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Introduction: Autoimmune encephalitis (AE) comprises a heterogeneous group of autoantibody‐mediated disorders targeting the brain parenchyma. Therapeutic plasma exchange (TPE), one of several first‐line therapies for AE, is often initiated when AE is suspected, albeit prior to an established diagnosis. We sought to characterize the role of TPE in the treatment of suspected AE. Methods: A single‐center, retrospective analysis was performed of adults (≥18 years) who underwent at least one TPE procedure for "suspected AE." The following parameters were extracted and evaluated descriptively: clinicopathologic characteristics, treatment course, TPE‐related adverse events, outcomes (e.g., modified Rankin scale [mRS]), and diagnosis once investigation was complete. Results: A total of 37 patients (median age 56 years, range 28–77 years, 62.2% male) were evaluated. Autoimmune antibody testing was positive in serum for 43.2% (n = 16) and cerebrospinal fluid for 29.7% (n = 11). Patients underwent a median of five TPE procedures (range 3–16), with 97.3% (n = 36) via a central line and 21.6% (n = 8) requiring at least one unit of plasma as replacement fluid. Fifteen patients (40.5%) experienced at least one TPE‐related adverse event. Compared with mRS at admission, the mRS at discharge was improved in 21.6% (n = 8), unchanged in 59.5% (n = 22), or worse in 18.9% (n = 7). Final diagnosis of AE was determined to be definite in 48.6% (n = 18), probable in 8.1% (n = 3) and possible in 27.0% (n = 10). Six (16.2%) patients were ultimately determined to have an alternate etiology. Conclusion: Empiric TPE for suspected AE is generally well‐tolerated. However, its efficacy remains uncertain in the absence of controlled trials, particularly in the setting of seronegative disease. [ABSTRACT FROM AUTHOR]

The prevalence of obesity tripled worldwide between 1975 and 2016, and it is projected that half of the US population will be overweight by 2030. The obesity pandemic is attributed, in part, to the increasing consumption of the high-fat, high-carbohydrate Western diet, which predisposes to the development of the metabolic syndrome and correlates with decreased cognitive performance. In contrast, the high-fat, low-carbohydrate ketogenic diet has potential therapeutic roles and has been used to manage intractable seizures since the early 1920s. The brain accounts for 25% of total body glucose metabolism and, as a result, is especially susceptible to changes in the types of nutrients consumed. Here, we discuss the principles of brain metabolism with a focus on the distinct effects of the Western and ketogenic diets on the progression of neurological diseases such as epilepsy, Parkinson's disease, Alzheimer's disease, and traumatic brain injury, highlighting the need to further explore the potential therapeutic effects of the ketogenic diet and the importance of standardizing dietary formulations to assure the reproducibility of clinical trials. [ABSTRACT FROM AUTHOR]

BACKGROUND: Obesity is now a leading public health problem affecting 30% of the world's population with increasing prevalence in both developed and developing countries (Neto A, Fernandes A, Barateiro A. The complex relationship between obesity and neurodegenerative diseases: an updated review. Front Cell Neurosci. 2023;17:1294420. doi:10.3389/fncel.2023.1294420). Obesity is associated with low-inflammatory states and is linked to autoimmune conditions including multiple sclerosis, systemic lupus erythematosus, and sarcoidosis. However, an association between body mass index (BMI) and encephalitis has not been reported. OBJECTIVES: Here we aim to determine if BMI has an impact on the clinical features and outcomes in patients with encephalitis. METHODS: We conducted an institutional review board--approved, retrospective chart review of patients diagnosed with encephalitis based on the 2013 International Encephalitis Consortium inclusion criteria between 2005 and 2022 at UTHealth Houston and John Hopkins University School of Medicine. We included 628 patients and collected data on demographic features, presenting signs and symptoms, imaging and serum findings, treatment regimens, and clinical outcomes. A bivariate analysis was used to analyze clinical features that were polychotomous by utilizing Pearson χ2 and Fisher exact test values. Descriptive statistics were also used to analyze the data, including analysis of variance for continuous variables. Variables with P < 0.05 and a reasonable CI were deemed statistically significant. RESULTS: Of 628 patients, 3.8% were underweight (< 18.5), 35.7% had normal weight (18.5-24.9), 29.5% were overweight (25- 29.9), and 31.1% were obese (> 30). Patients who were underweight were more likely to be immunocompromised, HIV+, have a greater mortality risk, have a low Glasgow Outcome Scale (GOS) score at presentation, and have higher rates of inpatient mortality. Patients who were obese were more likely to be female, have inflammatory cerebrospinal fluid (CSF) with white blood count (WBC) > 50, serum WBC > 11K, and experience sleep disturbances. These patients had unfavorable outcomes with a GOS < 4; however, they are more likely to be alive. CONCLUSIONS: There were significant differences in comorbidities, clinical findings at presentation, CSF studies, and clinical outcomes between patients with underweight, normal, overweight, and obese BMI. Future studies may be needed to further elucidate these differences. [ABSTRACT FROM AUTHOR]