Eoin Flanagan, M.B., B.Ch., explains autoimmune encephalitis misdiagnosis in JAMA Neurology

Patients mistakenly given a diagnosis of autoimmune encephalitis can experience harm from inappropriate treatment. A study led by Mayo Clinic and published in JAMA Neurology outlines the most common autoimmune encephalitis mimics and the potential reasons for misdiagnosis.

"It's important that neurologists have a good eye out for autoimmune encephalitis. But it's important also to consider the possibility of alternatives," says Eoin Flanagan, M.B., B.Ch., the study's first author and an autoimmune neurologist at Mayo Clinic.

Although autoimmune encephalitis is increasingly diagnosed, the condition remains rare.

"When evaluating suspected cases, neurologists should consider a broad differential diagnosis including common disorders," Dr. Flanagan says.

The study highlights the importance of increased education when it comes to ordering neural autoantibodies and how to interpret positive results. Education on this topic decreases misdiagnosis and the possibility of misinterpreting the comments provided by the reporting laboratories.

The JAMA Neurology study found that misdiagnosis is frequent and occurs in many settings, including specialized centers. Approximately half of the patients in the retrospective study who were mistakenly diagnosed with autoimmune encephalitis actually had functional neurological or psychiatric disorders.

"We think of autoimmune encephalitis as an inflammatory condition with rapid onset," Dr. Flanagan says. "An insidious onset — and lack of MRI or cerebrospinal fluid findings suggestive of inflammation — should prompt thinking about an alternative diagnosis."

The study also found that over-interpretation of serum nonspecific antibodies also frequently contributed to misdiagnosis.

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