively. Sequelae were reported in 22/60 (36.7%) COVID-19 associated and 10/13 (76.9%) vaccine-associated cases.
Conclusions
The study has revealed diagnostic, therapeutic, and pathophysiological aspects of AIE associated with COVID-19 and its vaccines, and its differences from postinfectious AIE. Systematic review registration PROSPERO registration number CRD42021299215
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