From the Guidelines
There is no established causal link between COVID-19 vaccines and autoimmune encephalitis, and the benefits of vaccination in preventing severe COVID-19 disease and its complications significantly outweigh the extremely rare risk of serious adverse events. While extremely rare cases of neurological complications have been reported following COVID-19 vaccination, autoimmune encephalitis specifically has not been proven to be directly caused by these vaccines 1. If someone experiences concerning neurological symptoms after vaccination such as confusion, seizures, behavioral changes, memory problems, or movement disorders, they should seek immediate medical attention. Diagnosis would involve neurological examination, brain MRI, EEG, lumbar puncture, and blood tests to look for specific antibodies. Treatment for autoimmune encephalitis typically includes immunotherapy such as corticosteroids (often IV methylprednisolone 1000mg daily for 3-5 days), intravenous immunoglobulin (2g/kg divided over 2-5 days), or plasma exchange. Some key points to consider in patients with autoimmune disorders or those on immunosuppressive therapies include:
- Vaccination is recommended for patients with multiple sclerosis (MS) and other neurological disorders, but the timing of vaccination should be carefully considered in relation to disease-modifying therapies (DMTs) and immunosuppressive agents 1.
- Patients on high-dose or long-term corticosteroids should delay vaccination until 4-6 weeks after treatment cessation 1.
- The immune response triggered by vaccines is designed to be protective against the virus and rarely leads to autoimmune conditions, as vaccines undergo rigorous safety testing before approval. It is essential to weigh the benefits and risks of COVID-19 vaccination in individual patients, particularly those with underlying autoimmune disorders or those on immunosuppressive therapies, and to closely monitor for potential adverse events 1.
From the Research
Covid Vaccine Autoimmune Encephalitis
- Autoimmune encephalitis (AE) is a rare condition that has been reported after COVID-19 infection and vaccination 2, 3, 4, 5.
- A study published in Neurology found that 5 patients developed AE after COVID-19 infection, with diverse clinical presentations and negative neural IgG and CSF viral particle tests 2.
- Another study published in Frontiers in Neurology reported a case of new-onset refractory status epilepticus due to autoimmune encephalitis after vaccination against SARS-CoV-2 3.
- A systematic review published in Multiple Sclerosis and Related Disorders found 81 cases of AE associated with COVID-19, including 7 cases of limbic encephalitis and 5 cases of anti-N-methyl-d-aspartate (NMDA) receptor encephalitis 4.
- A case report published in Cureus described a possible case of autoimmune encephalitis after mRNA COVID-19 booster vaccine, with rapid clinical improvement after watchful waiting 5.
Diagnostic Challenges
- Diagnosing AE can be complicated by issues with availability, sensitivity, and specificity of antibody testing, as well as nonspecific findings on MRI, EEG, and lumbar puncture 6.
- A study published in Neurology: Clinical Practice discussed the challenges of AE diagnosis and the role of antibody testing, highlighting the importance of clinical characteristics and treatment-related questions 6.
Clinical Presentations
- Clinical presentations of AE can be diverse, including delirium, seizures, rhombencephalitis, aphasia, and ataxia 2, 3, 4, 5.
- A study published in Neurology found that 5 patients with AE had median symptom onset age of 61 years, with 3 women and 2 men 2.
- Another study published in Frontiers in Neurology reported a case of new-onset refractory status epilepticus due to autoimmune encephalitis after vaccination against SARS-CoV-2, with fever, skin rash, and headache as initial symptoms 3.