Table 3.
Clinical Characteristics | Score |
---|---|
Rapid progressive mental change within 6 weeks or new-onset seizure within one year | 1 |
Neuropsychiatry symptoms: agitation, aggressiveness, emotional lability | 1 |
Autonomic dysfunction (sustained atrial tachycardia or bradycardia, orthostatic hypotension (≥20 mm Hg fall in systolic pressure or ≥10 mm Hg fall in diastolic pressure within 3 min of standing), hyperhidrosis, persistently labile blood pressure, ventricular tachycardia, or cardiac asystole) | 1 |
Viral prodrome (rhinorrhea, sore throat, low-grade fever) in the absence of underlying malignancy | 2 |
Facial dyskinesias or faciobrachial dystonic movements | 2 |
Refractory seizure | 2 |
CSF: signs of inflammation (elevated CSF protein >50 mg/dL and/or lymphocytic pleocytosis >5 cells/dL if the total number of CSF RBC is <1000 cells/dL a | 2 |
Brain MRI findings indicate limbic encephalitis (medial temporal T2/FLAIR signal changes) a | 2 |
Underlying malignancy (excluding cutaneous squamous cell carcinoma, basal cell carcinoma) | 2 |
Initiation of immunotherapy within 6 month of symptom onset | 2 |
Presence of neural plasma membrane autoantibody (e.g., NMDA-R Ab, GABAA-R Ab, GABAB-R AMPA-R Ab, DPPX, GAD-65, LGI-1 Ab, or CASPR-2 Ab) | 2 |
a: No brain MRI or CSF analyses were scored zero. | Max: 19 |
New-onset, rapidly progressive mental status changes that developed over 1–6 weeks or new-onset seizure activity (within 1 year of evaluation) | 1 |
Neuropsychiatry symptoms: agitation, aggressiveness, emotional lability | 1 |
Autonomic dysfunction (sustained atrial tachycardia or bradycardia, orthostatic hypotension, hyperhidrosis, persistently labile blood pressure, ventricular tachycardia, cardiac asystole, or gastrointestinal dysmotility) * | 1 |
Viral prodrome (rhinorrhea, sore throat, low-grade fever) only to be scored in the absence of underlying malignancy within 5 years of neurological symptom onset | 2 |
Faciobrachial dystonic seizures | 3 |
Facial dyskinesias in the absence of faciobrachial dystonic seizures | 2 |
Seizure refractory to at least two antiseizure medications | 2 |
CSF signs of inflammation # (elevated CSF protein >50 mg/dL and/or lymphocytic pleocytosis >5 cells/dL if the total number of CSF RBC is <1000 cells/dL | 2 |
Brain MRI suggesting encephalitis (T2/FLAIR hyperintensity restricted to one or both medial temporal lobes or multifocal in gray matter, white matter, or both compatible with demyelination or inflammation) | 2 |
Systemic cancer diagnosed within 5 years of neurological symptom onset (excluding cutaneous squamous cell carcinoma, basal cell carcinoma, brain tumor, cancer with brain metastasis) | 2 |
Initiation of immunotherapy within 6 month of symptom onset | 2 |
Neural plasma membrane autoantibody detected (NMDA-R, GABAAR, GABABR, AMPA-R, DPPX, mGluR1, mGluR5, LGI1, CASPR-2, neurexin-3α, MOG) | 2 |
* Scored only if no history of autonomic dysfunction prior to onset of suspected autoimmune syndrome and the autonomic dysfunction is not attributable to medications, hypovolemia, plasmapheresis, or infection # Patients scored zero if brain MRI or CSF analyses not performed |
Max: 22 |
Ab, antibody, AMPA-R = amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; CASPR-2 = contactin-associated protein 2; DPPX = dipeptidyl-peptidase-like protein 6; FLAIR = fluid-attenuated inversion recovery; GABAAR = γ-aminobutyric acid A receptor; GABABR = γ-aminobutyric acid B receptor; GAD-65, glutamic acid decarboxylase 65; GFAPα = glial fibrillary acidic protein; LGI1 = leucine-rich glioma-inactivated protein 1; NMDA-R = N-methyl-d-aspartate receptor; PCA-1 = Purkinje cell cytoplasmic antibody type 1; PCA-2 = Purkinje cell cytoplasmic antibody type 2; AMPA-R = amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid; CASPR-2 = contactin-associated protein 2; DPPX = dipeptidyl-peptidase-like protein 6; FLAIR = fluid-attenuated inversion recovery; GABAAR = γ-aminobutyric acid A receptor; GABABR = γ-aminobutyric acid B receptor; GFAPα = glial fibrillary acidic protein; LGI1 = leucine-rich glioma-inactivated protein 1; MOG = myelin oligodendrocyte glycoprotein; mGluR1 = metabotropic glutamate receptor 1; mGluR5 = metabotropic glutamate receptor 5; NMDA-R = N-methyl-d-aspartate receptor.