To systematically evaluate treatment approaches and outcomes for movement disorders in neuronal antibody-mediated autoimmune encephalitis and to characterize their heterogeneity across antibody subtypes.

Autoimmune encephalitis (AE) is an increasingly recognized cause of non-infectious encephalitis, presenting with neuropsychiatric and movement disorder features across all age groups. Although movement disorders are a prominent component of the clinical phenotype, their management is inconsistently described, and treatment strategies have not been systematically evaluated.

MEDLINE and PubMed were systematically searched for observational studies published up to December 6, 2025. Studies including adult or pediatric patients with laboratory-confirmed neuronal cell-surface or synaptic antibody AE were included, while those lacking extractable data or relevant outcomes were excluded. Two independent reviewers conducted screening with consensus-based conflict resolution. The Joanna Briggs Institute critical appraisal checklist was used for data extraction and risk-of-bias assessment. Of 588 records identified, 106 duplicates were removed, leaving 482 records screened, 143 full-text articles assessed, and 121 studies included.

Across 121 studies comprising 2,748 patients, most employed a stepwise immunotherapy approach, with first-line treatments including corticosteroids, IVIG, and plasma exchange, followed by escalation to rituximab or cyclophosphamide where necessary. Symptomatic therapies (antiepileptics, benzodiazepines, dopamine-depleting agents) and tumor resection in paraneoplastic cases were also widely used. The most common movement disorder phenomenology were dystonia (47%) and chorea (33%), with distinct antibody-specific patterns. Partial response was the most frequent outcome (55%), followed by complete resolution (35%), no response (17%), and clinical worsening (16%). Complete-resolution rates were highest in LGI1 (62%, n=8) and anti-NMDA receptor encephalitis (43%, particularly in pediatric and tumor-associated cases), and lowest in IgLON5 disease (5%).

These findings support early, individualized, stepwise immunotherapy as the optimal management strategy for movement disorders in AE. Standardized outcome reporting and longer-term follow-up are needed to facilitate timely treatment initiation and improve long-term outcomes.