Infectious Disease

Sleep issues typically happen in a number of mind networks with autoimmune encephalitis

January 22, 2021

2 min read

Source / information

Disclosure:
Braley and Muñoz-Lopetegi do not report any relevant financial information. In the full study you will find all relevant financial information from all other authors.

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

Autoimmune encephalitis can affect any sleep-related network in the brain and lead to various sleep disorders both during and after the acute phase of the disease. This emerges from a review published in The Lancet Neurology.

“… Sleep disorders in autoimmune encephalitis are usually severe and persist beyond the acute phase of the disease and affect the recovery process and quality of life.” Amaia Muñoz-Lopetegi, MD, the Hospital Clinic and August Pi i Sunyer Biomedical Research Institute at the University of Barcelona, ​​and colleagues wrote.

The review by Muñoz-Lopetegi and colleagues, which found that “all major types of sleep disorders can occur in autoimmune encephalitis,” described how these various disorders manifest themselves in the development of autoimmune encephalitis.

Clinical examination

According to Muñoz-Lopetegi and colleagues, video polysomnography (V-PSG) evaluation is “the gold standard” for performing physiological assessments and behavioral monitoring of sleep. While sleep-related symptoms are “rarely the primary reason” patients with autoimmune encephalitis seek medical attention, these symptoms can be easily identified when patients are asked.

Tiffany Braley

“Although treatment needs vary based on the specific sleep disorder encountered, early detection and diagnosis of sleep disorders in patients with encephalitis and efforts to standardize ratings in all cases should be prioritized to facilitate recovery and improve quality of life.” Tiffany Braley, MD, Associate professor of neurology at the University of Michigan and a specialist in MS / neuroimmunology, said Healio Neurology.

Types of sleep disorders

Autoimmune encephalitis can affect any of the neural networks associated with initiating or regulating sleep, leading to several sleep problems, according to the researchers. Muñoz-Lopetegi and colleagues wrote that sleep problems in autoimmune encephalitis “are most likely a manifestation of the effects of the antibodies or their associated immune responses on their specific targets”.

The four main types of sleep disorders – insomnia, parasomnias, sleep-related breathing disorders, and hypersomnolence – can occur in people with autoimmune encephalitis, according to the researchers. Additionally, sleep can be altered in a variety of ways in these patients, leading to a wide variety of symptoms.

For example, with anti-NMDA receptor encephalitis, up to 90% of patients initially had insomnia that was not accompanied by daytime sleepiness at the height of the disease, the researchers wrote. During recovery, many patients developed hypersomnias that persisted after they stopped taking antipsychotics, anti-epileptics, benzodiazepines, or other medications. The researchers suggested that “hypersomnia is part of the disease”.

management

According to the researchers, patients need symptomatic treatment for sleep disorders as well as immunotherapy. According to Braley, neurologists can play a key role in managing sleep disorders in patients with autoimmune encephalitis by enabling timely clinical sleep studies.

“Neurologists treating patients with known or suspected autoimmune encephalitis should routinely check for sleep disorders and initiate diagnostic tests when appropriate,” she said.

Braley added that neurologists should refer patients with complex cases or patients unresponsive to initial treatments to sleep specialists.

According to Muñoz-Lopetegi and colleagues, autoimmune encephalitis drugs can also affect sleep. For example, steroids can lead to insomnia, and certain benzodiazepines can lead to abnormal behavior during sleep. These side effects “are unlikely to be adequately reported,” the researchers wrote.

Future directions

While current research shows that “Sleep disorders are common, often severe, and normal [persistent] Beyond the acute disease stage of autoimmune encephalitis, more research is needed to determine the mechanisms that cause sleep disorders in this setting, the researchers said.

“Collaborative research that elucidates the prevalence and the most common representations of sleep problems across the spectrum of autoimmune encephalitis could improve the detection of these sleep disorders and optimize treatment. More work is needed to assess the impact of early treatment for sleep disorders on the course of these neuroimmunological disorders, ”said Braley. “The relative incidence and complexity of autoimmune encephalitis indicates the need for multicenter, multidisciplinary approaches, taught by both neuroimmunologists and sleep researchers.”

ADD SUBJECT TO EMAIL ALARMS

Receive an email when new articles are published

Please enter your email address to receive an email when new articles are published . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If you continue to have this problem, please contact customerservice@slackinc.com.

Back to Healio

Related Articles