RT Journal Article
SR Electronic
T1 Fatigue in Survivors of Autoimmune Encephalitis
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e1064
DO 10.1212/NXI.0000000000001064
VO 8
IS 6
A1 Luisa A. Diaz-Arias
A1 Anusha Kierty Yeshokumar
A1 Brittany Glassberg
A1 James F. Sumowski
A1 Ava Easton
A1 John C. Probasco
A1 Arun Venkatesan
YR 2021
UL http://nn.neurology.org/content/8/6/e1064.abstract
AB 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.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