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Abstract Details

Patient-reported Symptoms of Mood, Fatigue, and Sleep Are Not Captured by Clinician-reported Outcomes in Patients with LGI1-IgG Autoimmune Encephalitis
Autoimmune Neurology
S4 - Autoimmune Neurology: Autoimmune Encephalitis and Neuronal Autoantibodies (1:12 PM-1:24 PM)
002
To investigate the relationship between clinician-reported outcomes (ClinROs) and patient-reported outcomes (PROs) in patients with LGI1-IgG autoimmune encephalitis (LGI1-IgG-AE). 
In LGI1-IgG-AE research, outcomes include disease severity, measured by Clinical Assessment Scale in Autoimmune Encephalitis [CASE], and disability, measured by modified Rankin score (mRS). PROs may have a role in capturing additional longitudinal symptomatology.
mRS, CASE, and PROs (Neuro-QoL) were collected longitudinally from a retrospective LGI1-IgG-AE cohort.  At last follow-up, proportion with Neuro-QoL abnormal scores (≥ 5 T-score change from median 50) were calculated, and ClinROs and PROs were correlated.  Mixed-effects linear modeling evaluated age, sex, disease duration, and acute encephalitis severity and disability (CASE and mRS scores <1 month post-diagnosis) as predictors of longitudinal PROs.

Thirty-five patients were included (63% male, mean age=67.8 years [SD=11.6]).  Most (89%) received immunosuppressive therapies.  Disability (mRS mean=2.5, SD=1.1) and disease severity (CASE mean=5.1, SD=4.4) improved at last follow-up (mean=1.86, SD=1.17; mean=3.69, SD=3.07, respectively).  Of patients with Neuro-QoL (n=14, obtained median 26 months [IQR=22-64] post-diagnosis), 71% had cognitive dysfunction and 50% reported impaired sleep, fatigue, anxiety, and/or depression.  

 

At last follow-up, CASE and mRS correlated with Neuro-QoL domains of upper and lower extremity function, cognitive function, social roles participation and satisfaction (for all, p<.01).

 

Acute CASE and mRS predicted long-term patient-reported cognitive function (p<.05); additionally, acute CASE predicted anxiety (p=.026), and acute mRS predicted stigma (p=.018) at last follow-up. 

In LGI1-IgG-AE with median >2 years follow up, we demonstrate 1) symptoms of cognitive dysfunction, sleep, fatigue, anxiety, and/or depression are present in most screened patients; 2) at last follow-up, CASE and mRS correlated strongly with PROs of physical function, cognitive dysfunction, and social roles, but not these aforementioned symptoms, highlighting PROs as valuable additional outcome measures; 3) PROs regarding cognition, anxiety, and stigma are predicted by greater disease severity and disability at diagnosis. 

Authors/Disclosures
Carol Swetlik, MD (Cleveland Clinic)
PRESENTER 		An immediate family member of Dr. Swetlik has received personal compensation for serving as an employee of Pfizer. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech. Dr. Swetlik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen.
Nicholas Thompson The institution of Nicholas Thompson has received research support from EMD Serono.
Vineet Punia, MD (Cleveland Clinic) Dr. Punia has nothing to disclose.
Albert Aboseif, DO (Mayo Clinic Rochester) Dr. Aboseif has received research support from the Eugene & Marcia Applebaum Fellowship Grant.
Rachel Galioto Rachel Galioto has nothing to disclose.
Amy Kunchok, MBBS (Cleveland Clinic - Mellen Centre) Dr. Kunchok has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Neurology:Open Access Journal .