Fatigue in Survivors of Autoimmune Encephalitis
Citation Manager Formats
Make Comment
See Comments

Abstract
Background and Objectives To evaluate the impact of fatigue after autoimmune encephalitis, determine associations with patients' characteristics, and identify factors that contribute to its development.
Methods In a first cohort recruited via several encephalitis support organizations, self-reported questionnaires were used to evaluate fatigue, depression, and sleep quality in adults after autoimmune encephalitis. In a second cohort where more in-depth clinical characterization could be performed, adults with encephalitis from 2 tertiary hospitals were evaluated using the same questionnaires. Patients' characteristics were retrospectively captured.
Results In the first cohort (mean [SD] age; 43 [16] years, 220 [65%] female), 220 of 338 participants (65%) reported fatigue, 175 of 307 (57%) depression, and 211 of 285 (74%) poor sleep quality. In the second cohort (48 [19] years; 43 [50%] women), 42 of 69 participants (61%) reported fatigue, whereas 23 of 68 (34%) reported depression and 44 of 66 (67%) poor sleep quality, despite more than 80% having “good” modified Rankin scale (mRS) scores (0–2). Individuals with anti-NMDA receptor encephalitis reported lower fatigue scores than those with other autoimmune encephalitis types. In a multivariate analysis examining factors at discharge that might predict fatigue scores, only anti-NMDA receptor encephalitis was a (negative) predictor of fatigue and remained so when potential confounders were included.
Discussion The impact of fatigue after autoimmune encephalitis is prominent and not fully accounted for by depression or sleep quality, nor adequately captured by mRS scores for disability. Fatigue is pervasive across autoimmune encephalitis, although lower scores are reported in anti-NMDA receptor encephalitis. Fatigue should be screened routinely, considered as an outcome measure in clinical trials, and further studied from a mechanistic standpoint.
Glossary
- AE=
- adverse event;
- BDI-Fast Screen=
- Beck Depression Inventory-Fast Screen;
- CASE=
- clinical assessment scale in AE;
- ICU=
- intensive care unit;
- ISMMS=
- Icahn School of Medicine at Mount Sinai;
- mRS=
- modified Rankin scale;
- MFIS=
- Modified Fatigue Impact Scale;
- PPHS=
- Program for the Protection of Human Subjects;
- PSQI=
- Pittsburgh Sleep Quality Index;
- SREAT=
- steroid-responsive encephalopathy associated with autoimmune thyroiditis
Footnotes
Go to Neurology.org/NN for full disclosures. Funding information is provided at the end of the article.
↵* These authors contributed equally to this work (co-first authors).
The Article Processing Charge was funded by the authors.
- Received March 18, 2021.
- Accepted in final form June 21, 2021.
- Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
Letters: Rapid online correspondence
REQUIREMENTS
You must ensure that your Disclosures have been updated within the previous six months. Please go to our Submission Site to add or update your Disclosure information.
Your co-authors must send a completed Publishing Agreement Form to Neurology Staff (not necessary for the lead/corresponding author as the form below will suffice) before you upload your comment.
If you are responding to a comment that was written about an article you originally authored:
You (and co-authors) do not need to fill out forms or check disclosures as author forms are still valid
and apply to letter.
Submission specifications:
- Submissions must be < 200 words with < 5 references. Reference 1 must be the article on which you are commenting.
- Submissions should not have more than 5 authors. (Exception: original author replies can include all original authors of the article)
- Submit only on articles published within 6 months of issue date.
- Do not be redundant. Read any comments already posted on the article prior to submission.
- Submitted comments are subject to editing and editor review prior to posting.
You May Also be Interested in
Dr. Babak Hooshmand and Dr. David Smith
► Watch
Related Articles
- No related articles found.
Topics Discussed
Alert Me
Recommended articles
-
Article
Decreased occipital lobe metabolism by FDG-PET/CTAn anti–NMDA receptor encephalitis biomarkerJohn C. Probasco, Lilja Solnes, Abhinav Nalluri et al.Neurology: Neuroimmunology & Neuroinflammation, November 15, 2017 -
Articles
Modafinil for fatigue in MSA randomized placebo-controlled double-blind studyB. Stankoff, E. Waubant, C. Confavreux et al.Neurology, April 11, 2005 -
Article
Regional microglial activation in the substantia nigra is linked with fatigue in MSTarun Singhal, Steven Cicero, Hong Pan et al.Neurology: Neuroimmunology & Neuroinflammation, August 07, 2020 -
Article
Late-onset anti–NMDA receptor encephalitisMaarten J. Titulaer, Lindsey McCracken, Iñigo Gabilondo et al.Neurology, August 14, 2013